Nursing Licensure Form Completion Request

Complete this form if you have nursing licensure document(s) to be filled out by the university. Information will be sent directly to the requesting body.

Nursing students are not required to submit this form as part of their application for the CNO NCLEX exam.

A $102 non-refundable administrative fee will be placed on your account upon receipt of this request. It is your responsibility to pay this fee immediately. Please visit the following link for your payment options. If you do not pay this fee, a hold will be placed on your account and your request will not be sent to the requesting body.

The length of time for requests to be processed is normally 2-3 weeks. During peak periods, processing time may be longer.

If you require an official transcript be sent with your documentation you can request your transcript by completing the Transcript Request section at the bottom of this form, as it is a separate request. Official transcripts cost $18 and must be paid at the time of order. Please note, Ontario Tech University no longer produces paper transcripts. All nursing documentation and official transcripts will be sent electronically.

If your nursing documentation and transcript are for CGFNS, please enter 'CGFNS' in the email address field. We participate in the CGFNS Digital Credential Exchange Program. Your nursing documentation and transcript will be uploaded to the CGFNS portal.

General Information
Current Name Current Name First Last
Name while attending Ontario Tech (if different from above) Name while attending Ontario Tech (if different from above) First Last
Student Number
Must be 9 digits. Currently Entered: 3 digits.
Ontario Tech Email Address

We will only send information to a registered Ontario Tech email account.
Phone Number
Date of Birth Date of Birth / MM / DD YYYY
Email address nursing documentation is to be sent to
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Program Specific Information
Program Attended
What year did you start the program?
What year did you graduate?
Upload all information/paperwork that is required to be completed by the Faculty of Health Sciences, Nursing team.

Please ensure that you have completed any information that is to be provided by the applicant.

Attach Files

Note: If you also require an official transcript, this is a separate request which you must complete online through MyOntarioTech.
Is an official transcript required to be sent with this documentation?
Transcript Request

Please note, Ontario Tech University no longer produces paper transcripts. All nursing documentation and official transcripts will be sent electronically. Please fill in the required information below to request your official transcript.

If your transcript is for CGFNS, please enter 'CGFNS' in the email address field. We participate in the CGFNS Digital Credential Exchange Program. Your nursing documentation and transcript will be uploaded to the CGFNS portal.
Issued to (eg. CGFNS)
Email address transcript is to be sent to
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Acknowledgement

Acknowledgement
I understand that a $102 non-refundable administrative fee will be placed on my tuition account upon receipt of this nursing licensure form completion request. This fee must be paid before the completed form(s) can be sent to the requesting body.

I understand that an additional $18 fee will be placed on my tuition account if I have requested an official transcript, as it is a separate request.

Please visit the following link for your payment options.
Disclaimer

Personal information on this form is collected under the authority of the University of Ontario Institute of Technology Act, SO 2002, c. 8, Sch. O. and will be collected, protected, used, disclosed and retained in compliance with Ontario’s Freedom of Information and Protection of Privacy Act R.S.O. 1990, c. F.31. This information will be used for education, administrative and statistical purposes and to administer registration within the University. Questions regarding the collection of your personal information may be directed to the Registrar, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, 905.721.3190, email: connect@ontariotechu.ca.

If you require this information in an alternative format due to disability, please email records@ontariotechu.ca.

Nursing Licensure Form Completion Request

Nursing Licensure Form Completion Request

General Information

Program Specific Information

Transcript Request

Disclaimer