Fillable The director of the program or designated official (Texas Real Estate Contracts)

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The director of the program or designated official (Texas Real Estate Contracts)

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The Texas Real Estate Commission (TREC) is an agency that governs real estate practices in the state of Texas USA. I its headquarters are located in Ausin Texas at 1700 North Congress.

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Revised 10/2020
The director of the program or designated official (only if program is permanently closed) must complete this section after the completion date
and indicate information regarding the applicant’s advanced practice nursing education program of study. Please do not use a signature stamp.
Do not use white-out for corrections. All blanks must be completed. Send the signed form directly to the Texas Board of Nursing, 333
Guadalupe, Suite 3-460, Austin, Texas 78701, Attn: APRN Office. Note: The “completion date” is the date when the program/program director
deems the student to have finished and met all the requirements of the program and exited the program. It may not necessarily be the same
as the formal date of graduation.
1.
Name of Graduate: ______________________________________________________________________________________________
First Name M.I. Last Name
2.
Advanced Role and Population Focus for which the APRN was educated: ___________________________________________________
________
3.
Name of University/Institution ______________________________________ Location of Program (city/state) _________________________________
4.
Type of Program (check one): [ ] Certificate [ ] Master’s [ ] Post-master’s Certificate [ ] Doctor of Nursing Practice
5.
Program Completion Date (MM/YYYY or MM/DD/YYYY): _____________________________________________
6.
Length of Didactic (credit or clock hours) ____________________ Number of Clinical Hours (clock hours only) ___________________________
Include only clinical hours completed for academic credit from the university/institution identified
in # 3. Do not include clinical hours for which transfer credit or credit by exam was awarded.
7.
At the time the applicant completed the program, the program was accredited by (check one):
[ ] Accreditation Commission for Midwifery Education
[ ] Accreditation Commission for Education in Nursing
(formerly NLNAC)
[ ] Council on Accreditation of Nurse Anesthesia Educ. Programs
[ ] National Assoc. of Nurse Practitioners in Women’s Health
[ ] Commission on Collegiate Nursing Education
[ ] Texas Board of Nursing
[ ] Other (please specify) ____________________________________________________________________
8.
Please indicate the course number(s) in which the applicant completed the following content:
Advanced Assessment ___________________________________
Advanced Pharmacology _________________________________
Advanced Physiology and Pathophysiology ___________________
Role Preparation ________________________________________
I, (print director's name) , hereby certify that the above statement of information is true and correct and
that the applicant named above has met all requirements for completion of the advanced practice nursing education program for which I am
the program director or authorized designated official. I understand I am accountable and responsible for the information contained herein.
AFFIX SCHOOL SEAL BELOW Director’s original signature _____________________________________________
Please do not use signature stamp
Title/Position _________________ Telephone number _______________________
Texas Board of Nursing
333 Guadalupe, Suite 3-460 Austin, TX 78701
APPLICATION FOR TEXAS APRN LICENSURE—PART 2
VERIFICATION OF COMPLETION OF AN EDUCATION PROGRAM IN AN APRN ROLE
AFFIDAVIT
Date Signed ____________ Email: ________________________________________
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Revised 10/2020
Applicant must complete the following information and forward Part 2 of the APRN Application to the program director or designated
official (only if the program is permanently closed) authorized to certify that the individual has completed an advanced practice nursing
education program of study congruent with the role and population focus title for which the applicant seeks licensure in Texas.
I, (print name) , have applied to the Texas Board of Nursing for licensure as an
Advanced Practice Registered Nurse using the title . After I have completed all
requirements of the program of study, please complete the information on the verification of completion form and forward the signed
form directly to the Texas Board of Nursing, 333 Guadalupe, Suite 3-460, Austin, TX 78701, ATTN: APRN Office. I grant permission for
Texas Board of Nursing staff to discuss my education directly with representatives of the advanced practice nursing education program.
Student ID/SSN _________________________ Signature _____________________________________________ Date __________________
APRN licensure in the state of Texas is granted based upon formal education in a specific advanced practice role and population focus
area. ALL applicants, including those seeking licensure by endorsement, must demonstrate that they have met the education
requirements for licensure. The curricular requirements for licensure are set forth in 22 Tex. Admin. Code, Ch. 221.
1.
Advanced health assessment—A course that offers content supported by related clinical experience such that students gain the
knowledge and skills needed to perform comprehensive assessments to acquire data, make diagnoses of health status, and
formulate effective clinical management plans. Content must include assessment of all human systems, advanced assessment
techniques, concepts, and approaches.
2.
Advanced Pharmacology—A course that offers advanced content in pharmacokinetics, pharmacodynamics,
Pharmacotherapeutics of all broad categories of agents, and the application of drug therapy to the treatment of disease and/or the
promotion of health.
3.
Advanced Physiology and Pathophysiology—A dedicated, comprehensive, system-focused pathology course(s) that provides
students with the knowledge and skills to analyze the relationship between normal physiology and pathological phenomena
produced by altered states across the life span.
4.
Role Preparation—Formal didactic content and clinical experiences that prepare nurses to function in an advanced nursing role.
5.
Clinical Learning Experiences—An opportunity for students to apply knowledge by managing patient/client care in a healthcare
setting. Clinical learning experiences are planned and monitored by either a designated faculty member or qualified preceptor.
6.
Practicum/Preceptorship/Internship—A designated portion of a formal educational program that is offered in a healthcare
setting and affords students the opportunity to integrate theory and role in both the clinical specialty/practice area and advanced
nursing practice through direct patient care/client management. Practicums, preceptorships, and internships are planned and
monitored by either a designated faculty member or qualified preceptor.
A program designed to prepare APRNs for advanced practice roles shall include the following:
1. Separate, dedicated, graduate level courses in Advanced health assessment, Advanced pharmacotherapeutics, and Advanced physiology and
pathophysiology (integrated content, including content integrated in medical management courses, is NOT accepted in lieu of separate courses
in these content areas);
2. A minimum program length of one academic year that includes a formal preceptorship
3. Diagnosis and management of diseases and conditions
4. Evidence of theoretical and clinical role preparation;
5. Evidence of clinical major courses in the population focus area;
6. Evidence of a practicum/preceptorship/internship to integrate clinical experiences as reflected in essential content and the clinical major
courses; and
7. Faculty prepared in appropriate roles and population focus areas.
Texas Board of Nursing
333 Guadalupe, Suite 3-460 Austin, TX 78701
CONSENT TO RELEASE INFORMATION—TEXAS APRN LICENSURE APPLICATION PART 2
INFORMATION FOR THE PROGRAM DIRECTOR
SELECTED OPERATIONAL DEFINITIONS
SELECTED OPERATIONAL DEFINITIONS
NOTE: APRN applicants who completed their programs on or after January 1, 2003 shall demonstrate completion of a minimum of 500 unduplicated
clinical clock hours in each advanced role and population for which they have applied within their advanced educational programs.
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The director of the program or designated official (Texas Real Estate Contracts)

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Completed 1 March 2022

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