Demonstrate English language ability in reading writing listening and speaking as a nurse in day today duty set up

Demonstrate English language ability in reading writing listening and speaking as a nurse in day today duty set up

Evidence of Language Proficiency ─
Applicant 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

IMPORTANT: The evidence you provide in this form will be used by the College of Nurses of Ontario (CNO)
to determine if you can communicate and understand effectively as a nurse. Making a false or misleading
statement or representation on your application or supporting documents could result in the cancellation of
your application(s) for registration and/or any certificate that may be issued.
There are several forms required to complete the evidence of language proficiency process. Carefully read
and follow the steps below to make sure you submit this and other forms correctly.
Please review the Privacy Policy at www.cno.org/privacy to understand how your personal information will be
used.
How to complete this form:
Step 1: Complete sections 1 and 2 according to instructions provided in each section.
Step 2: Read and sign the agreement in section 3.
Step 3: Go to www.cno.org/language, download the “Evidence of Language Proficiency – Summary of
Evidence Form” and fill out the required information
Step 4: Once you have completed both forms, you must submit the Applicant Form and the Summary of
Evidence Form together to CNO by mail or fax using the information provided at the top of this
form, or via email to cno@cnomail.org and include “Evidence of Language Proficiency –
Applicant & Summary of Evidence forms” in the subject line of your email.
Step 5: Go to www.cno.org/language, download the appropriate forms that employers, educators and
others sources must complete to provide supporting evidence of your language proficiency.
Complete your portion of each form and send the form to the appropriate source. Ask them to
complete the form according to the instructions and mail it directly to CNO. Note: CNO may
contact these sources to validate the information they provide on the forms.
1. APPLICANT’S INFORMATION

Evidence of Language Proficiency ─
Applicant Form

Applicant’s Name: __________________ Application Number ___________
© College of Nurses of Ontario Evidence of Language Proficiency – Applicant Form (2019-97) 2
First name Last Name
Evidence of Language Proficiency ─
Applicant Form

Applicant’s Name: __________________ Application Number ___________
© College of Nurses of Ontario Evidence of Language Proficiency – Applicant Form (2019-97) 3
Application number Date of Birth (yyyy-mm-dd)

Evidence of Language Proficiency ─
Applicant Form

Applicant’s Name: __________________ Application Number ___________
© College of Nurses of Ontario Evidence of Language Proficiency – Applicant Form (2019-97) 4
2. PERSONAL STATEMENT
In the space below, provide an explanation of how you meet the language proficiency requirement using
education, employment/volunteer or other experience you’ve had within the past two years. Include
detailed examples of how you demonstrate proficiency in listening, reading, writing and speaking.
NOTE: If you run out of space, continue typing and the form will add space for you to continue writing. If
you are completing the form by hand, you can continue to write on a separate sheet of paper and attach it
to this form.
LISTENING
READING
WRITING
SPEAKING
Evidence of Language Proficiency ─
Applicant Form

Applicant’s Name: __________________ Application Number ___________
© College of Nurses of Ontario Evidence of Language Proficiency – Applicant Form (2019-97) 5
3. AGREEMENT
By signing and submitting this form to CNO, you are agreeing to each of the statements below. Your
signature and submission of this form, along with all the documents outlined in this form, are required in
order to proceed with the assessment of your language proficiency.
 I have reviewed and understand the language proficiency information on CNO’s website at
www.cno.org/language.
 I request that CNO review the information I provided above as evidence of my language proficiency.
 I have provided explanations and specific examples, of how I think I meet each component (listening,
reading, writing and speaking) of the language proficiency requirement.
 I understand that my evidence of language proficiency must be current and relate to the last two years.
 I understand that there are other evidence of language proficiency forms provided on
www.cno.org/language that must be submitted to CNO directly by other sources (such as, employers,
educators and others) and I will ask them to complete the forms and provide the required information to
CNO.
 I understand that the assessment of my language proficiency will begin only after CNO has received all
the required forms and accompanying documents, including my personal statement.
 I understand that it can take several months to receive the documents and complete the assessment
and I must still continue to meet all other registration requirements and consider their expiry dates.

I agree to each of the above statements and submit this form for consideration.

Evidence of Language Proficiency ─
Applicant Form

Applicant’s Name: __________________ Application Number ___________
© College of Nurses of Ontario Evidence of Language Proficiency – Applicant Form (2019-97) 6

Evidence of Language Proficiency ─
Applicant Form

Applicant’s Name: __________________ Application Number ___________
© College of Nurses of Ontario Evidence of Language Proficiency – Applicant Form (2019-97) 7
Signature Date
Evidence of Language Proficiency ─
Applicant Form

Applicant’s Name: __________________ Application Number ___________
© College of Nurses of Ontario Evidence of Language Proficiency – Applicant Form (2019-97)

(Visited 2 times, 1 visits today)