Forms

Please select the forms you need from the list below or to the left. If you have questions, contact us for assistance.

Many of these forms are Adobe Acrobat PDF files. To install free Acrobat Reader software, please click here.

Exam Applications

• The Certified Pediatric Nurse Exam:

This exam application form is for the nurse who has extensive experience in pediatric practice and who demonstrates knowledge and abilities related to pediatric nursing beyond basic RN licensure. Apply online for faster processing or use our Certified Pediatric Nurse Exam Application Form.

• The Primary Care Certified Pediatric Nurse Practitioner Exam:

This exam application form is for the advanced practice RN preparing to work or currently working in the primary care pediatric nurse practitioner role. Apply online for faster processing or use our Primary Care CPNP Exam Application Form.

• The Acute Care Certified Pediatric Nurse Practitioner Exam:

This exam application form is for the advanced practice RN preparing to work or currently working in the acute care pediatric nurse practitioner role. Apply online for faster processing or use our Acute Care CPNP Exam Application Form.

Special Accommodations Form

If you have a disability and need accommodations during testing, please use our Special Accommodations Form.

Recertification Forms

2011 Recertification begins October 1, 2010. For important changes to 2011 Recert, visit our Recert Updates page. If you have questions about your recertification, please email recert@pncb.org for assistance.

Verifications

Visit our Verification page for complete details about Verification of Certification or Verification of Exam Eligibility Status.

Name Change Form

For legal name changes, use our Name Change Attestation Form.

On-Site Testing Materials

Visit our On-Site Testing page for more about this convenient way to bring the Certified Pediatric Nurse Exam to your hospital!

• Paper Application for On-Site CPN® Exam
• Agreement to Offer Form UPDATED 12/08
• PNCB Proctor's Manual UPDATED 5/10
• On-Site Exam Checklist UPDATED 9/07
• On-Site Interest Flyer
• Exam Reminder Sign
• "Testing in Progress" Sign

PNP Program Review Forms

For information about PNCB Recognized Programs, see our PNP Programs page.

Applying for Acute Care PNP program recognition? Use our Acute Care Comprehensive Program Review Application (Word form).

Applying for Primary Care PNP program recognition? Use our Primary Care Comprehensive Program Review Application (Word).

Applying for renewal of recognized status? Use our Primary Care and Acute Care Amended Program Review Application (Word). You will be notified by email 30 days prior to the month your review is scheduled. Your renewal application is due in our office by the end of the month that is scheduled for your program's review. For example, we would email October 2008 programs September 1, 2008 and ask that materials be returned by October 31, 2008.

Need to update your program's contact information? Use our PNP Program Faculty Information Worksheet (Word).