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:

Use our online application to apply for this exam. This exam 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.

• 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 then arrange for submission of supporting documentation.

• 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 then arrange for submission of supporting documentation.

Special Accommodations Form

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

Recertification Forms

For 2011 Recert, enrollment is paperless. Our online Recert application for processing credit cards and electronic checks meets the highest industry standards for security, but you may also opt to print your online enrollment as an invoice and mail a paper check or money order. When using credit cards and electronic checks, we protect the security of your information by using Secure Sockets Layer (SSL) software, which encrypts information you input.

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.

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).