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Licensure: US State Licenses for International Nurses

Credentials Review


The purpose of each credentials review service (not to be confused with the Credentials Evaluation Service, the name of a specific CGFNS credentials review) is to determine if the individual foreign nurse’s education and licensure meet the standards set by the state board of nursing where the nurse is seeking an RN license. The majority of state nursing boards rely on CGFNS to complete the nurse’s credentials review. CGFNS offers three credentials programs to meet state board requirements.

  1. Certification Program: The CGFNS CP begins with a credentials review, upon completion of which a candidate is “rostered” to take the CGFNS Qualifying Examination (also know simply as the CGFNS exam). In order to complete the service and obtain the Certificate, a candidate must either have a past English language examination reported, or must take and report an English examination within two years after completion of the Qualifying Examination. CGFNS will not officially verify that a candidate has passed the CGFNS examination alone: in order to use the CGFNS exam to apply for US state licensure, the candidate must complete the entire Program, including the requisite English language examination. Out of the 57 Boards of Nursing in US states/territories, 25 will accept ONLY the CP for license by examination. Further, eleven (11) state boards will accept either the CES or the CP.
  2. CES: The Credentials Evaluation Service is intended for foreign nurses taking the NCLEX examination without completing the CGFNS Certification Program. It basically consists of the same credentials review found in the CP, but without the Qualifying Examination. No English language examination is built into the requirements for issuance of a CES report, though some US states will accept the CES only if it is supplemented by a language exam. Twelve (12) state nursing boards will accept the CES, and thirteen (13) more will accept only the CES. Lastly, the Alabama Board of Nursing requires BOTH the CP and the CES.
  3. CVS: The Credentials Evaluation for New York State is a unique and specific service for New York foreign nurse licensing.
 
Worldwide NCLEX locations

Australia
Sydney
Canada
Toronto
Vancouver
China
Hong Kong
India
Bangalore
Chennai
Hyderabad
Mumbai
New Delhi
Germany
Frankfurt
Japan
Yokohama
Mexico
Mexico City
South Korea
Seoul
Taiwan
Taipei
United Kingdom
London
(Manila, Philippines will be added to the list some time in 2007)

For your reference, the following is a breakdown of what CGFNS services are accepted by US state boards:

Accept ONLY the CGFNS CP: Alaska, Connecticut, Delaware, District of Columbia, Indiana, Iowa, Louisiana, Michigan, Missouri, Montana, Nebraska, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Virgin Islands, Virginia, Washington, West Virginia, Wisconsin and Wyoming.

Will accept the VisaScreen: Arizona (as well as CES or CP), Kentucky (accepts ONLY the VisaScreen), Massachusetts (as well as CES or CP), Oregon (as well as CES or CP).

Accept the CES only in the form of the Full Course-by-Course Report: Alabama, Georgia, Kansas, Maine, Maryland, New Hampshire, Ohio and Texas.

Accept the CES only in the form of the Healthcare Profession and Science Course-by-Course Report: Arizona, Arkansas, Colorado, Florida, Hawaii, Idaho, Illinois, Massachusetts, Minnesota, Mississippi, Nevada, New Jersey, New Mexico, North Carolina, Oregon, South Carolina and Vermont.

Accept BOTH the CP and CES: Arizona, Georgia, Hawaii, Idaho, Illinois, Maine, Massachusetts, Mississippi, New Hampshire (CES Full), New Mexico, Oregon and Utah.

Accept the CP/CES but do not require any outside credentialing: New Mexico and Wisconsin.

Note that, when verifying a CES report to a state board, candidates may “upgrade” a Healthcare Professionals Report (HS/P) to a Full Report for an additional fee. Re-reporting of license and transcript credentials may also be required for the upgrade, but upgrading does not necessitate re-applying.

English Language Examination


When it comes to language exams, the TOEFL is more widely accepted, though many nurses educated in the British-based systems of India and some African countries may lean toward the IELTS. The language exam is arguably the simplest part of the process, so call your state’s board, or the board in which most of your partnering facilities are located, so that you can save yourself some time from the start by encouraging one exam over another. We will take a look at state boards’ language requirements in more specific terms at the end of the section, but for now, we will attend to the TOEFL, TSE and IELTS in general.

Language examinations are absolute requirements for the nurse exams and immigration process, whether required for the CGFNS exam, state licensure or the VisaScreen. We remain focused on language requirements as they relate to licensure, but it bears mentioning that encouraging the nurses to sit for the TOEFL iBT, if it’s offered in their area, will save them the trouble of taking the Test of Spoken English (TSE) or retaking the iBT later on for the sake of meeting VisaScreen’s speaking requirement. In any event, the Educational Testing Services (ETS) is slowly phasing out the TOEFL paper-based test (pBT), which will make the selection between the IELTS (which includes a speaking component) and the TOEFL (which does not) a little less obvious.

This roll out of the TOEFL iBT will also make the combination of acceptable CGFNS options and language exams less boggling: your only basis for selecting an English exam will be, ‘Does my state accept it?’ As long as the IBT version of the TOEFL is offered in your client’s area, the way you should decide on an English exam is by checking which exam is accepted in the state in which your client will be working. A secondary deciding factor would be when the next available TOEFL iBT and IELTS dates are. You may also want to consider that you can access your client’s TOEFL scores online while you are waiting to receive the official score report.

To return to the general subject of language examinations and licensure, however, all US state licensure boards except for California, New Mexico, Nevada, Idaho, Utah, Colorado and New York require either 1) a CGFNS service which requires a language exam or, 2) direct reporting of language scores before granting permission to take the NCLEX test—that is, before conferring a license by examination. Nurses who have not taken a language exam in the past two years and would like to take the NCLEX without doing so will need to apply to one of the seven above states.

Let’s turn, now, to the subject of both registration for, and reporting of, language examinations. Since language examinations have not been addressed in great detail in other sections, we will cover exam content and format, as well as exam procedures in much more detail than we dedicated to the CGFNS services.

