Request for Verication of
Registration form
College of Nurses of Ontario
101 Davenport Rd., Toronto, ON M5R 3P1
www.cno.org
Telephone: 416 928-0900
Toll-free (Canada): 1 800 387-5526
Fax: 416 928-6507
The purpose of this document is to verify to another regulatory board that you are, or were, registered with the College of
Nurses of Ontario (CNO). We will not send this document to an employer or a school
Instructions
• Type your responses on this form.
• Please download the pdf form to your computer; then ll, save and email it to cno@cnomail.org using the subject line “Request for
Verication of Registration Form”. You can also print and fax the form to 416-928-6507.
Please review the Privacy Policy on CNO’s website (www.cno.org/privacy) to understand how your personal information will be used.
Personal Information
First name Last name
CNO Registration number Year of graduation Street address City
Date of birth Telephone number Province/State Postal Code/Zip Code Country
School of nursing Email address
Regulatory board Information
Name of regulatory board to receive your verication of registration Email address of regulatory board
Street address City
Province/State Postal Code/Zip Code Country
I hereby authorize CNO to release my registration history, examination scores and any information related to my
conduct and/or health that has been reviewed by CNO to the party identied above.
Signature
Fees & delivery information
Verication information will be sent directly to the identied
regulatory board via email at this time
Processing fee $16.95 CAD Total: $ _________
$16.95
This total will be charged to your credit card.
Payment information
Payment is accepted by credit card (Visa, MasterCard,
American Express). CNO does not collect payment
information in writing. Please submit your completed form
to CNO. Once it has been received, you will be contacted
for payment by email within 10 business days. Please do
not contact CNO to provide payment until we have notied
you that your form has been received. Once the payment
notication email has been sent, you have 30 days to
make your payment or your request will be cancelled.
NOTE: Delivery by mail, fax or courier is not available at this time. Your verication information will be sent electronically; please check with the regulatory body
you are applying with to ensure they accept this means of delivery.
AUG 2020
2020-72
click to sign
signature
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