Examination Committee

Nepal Nursing Council

Dhumbarahi, Kathmandu

APPLICATION FORM FOR NATIONAL LICENSURE EXAMINATION FOR NURSES (NLEN)

Please fill up in CAPITAL LETTER in English or Type.

A. PERSONAL INFORAMTION

1. Full name of Applicant:

2. Father ’s name:

3. Mother ’s name:

4. Nationality:

5. Date of Birth: / /

Day Month Year

6. Completed age: year

7. Permanent Address:

District Zone

VDC / Municipality Ward No.

8. Temporary Address:

Telephone number: (Home) (Mobile)

E-mail address (if available):

Affix

applicant

photo

B. PROFESSIONAL EDUCATION

1． Name of Nursing School / Institute：

2． Address:

３．Telephone number:

４．Type of Program(Give tick into the box or specify it.)

Proficiency Certificate Level of nursing (P.C.L.) in Nepal

Bachelor Science in Nursing (B.Sc. N.)in Nepal

Other: (country)

(program)

Date of Entry: / /

Day Month Year

Date of Graduation: / /

Day Month Year

Received by:

Name of NNC Staff : Signature of applicant:

Date : Date :

Note: Attach the documents as prescribed in Test Guideline (NLEN)