IELTS

The International English Language Testing System (IELTS), managed jointly by the British Council, Cambridge University ESOL and IDP:Australia, measures the test-takers’ English abilities in four areas. It is accepted widely in the UK, New Zealand, Australia and the US and about 1.5 million people sit for it each year in 135 countries. Aside from the differences in format, many nurses who were educated in British-based systems (Nigeria, for one) insist that the IELTS is easier to pass than is the TOEFL due to the IELTS’ UK beginnings.

General Information

The IELTS breaks down into nine bands, or spans of English ability into which a single score falls. That is, no precise score numbers are given, but rather an identification that the score is in the 7.0 band. A band score is given for each of the four sections of the exam, Listening, Reading, Writing, Speaking, with a final average, or General Band score. The bands begin with 1.0—indicating a non-user of English and 9.0, indicating an expert user.

IELTS offers two types of English exam, called modules: one for General use and one for Academic use. All CGFNS services and state boards of nursing accept only the Academic Module. This test allows candidates two hours and 45 minutes, with the following allotment for each exam section:
Listening: 30 minutes for 4 sections of ten items each.
Reading: 60 minutes for 3 sections (40 items total.)
Writing: 60 minutes for 2 essays of 150 and 250 words, respectively.
Speaking: 11-14 minutes, administered either before or after the other
sections in a separate session.
With the exception of the separate Speaking section, the IELTS is a paper-based exam, though British Council and IDP have initiated computer-based exams in Bangladesh, Egypt, India, Italy, Jordan, Kenya, United Arab Emirates and Vietnam. Currently, only the Academic Module has a computer-based version, though IELTS plans to expand testing centers and dates for the new system. The score system for computer-based testing is the same, as is the reporting time and level of difficulty.

Testing Centers and Dates

On its website, IELTS lists active testing centers in 125 countries, though you may discover upon calling one of the international centers that all tests at that location have been suspended indefinitely (Ghana, for example). Hence, making a call to the center is always advisable, since this is the only reliable way to find out the next available test dates and the accepted payment methods.

The U.S. IELTS testing centers are as follows:
The IELTS has 48 fixed test dates per year, though not all testing centers offer the test on all 48 days. Many international testing centers will skip certain dates altogether, depending on the demand in that particular area. In general, however, all active centers will offer at least one test per month, 12 months a year.

Internationally, countries that list their test dates online reveal in general 1-3 dates per month, though many of them note only the next few testing dates and others do not list any dates at all. Whether your candidate tests in the US or abroad, call centers directly for information about dates as well as for updates about possible suspensions of test administration.

Scheduling

Each IELTS testing center is entirely autonomous and not connected by an online registration system, which means that exams must be arranged through individual testing centers via a paper application. See the IELTS website lists individual sites for each testing center. These individual websites will provide all contact information for the location, and will set testing dates and their deadlines. US testing center websites will have extensive information, including downloadable credit card authorization forms and information about preparation classes. Paper applications must be sent by mail, along with two passport photos, directly to the selected testing center. Nurses can select two preferred testing dates, which will be confirmed by an IELTS agent as soon as the application is received. If neither preferred date is available, the agent will work with the test-taker to select one that is available.

Test-takers must also schedule the 11-14-minute session for the completion of the IELTS spoken English component. They may sit for this session directly after the exam, though it is better to schedule a separate date for this since the candidate may have to wait for hours as their fellow test-takers line up to complete the session. Speaking sessions may be completed within seven days before or seven days after the exam. An IELTS agent will administer it face-face, in accordance with IELTS’ emphasis on a personal approach to language testing. The approach is based on the belief that subjective evaluation of spoken English will more accurately determine how successful the test-taker will be in an English-speaking environment.

Payment

Each testing center has different fees as well as payment requirements. In all US testing centers, the fee is $140.00, but international fees vary greatly and often list the cost only in local currency. As for payment methods, Newton, MA, for example, allows use of a Credit Card Authorization form for payment, though some others require cashier’s check or money order. International testing centers sometimes accept payment only in local currency and do not accept credit card payments, which are important considerations when dealing with third-party billing for international nurses.

Reporting

Testing centers mail score reports to both candidates and selected score recipients 13 calendar days after test administration. Candidates can choose up to 5 additional score reports for recruiters, CGFNS, state boards, etc., by entering the agency information on the application form. One additional report can be ordered and sent to the candidate after the exam, and five more reports can be ordered and sent to agencies, though the request must be made by the candidate within a month after taking the IELTS. There are usually handling fees associated with post-exam orders for score reports, and the test-taker will need to contact their testing center to find out the fees, if any, and the procedure.

As of early 2006, scores can also be reported electronically to organizations which have registered on the IELTS system as “Recognizing Organizations” (ROs). Such organizations can check scores as soon as they are up via an online verification system (instituted early 2006). This is only for the purposes of reporting to CGFNS, ICHP, or state boards of nursing, since legal and recruitment agencies, etc., cannot register with the system. That is, only licensing and government agencies can be identified as ROs. Here is the form necessary to apply for RO status: https://ielts.ucles.org.uk/ielts-trf/applicationform.pdf. The system aims for high security, so once an organization’s administrator has applied for and received access to scores as an RO, individuals employed within the organization must apply as separate users of the system in order to gain access. The Administrator who initiated the RO application will receive the username and password for individual Users (their employees) via e-mail. Here is the User application form: https://ielts.ucles.org.uk/ielts-trf/userapplicationform.pdf.

For non-ROs recipients, score reports are still mailed in thirteen days. Unlike the TOEFL’s configuration, there is no online account system that would allow test-takers to immediately access electronic results.

In the Event of Exam Failure

As of May 1, 2006, nurses may re-take the IELTS exam at any time after failing it via the standard application process.

Rescheduling, Cancellation or Change of Testing Center

Postponements or cancellation must be made up to 5 weeks before the test in order for the test-taker to receive a refund. In the case of medical emergency, a test can be refunded up to 5 days before the test provided that medical documentation is provided. Changing testing centers is not possible due to the fact that each center is independent: a change in location would require registration with that center and repayment of the IELTS fee.

