★ Section1은 지원자가 작성, Section2는 학교가 직접 작성합니다.

The University of the State of New York

The State Education Department
Office of the Professions
Nurse Form 2F
Division of Professional Licensing Services Certification of Foreign Nursing Education
www.op.nysed.gov

Use this form ONLY if your nursing school is located outside the United States or its territories and you were advised that CGFNS did not obtain full
documentation needed for a New York State nursing license review of your CGFNS Credentials Verification Service for New York State Application or
you are not utilizing the services of CGFNS.
Applicant Instructions
1. Complete Section I. In item 4, enter your name exactly as it appears on your Application for Licensure (Form 1). Be sure to sign and
date item 9.
2. Have the professional school you attended complete the appropriate parts of Section II. Be sure to include any fee required by the
school. The school of nursing must return the entire form in a sealed official school envelope along with an official transcript directly to
the Office of the Professions at the address at the end of this form. If the transcript is not in English, a qualified translation is also
required. For information on what constitutes a qualified translation, see our website https://www.op.nysed.gov/about/general-information-policies#verif.
This form and transcript will not be accepted if submitted by the applicant or any person or agency other than the proper school
authority.

Check what you are applying for (check one): ✔ Registered Professional Nurse Licensed Practical Nurse

Section I: Applicant Information

1. Social Security Number 2. Birth Date Month 0 9 Day 0 6 Year 1 9 8 9

(Leave this blank if you do not have a U.S. Social Security Number)

3. Print Name Last K I M

First E U N H Y E 5. Telephone/Email Address

지원자 이름
- 여권 및 응시원서와 철자, 띄어쓰기 동일하게 Daytime Phone 전화번호 / 이메일 주소
Middle ✔ Home or Business
Licensee business address, phone and email address are public information. Failure to
indicate business or home on this form for each item will deem it public information.
8 2 1 0 1 2 3 4 5 6 7 8
Area Code Phone
4. Mailing Address ✔ Home or Business
(You must notify the Department within 30 days of any address or name changes) Email Address (please print clearly)
✔ Home or Business
Line 1 2 8 - 1 4 T E H E R A N - R O
eunhyekim@enclex.com
Line 2 G A N G N A M - G U

Line 3 6. New York State DMV ID Number

(Driver or Non-Driver ID)
City S E O U L
State ZIP Code 0 6 1 2 9 (Leave this blank if you do not have a
Country/
New York State DMV ID Number)
Province K O R E A ( S O U T H )

지원자 이름
7. Name as it appears on your Degree/Diploma/Certificate EUNHYE KIM - 여권 및 응시원서와 철자, 띄어쓰기 동일하게

8. Name of institution attended EWHA NCLEX UNIVERSITY 학교명

Address of institution 1, EWHADAE-GIL, GANGNAM-GU, SEOUL, 03760, KOREA(SOUTH) 학교주소

Dates of attendance from 03 02 2011 to 02 20 2015 재학기간 (입학일/ 졸업일)

mo. day yr. mo. day yr.
Title of Degree/Diploma/Certificate awarded (in original language) GANHOHAKSA(BSN) 3년제는 GANHOJEONMUNHAKSA(ADN)
Date Degree/Diploma/Certificate awarded 02 2015 Not yet awarded
mo. yr. 졸업일과 동일하게 작성

9. I request and give my permission to the institution listed in item 8 above to complete Section II of this form and mail it to the Office of the
Professions at the address at the end of this form, and to release any other information requested by the State Education Department in
connection with my application.
지원자 사인 작성날짜
Signature Date

Nurse Form 2F, Page 1 of 2, Revised 3/23

Section II: Certification of Nursing Education
Instructions to the Registrar: Complete Section II to document the applicant's education. Sign and date the Certification. Return the entire
form along with an official transcript documenting completion of the program in an official school envelope directly to the Office of the
Professions at the address at the end of this form. Form 2F will not be accepted if submitted by the applicant.
지원자 이름
Name of the applicant EUNHYE KIM - 여권 및 응시원서와 철자, 띄어쓰기 동일하게
(see Section I, item 7)

1. Nursing school name EWHA NCLEX UNIVERSITY

Former school name

Address 1, EWHADAE-GIL, GANGNAM-GU

(Street)
SEOUL 03760 KOREA(SOUTH)
City (State/Province) (ZIP Code) (Country)

2. Nursing Program Information

Length of the program 4 YEARS 3년제는 3 YEARS Language of instruction used KOREAN/ ENGLISH

Date of admission 03 02 2011 Date of completion 02 20 2015 재학기간 (입학일/ 졸업일)

mo. day yr. mo. day yr.
Years of education required for admission 12 YEARS Date of graduation 02 20 2015 졸업일
mo. day yr.
Title of degree or diploma awarded B.S.N 3년제는 ASSOCIATE DEGREE IN NURSING
Date degree or diploma was awarded 02 20 2015
mo. day yr.
졸업일과 동일하게 작성
Type of program ✔ Baccalaureate Diploma Associate Other
└> 3년제는 이곳에 체크
This program was approved as preparing for licensed practice as a ✔ general or professional nurse or as an auxiliary/second level nurse
by:

Name of the Registration Authority who approved this program MINISTRY OF EDUCATION

Initial date the program was approved by the Registration Authority 간호학과 인가 날짜
mo. day yr.
If NOT approved for general nursing practice, please explain

Note: An official transcript or marksheets is issued by the school showing completed courses by year and grades and bears original school
official's signature(s) and an original school seal(s). It must be received directly from the school along with this form in a sealed official school
envelope.
Certification - To be completed by the Registrar:
I hereby certify that to the best of my knowledge and belief the information in Section II is a true statement of the record of the professional
education of the individual named on this form.

담당자 사인 작성 날짜
Signature of Registrar Date
Print Name 담당자 이름
Title or official position

Institution
Institution Seal
Address 담당자 기타 정보 학교 압인 (직인)

Telephone Fax Email

Return Directly to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Nurse Unit,
89 Washington Avenue, Albany, NY 12234-1000.
Nurse Form 2F, Page 2 of 2, Revised 3/23