Program Completion Form

Please complete with your full legal name as required on your application. This form is mandatory to ensure accuracy for the Certification of Registered Nurse (RN) Education Program Completion (as submitted to Ohio Board of Nursing.)
First Name * Required
Middle Name * Required
Last Name * Required
Phone * Required
Student ID number * Required
Date of Birth * Required
MM slash DD slash YYYY
Date of education program requirements completion * Required
MM slash DD slash YYYY
Please specify what state you are applying for licensure * Required
When do you plan to take NCLEX? (please give an estimation in MM/YYYY) * Required
Are you currently working in the nursing field? * Required
- Yes
- No
Employer Name (If Yes working in the nursing field) Please list Agency - City, State
Area of Field (If Yes working in the nursing field)
Do you plan to change jobs upon graduation? * Required
- Yes
- No
Where do you plan to work? (If Yes change jobs upon graduation) Please list Agency - City, State
**Please note**
- This is the name and date that should be submitted on your NCLEX application
- The correspondence is electronic, so this should decrease the wait time
- We do not have access or influence to the status of your application submission
- Please continue to check the Ohio Board of Nursing (OBN) website for status inquires
A letter will be sent along with the certificate of program completion upon obtaining the required minimum score on the final comprehensive predictor at the end of semester 5 or by obtaining a 'green light' status if the required minimum score was not obtained on the final comprehensive predictor. Please refer to policy in Student Handbook.

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