In general, however, any questions about the exam should be asked of individual testing centers. They often institute their own rules for cancellations, etc., and the main IELTS website will not provide extensive current information about specific centers.

Expiration of Scores

For all purposes, IELTS exam results are valid only for two years.

Test Preparation

IELTS offers daylong courses at US testing centers. The course costs $100 and can be arranged by calling the test center as few as two business days before the scheduled exam. As always, each IELTS center has different policies, and candidates should obtain more specific information by calling the testing center or visiting its website.

Additionally, candidates may order a full test preparation packet (including graded essays, IELTS Official Practice Tests, and other review texts) from either testing center, IDP:Australia or the British Council via the order form on the IELTS website. Prices for ordering from IDP are: A $33 plus an $11 for postage within Australia. From overseas and New Zealand, add a $20 and a $15, respectively. Prices for ordering from British Council are: £9.10 plus postage and £10.70 plus postage for mailing overseas. British Council will accept credit card payments. Note that samples of specimens from all sections of the exam are offered free of charge on the general IELTS site.

TOEFL and TSE


The Test of English as a Foreign Language is offered through Educational Testing Services (ETS), the nonprofit organization that also administers the TOEIC and the GRE, among other exams. Harvard President James Conant inspired the organization to improve US education by providing educational research and analysis, and a Carnegie Foundation grant provided for its formation in 1947. Today TOEFL’s website boasts that over 6,000 agencies in 100 countries accept TOEFL scores and depend on them to select students and practitioners based on English language abilities.

ETS first administered the TOEFL test in 1964 in the paper-based format, which is still in use today among testing centers that have not yet adopted the iBT, or internet-based test. The supplementary Test of Spoken English (TSE) began in 1995, but will discontinue in late 2007. A computer-based test (cBT) was established in 1998 but was discontinued in September of 2006 after the 2005 launching of the TOEFL iBT. The TOEFL is offered in approximately 168 countries, and as of December 2006, about 125 of those countries offer the TOEFL iBT. As of the publishing of this book, all countries in which the TOEFL is offered will offer the iBT. 34 countries currently offer both the pBT and the iBT, though the pBT will be discontinued after its last scheduled date: May 12, 2007. Despite the phasing out of the TSE, pBT and cBT, candidates who have results from any of the exams may still have them reported for the purposes of the CP or licensure provided that the scores are less than two years old.

The new and thorough “roll-out” of the iBT is of particular significance to nurse licensure due to its inclusion of a spoken English section. Many state boards, such as Maryland’s, require a breakdown of an RN’s spoken English ability, and other state boards, such as Arizona’s simply require the VisaScreen, obliquely requiring that nurses meet spoken English requirements. The iBT is now the only ETS-administered test that gauges both non-spoken English skills and spoken fluency in one: the internet-based voice recordings bypass the need for separate speaking sessions (as in the IELTS) or a second, separate spoken English examination. Whereas the TOEFL cBT or pBT had before 2006 been automatically paired with the ETS-administered Test of Spoken English (TSE) for the purposes of the VisaScreen, the iBT streamlined this process and is now the counterpart to the IELTS, which also contains a speaking component but is less widely accepted by state boards of nursing.

General Information

The iBT version of the TOEFL takes about 4 hours to complete and includes four sections: Reading, Listening, Writing and Speaking. The reading section contains three passages on which 36-70 total questions will be based. Next, in the listening section, test-takers answer questions based on two conversations and four lectures, as the TOEFL is designed to replicate, and thus judge a candidate’s or professional’s ability to succeed, in a university or professional setting. The listening section contains 34-51 free-response and multiple-choice questions. Note-taking is permitted during the lectures. A ten-minute break separates the first two and last two sections.

During the speaking session candidates answer six questions in the 20-minutes of allotted time: the first two ask the candidate to respond to topics they are familiar with, while the last four questions are referred to as integrated, and are responses based on a text, a lecture and then a questions that calls for the test-takers to draw connections between the two.

Lastly, in the writing section, test-takers will first answer questions based on a text, with a related lecture and then a question which requires the candidate to connect the two in well organized paragraphs. The second task, the independent question, simply requires the student to write about a subject of his or her own interest. Total time for this section is 50 minutes.

Each iBT section is scored on a scale from 0-30, with the two writing and the six listening tasks averaged and converted to the 30-point scale. Total scores, then, range from 0-120. Scoring scales vary for each the three types of TOEFL (pBT, cBT and iBT), but ETS has provided a handy conversion tool, which can be found at this link: http://www.ets.org/Media/Tests/TOEFL/pdf/TOEFL_iBT_Score_Comparison_Tables.pdf.

For those nurses who must take the paper-based test, the format is a little different. The writing section (TWE) is given its own separate score, though the TOEFL and TWE are not separate examinations. The writing score from the TWE section appears in the corner of the score sheet for the TOEFL. While another writing section is included in the pBT, it involves objective, multiple-choice questions, while the TWE requires candidates to generate paragraphs themselves.

Testing Centers and Dates

pBT and TSE

TOEFL’s comprehensive website allows for very easy searching by both date and testing center for pBTs and TSEs. It bears mentioning at the outset that both the pBT and TSE are slated for phase-out in 2007: there is only one remaining date for the either exam: May 12. Further, the May12 date for the TSE is available only abroad. It makes sense that, with the rollout of the iBT, a separate speaking test is rendered irrelevant. The most simple method of checking whether or not the nurse’s country still offers the pBT is to search by date, select May 12, and then select your country from the drop-down list to see if there are any open testing centers or seats. Unless the nurse has taken the TSE already and simply wants to avoid taking a speaking section, there is no good reason for taking the pBT, especially since the only date is so far in advance.

iBT

The TOEFL is generally offered six times a month, but not all cities in all countries will have tests on each of the possible dates. Once again, TOEFL’s website will offer complete information about the country you have in mind if you simply click on the “Register for the Test” link on TOEFL’s page of the ETS website. As for general information pertaining to test date availability, our recommendation is to book far in advance, as even US test locations may be full for three months from the current date. Cancellations are rare, though it may be worth it to check daily on the nurse’s account if you have a particularly pressing situation. Checking for availability by phone is not advisable, as the online search function is very user-friendly and agents may not have the patience to check for dates in as many cities as you would like to consider.

