Request for Verification of CPN Certification Status



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Policies Governing Verification Process

A signed, release statement (below) granting the PNCB permission to release certification status to Excelsior College MUST BE provided by the Certified Pediatric Nurse. The PNCB respects the privacy of its certified nurses and WILL NOT process a Verification of Certification request without signed permission.

Pediatric Nursing Certification Board

9605 Medical Center Drive, Suite 250

Rockville, MD 20850

Phone: 1-888-641-2767

Phone: 301-330-2921

Fax 301-330-1504

Email: verif@



Signed Release for Verification of Certification:

Name:      

Last 4 digits of SSN:     

Address:      

Address:      

Phone:       Date:     

I grant permission to the PNCB to release verification of my certification status to Excelsior College. This information will include my name, the last 4 of my SSN, date of birth and certification and date of current recertification expiration.

Print Name     

Verification will not be processed without signature to release information.

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