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NMI BOARD OF NURSING
P. O. Box 501458
Saipan, MP 96950
Telephone: (670) 233-CBNE(2263)/ 234-2264
Fax: (670) 664-4813
Email: cbone@
CONTINUING EDUCATION FOR NURSES
COMPLETION | PROVIDER PROG. | COURSE | CONTACT
DATE | NUMBER | NAME | HOURS/CEU
NOTE: You are required to maintain Continuing Education (C. E.) records for three (3) years.
I successfully completed thirty (30) hours or more of Continuing Education (CE) during my last license period. I declare under penalty of perjury under the laws of the CNMI that the foregoing is true and correct.
___________________________________________
Signature of Applicant
Subscribed and sworn to before me this _____________day of _____________, 20__________.
___________________________________________ (NOTARY SEAL) Signature of Notary Public
My Commission expires _______________________
(DATE)
Doc. 30: Revised 05.30.16
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