Scheduling

For fastest service, online registration is best for both the pBT and iBT. Mail-in forms for both types of exams are available in the TOEFL Handbook and phone registration may be completed by the applicant, but not by a third party.

Online registration for the pBT entails entering test-taker information and selecting the testing center via a series of online prompts. E-mail notification follows instantly, but note that it will not be possible to change any of the personal information for the nurse without the nurse’s calling ETS herself. The iBT registration, on the other hand, requires making an online profile, which has username and password access. That allows editing of personal and contact information, as well as easy rescheduling. Theoretically, the system is ideal: third party agents can access the account and pay via credit card as long as they have the user information, and third parties can even make the account on behalf of their nurse, which is ideal for nurses who cannot easily access computers. In reality, however, TOEFL is experiencing some growing pains in the form of technical difficulties and even server downtimes that have, in the author’s own experience, prevented online access for three weeks. Credit card payments may not always go through, and rescheduling in particular will frequently fail, requiring a phone call to secure the refund. Fortunately, TOEFL operators are easily accessible via phone and are, almost without exception, friendly and helpful. Once again, however, TOEFL agents will not release candidate-specific information to any third party.

Reporting

Candidates may report scores directly to up to four agencies by noting the recipient on the paper application or by entering them when prompted online at the time of test registration. All score recipients, including candidates themselves, may check iBT scores online after 15 business days, at which time paper score reports are also mailed. For the pBT, only paper reports are mailed, though the timeframe is the same.

Once again, the online account system makes for very easy score checking by anyone who can access the account. Nursing boards, however, will require official score reports, not online verification or photocopies of reports. An unlimited number of additional score reports may be ordered online after the exam and will be mailed in four to seven business days at a cost of $17.

For the pBT, scores reporting can take up to five weeks by mail and four weeks by phone if the candidate’s essay was handwritten.

In the Event of Exam Failure

Candidates may re-apply as soon as they can get another test date. Some state boards that do not require a spoken English score will still accept TOEFL iBT scores provided that candidates failed only the speaking section. The Massachusetts Board, for example, has set acceptable score cut-offs for all general (that is, non-speaking) sections of the TOEFL and will ignore the speaking section even if it falls below the mark that CGFNS has set.

Rescheduling, Cancellation or Change of Testing Center

Candidates can reschedule or change testing center by phone for any available test date/center, as long as the candidate reschedules three business days before their original examination date, not counting the examination date itself. A $40 fee applies. Rescheduling online is possible, and follows the same regulations, though it pays to take note of the caveats mentioned in the Scheduling section.

Refunds are offered for cancellations as long as they are made within three business days of the exam, not counting the day of the exam itself.

Expiration of Scores

As with any language exam, TOEFL scores are invalid after two years.

NCLEX Rules and Process


It’s likely becoming apparent to you, now, that each state is unique when it comes to licensure, and the only absolute requirement for any state is the credentials review, the National Council Licensure Exam (NCLEX) and the state board’s licensure application. This means that candidates must apply to a State Board before they are even permitted to sit for the NCLEX.

At this point, you have seen all of the processes leading up to the final licensure process, which is application to a state board of nursing and registration with Pearson Vue, the company that administers the NCLEX. While we have addressed the procedures for reporting language scores to state boards, we have yet to examine the verification of a CGFNS to state boards. It is a simple, yet essential process.

First of all, note that verification of a CP or a CES report online will take one month, so plan to do this even before the nurse has submitted any state licensure application. The process itself requires access to the nurse’s CGFNS account: simply log in, select “Order Services” and then “Additional Services.” This interface will allow you to choose which service you would like reported: the CGFNS certificate or the CES report. The fee for this verification is $75 in either case, unless your client has had more than two licenses or nursing schools included in a CES report.

Once verification is complete, the best way to send licensure applications to the nurse is, in most cases, to send links to .pdf documents so that the nurse can print them out, complete them, and send them to you for editing. In most cases, the most efficient way to ensure that the nurse’s license will ultimately arrive safely is to use your company’s own address: state boards often do not use enough postage for international mailings, or incorrectly type out unfamiliar international addresses. What’s more, the nurse may have already moved to the United States by the time the license arrives, especially since many boards will not send the physical license before they have a candidate’s Social Security Number on file.

Before we immerse ourselves in the topic, however, a simple explanation of NCLEX protocol will help maintain clarity. Many nurses know to refer to the ATT, but may be confused about where it comes from and when it will come. Here is the simple explanation: after the nurse has met the requirements for the state board to which she applied, the state board will send an eligibility or electronic “go-ahead” to Pearson Vue. As soon as the nurse registers with Pearson Vue and pays the $200 fee, Pearson Vue will note the eligibility and issue an ATT. So, let’s say that you register the nurse on Pearson Vue first, before verifying the CGFNS certificate to the state board. The nurse will have a profile and a username and password with Pearson Vue, but will not be able to schedule a test. As soon as you verify the CP to the state board and give the board time to send the eligibility, a link reading “Schedule” will appear on the right-hand side of the nurse account interface. You can click on the link and go as far as to search for exam dates, but you will not be able to actually select on and confirm without entering the ATT number. That means that, after the eligibility has been received by Pearson Vue and the Schedule link appears, Pearson Vue must still send the ATT e-mail that contains the ATT number. Their website states that it may take up to a month for this e-mail to be sent, but it usually takes less than one day. As soon as you have the number in hand, click the Schedule link, select a test date and, when prompted, enter the ATT. The harrowing process of securing an NCLEX date is complete!

As for the basics of NCLEX registration and scheduling, the NCLEX account remains open for only one year, and no refunds are given for any reason. An additional fee of $150 applies for testing abroad and must be paid over the phone at the time of scheduling.

