Evidence of Language Proficiency ─

Summary of Evidence Form

College of Nurses of Ontario Telephone: 416 928-0900
101 Davenport Rd., Toronto, ON M5R 3P1 Toll-free (Canada): 1 800 387-5526
www.cno.org Fax: 416 928-6507

IMPORTANT: The evidence you provide in this form will be used by the College of Nurses of Ontario (CNO)
to determine if you can communicate and understand effectively as a nurse. Making a false or misleading
statement or representation on your application or supporting documents could result in the cancellation of
your application(s) for registration and/or any certificate that may be issued.

There are several forms required to complete the evidence of language proficiency process. Carefully read
and follow the steps below to make sure you submit this and other forms correctly.

Please review the Privacy Policy at www.cno.org/privacy to understand how your personal information
will be used.
How to complete this form:
Step 1: Fill out your personal information in section 1.
Step 2: Use section 2 of the form to provide a list of all the sources that will mail the evidence of your
language proficiency directly to CNO. If this form does not have enough space for you to list all
the sources that will send evidence, you can print a second copy of this form and continue listing
the sources.
Step 3: Once you have completed this summary form, attach it to the “Evidence of Language Proficiency–
Applicant form”, and send them to CNO by mail or fax using the information provided at the top of
this form, or via email, to enp@cnomail.org and include “Evidence of Language Proficiency–
Applicant & Summary of Evidence forms” in the subject line of your email.

1. APPLICANT’S INFORMATION

           
First name Last Name

           
Application number Date of Birth (yyyy-mm-dd)

Applicants Name: __________________ Application Number ___________

© College of Nurses of Ontario Evidence of Language Proficiency – Summary of Evidence Form (2021-30) 1
 Evidence of Language Proficiency ─
Summary of Evidence Form

2. SOURCES OF EVIDENCE OF LANGUAGE PROFICIENCY

How many sources of evidence are you listing on this form? (Provide number)      

Note: Sources include educational institutions, employment or volunteer experience, and other referral
sources. The education, employment/volunteer or other experience must have occurred within the last
two years, or be ongoing. The primary language used for communicating orally or in writing by the
school/organization/other must be in English or French.

Name of school/Organization/Referee:

     

Name of contact:

First name       Last name      

Check one:

Education Employment Volunteer Other

The focus of the education/employment/volunteer/other was: Nursing Non-Nursing

Name of school/Organization/Referee:
     

Name of contact:

First name       Last name      

Check one:

Education Employment Volunteer Other

The focus of the education/employment/volunteer/other was: Nursing Non-Nursing

Applicant’s Name: __________________ Application Number ___________

© College of Nurses of Ontario Evidence of Language Proficiency – Summary of Evidence Form (2021-30) 2
 Evidence of Language Proficiency ─
Summary of Evidence Form

Name of school/Organization/Referee:
     

Name of contact:

First name       Last name      

Check one:

Education Employment Volunteer Other

The focus of the education/employment/volunteer/other was: Nursing Non-Nursing

Name of school/Organization/Referee:
     

Name of contact:

First name       Last name      

Check one:

Education Employment Volunteer Other

The focus of the education/employment/volunteer/other was: Nursing Non-Nursing

Name of school/Organization/Referee:
     

Name of contact:

First name       Last name      

Check one:

Education Employment Volunteer Other

The focus of the education/employment/volunteer/other was: Nursing Non-Nursing

Applicant’s Name: __________________ Application Number ___________

© College of Nurses of Ontario Evidence of Language Proficiency – Summary of Evidence Form (2021-30) 3
 Evidence of Language Proficiency ─
Summary of Evidence Form

Applicant’s Name: __________________ Application Number ___________

© College of Nurses of Ontario Evidence of Language Proficiency – Summary of Evidence Form (2021-30) 4