Verification of Course Completion

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

How to complete this form

Step 1: Save the application form to your computer Step 4: The school must submit a copy of the
before filling out. applicant’s transcript with this form. Faxed
or altered copies of this form will not be
Step 2: Fill form completely then print sign and date.
accepted.
Step 3: This form must be completed by the school
and mailed DIRECTLY to the College of Nurses
of Ontario (CNO) in a sealed envelope.

Collection of Personal Information Please review CNO’s Privacy Policy to understand how your personal
information will be used.

SECTION 1
Applicant information
Program was primarily delivered:
Last name ❏ In-class learning ❏ Online ­­­— distance learning
First name ❏ Other ___________________________________________

Date of birth (DD/MMM/YYYY) Program language of instruction: Clinical

CNO application number Program language of instruction: Theoretical

Name of Educational Institution

Program type ❏ RN ❏ RPN

Program completion date (mm/dd/yyyy)
Enrolled ❏ Part-time ❏ Full-time

SECTION 2
Please consult applicant’s letter issued by CNO for a list of required theory elements.
Theory Elements Course title Results Advance Standing
(include RN or RPN) P=PASS
Y=Yes
F=FAIL
I=IN PROGRESS N=No
Cultural Context
Computers
Technology
Pharmacology
Practice Standards
Health Assessment
Legal/Ethical Issues
Gerontology
Communication
APR 2023

2023--32

Mental Health

continued on next page

Verification of Course Completion
Form (continued)

Theory Elements Course title Results Advance Standing

(include RN or RPN) P=PASS
Y=Yes
F=FAIL
I=IN PROGRESS N=No
Crisis Management
Communication (includes
mental health strategies)
Family Centred Care
Growth Development Across
the Life Span
Nursing Research
Chronic Illness & Hospitalization
Effects on the Family & Family
Dynamics
Nursing Theory/Framework
Leadership
Advanced Communication
Community
Anatomy/Physiology/
Pathophysiology

Clinical Elements Course title Results Advance Standing

(include RN or RPN) P=PASS
Y=Yes
F=FAIL
I=IN PROGRESS N=No
Clinical 200 hours
Practicum/Consolidation
Practicum 200 hours
Clinical 400 hours
Practicum/Consolidation
Practicum 300 hours

Name of contact at school Signature

Title

E-mail address of contact