Make sure that the name listed on the license application and the name on the Pearson Vue account precisely matches the name listed on the candidate’s passport or international driver’s license. If the name does not exactly match, the candidate will be turned away at the testing site. Note also that any discrepancies in the personal information sent by the board of nursing when they send the eligibility and the personal information for the nurse on Pearson Vue will result in delays in receiving the ATT. Furthermore, candidates’ names can be changed very easily via phone with Pearson Vue unless the eligibility has already been received. In the latter case, the name must be changed—often with great difficulty—in the records of the board of nursing itself.

Getting this far means that the nurse has secured an NCLEX date and, upon passing, will have a record with the state board of nursing that will 1) allow for endorsement into another state or 2) result in a license upon completion of any remaining requirements, such as notification of SSN or, in the case of California’s nursing board, completion of credentials validation and fingerprinting, etc.

Let’s pause here for another note on strategy. Two of the most important questions you can ask the nursing board your client has applied to are: 1) how long will the eligibility they issue be valid for?, and 2) how long will the ATT be valid? Although it is Pearson Vue, and not the state boards themselves, who issue the ATT, ATTs from different state boards have different validity dates. It is important to clarify that, as one of the most common mental glosses related to sitting the NCLEX is to not differentiate between the eligibility and the ATT. Once again, application to Board and verification of CP or CES equals eligibility. Eligibility plus registration with Pearson Vue equals an ATT.

You will have a finite amount of time in which to register with Pearson Vue as well as a finite amount of time in which to test. California is one of the most lenient boards when it comes to timeframes: the CA eligibility lasts for two years, while the ATT lasts for one year. There is quite a range of validities, from the Vermont eligibility that lasts only for 90 days, the Massachusetts ATT which lasts for three months and the Montana ATT, which allows clients an indulgent three years in which to take the NCLEX after the ATT arrives. For a client who cannot take an NCLEX abroad, wants to have her ATT in hand when she arrives in the US at the end of her immigration process, but worries about the duration of that process, the criterion by which you choose a board of nursing might well be based on which has the lengthiest ATT validity.

In the remaining sections you will find information on specific state board requirements for licensure, though you will see that this section has not covered every state board to the same degree of detail—or even covered every single state board. Let this re-emphasize the importance of contacting boards directly for the most accurate information: we find that an understanding of the workings and protocol for each board is incomplete until we have taken a nurse through the process in its entirety. Moreover, much of the information may be out-of-date by the time you read this book. Bear in mind that we have listed only the state requirements we have actually met and confirmed through experience. You will find yourself confirming them in the same manner, and we wish you the best of luck in that effort.

State Licensure Requirements


Alabama: Requires BOTH the CP and CES Full. Fees for Lic. by Exam/Endorsement: $85/$85.

Alaska: Accepts the CP in combination with TOEFL. Fees for Lic. by Exam: $265.

Arizona: Accepts the VisaScreen, and accepts the CP only with additional reporting of the TSE and the CES HP/S only with the additional reporting of the IELTS, TOEFL iBT or TOEFL cBT/pBT + TSE. Thus licensure by examination will not be conferred without the completion of a spoken English exam. Fees for Lic. By Exam: $200 if you have fingerprinting cards that were completed in the past two years; $263 total for application fee plus fingerprinting.

Arkansas: Accepts CP, CES Full and IERF (a non-CGFNS credentialing service). In addition to verification of one of these services to the Board, Arkansas also provides transcript and license validation forms and requires that candidates send them on to the school/licensing authority in a process identical to CGFNS’ credentialing process. TOEFL, TOEIC or IELTS results must be reported directly. The Board requires FBI background check, which takes 2-4 months and must be completed no more than 12 months before submission of the application for Licensure by Examination. Fees for Lic. by Exam/Endorsement: $75/$100.

California: Eligibility valid for two (2) years; ATT valid for one (1) year. Fees for Lic. By Exam range from $75 to $137 depending on whether or not the candidate does the live-scan fingerprinting or the fingerprint cards, and whether or not an interim permit is desired. California does its own credentialing, meaning that the candidate must submit an education breakdown form to their school that must be completed by the school and return directly to CA. Foreign licenses, on the other hand, may be verified by presenting a photocopy of the license. The education breakdown form requirement may be bypassed, since CA will accept a transcript validation (Request for Academic Records form) forwarded to them electronically from CGFNS. Clients verify credentials to CA from CGFNS in the same way that they verify CES’ or CGFNS certificates to state boards: via their online account and the option, ‘Additional Services.’

  • For nurses with NCLEX in other states, endorsement into California can be obtained with a very convenient system called the “walk-through”. It is of great assistance in light of the often six-month processing times for CA licenses. Simply complete the CA application and go to the Board in Sacramento for the walk-through, which will take about an hour. After obtaining a temporary permit that is valid for six (6) months, candidates will have time to get credentials reported and have their permanent license released. Temporary permits may be renewed only three (3) times.
 
Colorado: Accepts CES HP/S. Fees for Lic. by Exam: $84 (subject to change on July 1 of every year).

  • One prickly requirement for this state is that you must be in the US at the time of application. Many clients will be most successful in getting a US visitor visa if they secure their ATT and use it as evidence to apply for the visa. Colorado, however, requires that applicants be either US citizens, US Nationals abroad, or visitors on nonimmigrant visas. This means that a citizen of a foreign country who is applying for examination through this state would first have to secure her visitor visa and then apply to CO’s nursing board. Keep this in mind, as US embassies will most likely ask to see an ATT before issuing a visitor visa if taking the NCLEX is your client’s stated purpose for entering the US. Also keep in mind that CO’s requirement would make it impractical for your client to take the NCLEX in any non-US NCLEX site, unless the client wants for some reason to come to the US on a visa, get the ATT, and return to test at an NCLEX location abroad.
 
Connecticut: Accepts CP ONLY. No CGNFS documentation required for foreign-educated endorsement candidates. Fees for Lic. by Exam/Endorsement: $90/$90.

