900 – 200 Granville St.

Vancouver, BC
Tel: 604.742.6200
Toll-free: 1.866.880.7101
Form 152
Canada V6C 1S4 Fax: 604.899.0794
Email: IENapplications@bccnm.ca
www.bccnm.ca

Verification of Nurse Registration for Internationally Educated Nurses

APPLICANT: Complete Part A of this form and forward a copy to each regulatory body in which you have been
registered/licensed.

Part A: Applicant
Last name:_______________________________________________________ _First name:_______________________________________________

Middle name(s): _________________________________Former name(s) if applicable:_____________________________

Address (Apt/Box/#/Street): ____________________________________ City/town:______________________________
Province/State: ___________________ _ Country: _________________________ _Postal code/zip code: _______________
Telephone (include country code): _______________________________ Email:_________________________________
Date of birth: ____________________
Nursing school where you completed your basic program ___________________________________________________
Date graduated:___________________ _Initial nurse registration date :_____________________
Nurse registration number: ________________________Type: LPN RN RPN Other: _______________
Date:______________ _Signature:_____________________________________________
I am applying for nurse registration in British Columbia. A record of my nurse registration is required.

REGULATORY BODY: Complete Part B of this form and mail or email it to the BCCNM address at the top of this form.

Part B: Regulatory Body

Name of regulatory body:_______________________________ _ Name of registrant:_____________________________
Registration number:_____________________________ Type of registration granted (title):________________________
Initial registration date:_____________ _Expiry date of registration:__________________
Registered by: Examination Endorsement
Has this person’s registration/licence ever been denied, revoked, suspended or under review? Yes No
Examination written:
CAN Testing Service NLN State Board Test Pool NCLEX Other (specify): _________________________
Number of writings:_________ _Date of exam:______________ _ Passing score:_____________________
Name of registrar or person completing this form:_________________________________________________________

Title:________________________________________________________ Date: ________________________________

Page 1/1 Form 152 (March 2023)