Florida: Accepts CES HP/S, ERES, IERF, and credentials reports produced by Josef Silny & Associates, Inc., International Education Consultants. Accepts CGFNS certificates ONLY for the purposes of verifying English scores. Requirements for direct reporting of TOEFL, TOEIC, IELTS, MELAB and ECPE scores waived, additionally, in the event that the RN has completed a college-level course for credit in a US institution or completed nursing education in an approved country. The list of these countries is quite extensive and can be found at http://www.doh.state.fl.us/mqa/nursing/nur_foreign.html. Fees for Lic. by Exam: $190.

  • In case of a fail on the NCLEX exam, the client must wait 45 days before re-applying. Three consecutive failures will necessitate completion of a remedial course before re-application.
 
Georgia: Accepts CP and CES HS/P (if supplemented by directly reported TOEFL). Fees for Lic. by Exam: $40. Eligibility valid for three (3) years. In case of NCLEX failure, candidates may take the NCLEX four times in one calendar year.

  • In addition to requirements for the CES/CP, Georgia’s Board requires that applicants complete the provided license verification forms and send them to licensing authorities abroad. Likewise, Georgia requires an official transcript from international nursing schools, though this information may be forwarded to them from CGFNS.
 
Idaho: Accepts CP or CES. Fees for Lic. by Exam: $90 plus $34 fingerprinting cost.

Illinois: Accepts CES HS/P and ERES in combination with the TOEFL. No other language exams accepted, and scores must be reported directly. The same applies to licensure by endorsement. Requires a background check, which may be waived for foreign applicants. Fees for Lic. by Exam/endorsement: $79/$50.

Iowa: Accepts ONLY CP. Submit the Request for Application by Examination form along and have CGFNS certificate verified to the Board and they will send you the full application. Applications will not be accepted without an SSN, so applicants taking the NCLEX abroad—before they have are issued the SSN—will not be able to obtain eligibility through this board. Fees for Lic. by Exam/Endorsement: $143/$119. Fee includes $50 background check.

Kansas: Accepts CES Full and IERF. Accepts only TOEFL. Fees for Lic. by Exam: $75.

Kentucky: Accepts ONLY VisaScreen. Fees for Lic. by Exam/Endorsement: $110/$174.

Louisiana: Accepts CP ONLY. Requires that English language exam scores be reported directly, though it does not specify which exam they will accept. Fees for Lic. by Exam: $100, plus $50 for fingerprinting.

Maine: Accepts CP or CES HS/P, but also requires separate reporting of nursing school and license credentials to ME. Provides credentialing forms that are similar to CGFNS’ validation forms. Requires photocopy of Social Security card before issuing eligibility, a policy which very prohibitive to most internationally-educated nurses who might apply for Licensure by Examination through this state. Fees for Lic. by Exam/Endorsement: $60/$60.

Maryland: Accepts CP, CES HS/P and VisaScreen. Website indicates that only the CES is accepted, but this information is incomplete. Spoken English exams must accompany the CP, and the IELTS and TOEFL iBT or TOEFL plus TSE must accompany the CES. Fees for Lic. by Exam: $75.

Massachusetts: Accepts CP and CES HS/P (when combined with TOEFL for non-English-educated nurses). Fees: $225 total (Foreign-educated plus general application fee). The foreign-educated application does not have to be re-submitted in the event that the candidate fails the NCLEX and needs to reapply, though the general application will need to be resubmitted.

  • Applications are processed by a third party, Professional Credential Services, Inc. (PCS), though applicants should request that their CES be reported to the Massachusetts Board of Nursing, and not to PCS.
  • Note that, for international nurses, two (2) applications must be submitted: an application specifically for international graduates and the general application for examination.
 
Michigan: Accepts the CP ONLY. If the CGFNS certificate is more than two years old, the applicants is required to give proof of active licensure in her home country. Keep that in mind, as nurses who have been in the country for months or who have resigned their positions may encounter problems with this requirement. Fee for Lic. by Exam: $48.

  • Applicants may take the NCLEX three (3) times in a 12-month period. If they do not pass within 12 months, they must complete a refresher course or exam review course. After completing this course, applicants will have three more chances to pass the exam. Applicants may take the NCLEX through Michigan ONLY six (6) times.
 
Minnesota: Accepts ONLY CES HS/P in combination with either TOEFL or IELTS (directly reported). Fees for Lic. by Exam: $105.

Mississippi: Accepts CP and CES HS/P. This board provides an Authorization to Release Information form, which will be of great help to recruiters/third parties. Fees for Lic. by Exam: $100.

Missouri: Accepts CP only. Requires the following additional items specifically for international graduates:
Fingerprinting (fee paid directly to the agency listed on their application form)
Copy of marriage certificate
Copy of original license abroad
Copy of birth certificate or passport
Fees for Lic. by Exam: $45.

Montana: Accepts CP. Fees for Lic. by Exam: $100.

New Hampshire: Accepts CP or CES Full. Applicants are required to submit a background check form to the NH Police Department. Fees for Lic. by Exam/Endorsement: $120/$120 plus $15 background check fee for both.

  • All nurses must have their nursing school confirm that they have completed 1080 hours of nursing theory and practice during their course of study.
  • Canadian nurses who passed the CNAT after August 1980 may have their Canadian licenses directly endorsed by NH.
 
New Jersey: Accepts CES Full in combination with TOEFL. Requires Criminal Background Check clearance (a form included in the application). Upon receipt of the application, fee, and Background Check form, the Board will mail the proper fingerprinting forms. Fees for Lic. by Exam: $220 (not including fingerprinting fees).

New Mexico: This state nursing board, along with Wisconsin’s board, are the only state boards which will issue an ATT eligibility without any CGFNS/third-party credentialing requirement. NM accepts a notarized photocopy of CGFNS certificate; it is not necessary to have the certificate verified directly from CGFNS. Also accepts notarized copy of CES HP/S. In lieu of either of these, NM will accept a translated, official transcript be sent from international applicants’ schools of nursing. This requirement makes taking the NCLEX through NM very easy for foreign-trained nurses, but be aware that most other states will require the completion of some kind of CGFNS credentialing before endorsing the NM license. Fees for Lic. by Exam: $110 plus $50 (transcript evaluation fee).

  • In case of a fail on the NCLEX exam, the client must wait 45 days before re-applying. If more than a year has passed since originally applying, clients are required to remit payment again ($31) for fingerprinting.
 
New York: Accepts ONLY the CGFNS service CVS (Credentials Evaluation for New York State). The CVS is a service very similar to the CES: applications may be submitted via mail or online, and nursing schools and licensing boards must report candidates’ credentials to CGFNS. The essential difference between the CVS and CES, however, is that CGFNS itself makes the request for academic/license records. Candidates complete these request forms and, instead of mailing them to the institutions in question, send them instead to CGFNS. CGFNS pays all fees for transcripts, etc, if any. The institutions have 6 months in which to report credentials; if they do not, CGFNS will wait an additional 45 days before simply forwarding the report to NY with a note of any deficiencies. NY will make the determination of whether or not they can issue an eligibility. In fact, the CVS serves only to verify the authenticity of documents: NY’s Board will review the report and may or may not issue an eligibility based on the received credentials. Thus, in contrast to the CES/CP, completing the CVS does not guarantee that the nursing credentials are acceptable or comparable to a first-level, general nurse.

CVS applications must be paid in full within 60 days after the order is made. As soon as the service is complete, CGFNS reports credentials directly to the NY Education Document, which will in turn inform both the client and Pearson Vue of NCLEX eligibility.

A note on CGFNS’ procedures regarding the CVS: Contrary to credentialing procedures for the CP/CES, credentials reported for use by another CGFNS service will not satisfy the credential requirements for the CVS. That is, license and transcript validations will not ‘transfer’ from the CP/CES to the CVS or vice-versa. Fees for CVS: $325; Lic. by Exam application fees for NY: $135.

Nebraska: Accepts only CP. Fees for Lic. by Exam range from $26 on even numbered years during the months of May-October, to $76-77 on odd-numbered years or even numbered years during the months of November-April. Accepts TOEFL and IELTS.

Nevada: Accepts CES without requiring complementary English language testing. Eligibility valid for one (1) years or two (2) NCLEX attempts, which means that re-application to the board is not necessary for re-examination (although client will need to re-register with Pearson Vue). It is extremely rare for boards not to require re-application after a failed exam. Fees for Lic. by Exam: $100.

North Carolina: Accepts CES HP/S (with supplemental TOEFL, IELTS or TOEIC scores) and CP. Candidates must either apply online or request that an application be mailed to them. Fees for Lic. by Exam: $70.

  • In case of a fail on the NCLEX exam, the client must wait 45 days before re-applying.
 
Ohio: Accepts CES Full in combination with the Test of Spoken English (TSE) ONLY. Background check is required, and Board must be contacted for the associated form. Fees for Lic. by Exam/Endorsement: $75/$75.

Oklahoma: Accepts CP and CES HP/S. English examination is required, but the board will accept photocopies of TOEFL, TOEIC or IELTS scores. Fees for Lic. by Exam: $125.

  • White-out on applications will render them void. Applications must be signed in the presence of a notary.
 
Oregon: Accepts CP, CES or VisaScreen. Fees for Lic. by Exam: $100. Accepts TOEFL, IELTS and TOEIC.

Pennsylvania: Accepts CP and requires that candidates also have nursing school credentials verified to the Board from CGFNS. Board policies on the mandatory reporting of SSNs for Licensure by Examination are very prohibitive to most internationally-educated nurses. Fees for Lic. by Exam: $135.

Rhode Island: Accepts CP ONLY for Licensure by Examination, though the CES will be accepted for endorsement candidates. BCI (background check requirement) waived automatically for foreign-trained applicants. Fees for Lic. By exam/Endorsement: $93.75/$93.75.

South Carolina: Accepts CES HP/S. Requires direct reporting of TOEFL. Fees for Lic. by Exam/Endorsement: $97/$114-124 (the latter if a temporary permit is desired).

  • Applicants must provide a photocopy of all foreign nursing licenses.
  • In case of a fail on the NCLEX exam, the client must wait 45 days before re-applying.
 
Tennessee: Accepts CP ONLY. The board’s stance on additional English language testing is that if they find “reasonable doubt” that an applicant can comprehend English, they may withhold the eligibility until further testing is complete. TN has an application specifically for international candidates, which may be ordered by submitting a request to them that contains candidate’s CGFNS id number.

Texas: Accepts only CES Full. ATT valid for 75 days. Fees for Lic. by Exam: $139. English exams for graduates on non-English nursing programs must directly report TOEFL or IELTS exam results.

  • In addition to requirements for the CES Full Report, Texas’ Board requires a separate report from all countries in which the RN was licensed. They provide a form for this license validation.
  • Foreign-trained RNs must show proof that they have worked for at least 24 months after graduation from their nursing program. Nurses who have not worked for at least 24 months as RNs in the past four (4) years must complete a Foreign Educated Nurse (FENS) refresher course totaling 120 classroom hours and 120 clinical hours under the supervision of a US RN.
  • White-out applied to any section of the application renders it invalid.
 
Utah: Requires CP or CES (though CES need not be supplemented by language exam). Fees for Lic. by Exam: $99, which is inclusive of BCI/FBI fingerprinting services.

Vermont: Accepts CES Full ONLY if applicant attended a nursing school in which the language of instruction was English. Applicants not educated in English must obtain and report a CGFNS certificate. Applicants with a CES must submit a transcript verification form to their school abroad. Fees for Lic. by Exam: $150.

  • Copy of applicant’s active nursing license is required.
  • In the case of a two failures on the NCLEX exam, candidates must complete an exam preparation or refresher course in order to receive a third eligibility.
 
Virginia: Accepts only the CP. Board policies on the mandatory reporting of SSNs for Licensure by Examination are very prohibitive to most internationally-educated nurses. Fees: $130.

Washington: Accepts only CP. In addition, WA requires that foreign nursing transcripts and licensure abroad are reported directly to them, as with CGFNS. They provide the forms for the reporting of these credentials. SSN also required for processing of the license application, which means that WA is an option only for those nurses who have already been issued an SSN. Fees for Lic. by Exam/Endorsement: $70/$70.

  • In case of a fail on the NCLEX exam, the client must wait 91 days before re-applying.
  • WA requires the completion of 7 hours of AIDS education before issuance of a license.
 
Wisconsin: Accepts CP, though this requirement will be waived if applicant has nursing school and licensing authority complete the two validation forms provided by the Board. In other words, this board will do its own credentialing in lieu of the CGFNS certificate. No other state board except for NM can match Wisconsin in terms of ease of securing an eligibility. Be aware, however, that most other states will require the completion of some kind of CGFNS credentialing before endorsing the WS license. Fees for Lic. by Exam: $110 plus $50 (transcript evaluation fee). Fees for Lic. by Exam: $68.

BREAKDOWN OF STATE REQUIREMENTS


States which require some form of fingerprinting: Arizona, Arkansas, California, Idaho, Iowa, Louisiana, Kentucky, Missouri, New Jersey, New Mexico, Nevada, Ohio, Texas and Utah.

States which require reporting of a Social Security Number [SSN]:
Colorado (eligibility granted without SSN, but physical license not mailed until it is reported.)
Florida (eligibility granted without SSN, but physical license not mailed until it is reported.)
Iowa (application for licensure will NOT be processed without SSN. Thus the VA board is an option only for nurses who have obtained an SSN i.e. by virtue of an F-visa.)
Maine (application for licensure will NOT be processed without photocopy of Social Security card. Thus the ME board is an option only for nurses who have obtained an SSN i.e. by virtue of an F-visa.)
Massachusetts (sworn affidavit allows applicants to simply report SSN once they have it. Eligibilities and physical licenses issued without it.)
Missouri (eligibility granted without SSN, but physical license not mailed until it is reported.)
New Hampshire (application for licensure will NOT be processed without SSN. Thus the PA board is an option only for nurses who have obtained an SSN i.e. by virtue of an F-visa.)
North Carolina (eligibility granted without SSN, but physical license not mailed until it is reported.)
Pennsylvania (application for licensure will NOT be processed without SSN. Thus the PA board is an option only for nurses who have obtained an SSN i.e. by virtue of an F-visa.)
Washington (eligibility granted without SSN, but physical license not mailed until it is reported.)
Virginia (application for licensure will NOT be processed without SSN. Thus the VA board is an option only for nurses who have obtained an SSN i.e. by virtue of an F-visa.)

A note on SSN requirements:

Of the state boards who do require a SSN for licensure, most of them make allowances for foreign nurses and will issue eligibilities, but not licenses, before applicants have secured a SSN. This allows for candidates to receive ATTs and complete the NCLEX requirement, but real problems may occur in the case of RNs who have a CES and try to obtain a VisaScreen (which must be brought to IV interviews). The complication arises due to the VisaScreen’s requirement for either passing NCLEX or CGFNS scores. The Florida state board of nursing, for one, has only one option for verification to CGFNS for the purposes of the VisaScreen, and that option is verification of license. A candidate who does not yet have a SSN does not yet have a license, and requesting that this board send a simple verification of the NCLEX score will be difficult and will involve coordination with a supervisor, a hand-written letter, etc. Be wary of the possible entanglement and, when dealing with Consular clients who have CES’, choose the state board of nursing with extreme care. Call as many boards as you can until you get solid confirmation that NCLEX scores, alone, may be reported to CGFNS separately from verification of the actual license. Also be aware that not all state boards will allow endorsement of a license that is pending due to lack of SSN. This is a less severe complication, as the solution to the problem of endorsement would be to simply wait to apply for a second state license until your client is on US soil and has their SS card in hand.
States which will issue eligibility without directly or indirectly requiring passing English exam scores: California, New Mexico, Nevada, Idaho, Utah, Colorado and New York.

States which have their own credentialing system and will accept, but do not require, completion of CGFNS services: New Mexico, Wisconsin.

Boards who accept Nursys® license verifications for the purpose of Licensure by Endorsement: Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Idaho, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia and Wisconsin.

National Licensure Compact (NLC) States: Nursing Boards which have implemented the NLC have a mutual agreement that allows a nurse licensed in a Compact State to practice across state lines without going through new credentialing processes or endorsements. The nurse must have primary residence in a state with membership in the NLC, and may practice only in another Compact state. The following states are members of the Compact: Arizona, Arkansas, Delaware, Idaho, Iowa, Maine, Maryland, Mississippi, Nebraska, New Hampshire, New Mexico, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia and Wisconsin. Colorado will enter the NLC in October 2007.

ACRONYMS AND IMPORTANT DEFINITIONS


ATT: Authorization to Test. Pearson Vue, the company which administers the NCLEX, e-mails ATT to candidates who have 1) registered on their system and paid the $200 fee, 2) have successfully applied to a state board of nursing and been issued an electronic “eligibility” to Pearson Vue by the Board. Candidates cannot schedule an NCLEX date without their ATT number, and will not be permitted into the exam center without the original ATT.

CP / Certification Program: once the most popular CGFNS service. Completion of the Certification Program (CGFNS exam plus English language exam) fulfills the exam requirement for permanent residency. The CP also fulfills many states boards’ requirements for issuing the letter of eligibility.

CGFNS: Commission on Graduates of Foreign Nursing Schools, an agency created in 1977 to assure “the integrity of healthcare professionals in the context of international migration.”

CES: Credentials Evaluation Service, a program run by CGFNS that is essentially the Certification program minus the CGFNS exam and language requirement. The CES judges candidates’ credentials so that state boards can objectively decide whether or not to issue an eligibility to test for the NCLEX.
HS/P: Healthcare Professional Course-by-Course Report, a type of CES report accepted by most boards of nursing which accept the CES.
Full: Full Education Course-by-Course report. Is a bit more extensive (and expensive) than HS/P.
CVS: the Credentials Evaluation Service for NY. Essentially identical to the CES, but for NY applicant for licensure by examination only.

Eligibility: once a nurse has applied to a state board of nursing and completed the requirements specific to that board, the board will send electronic eligibility to Pearson Vue in that client’s name. An eligibility combined with a candidate’s registration on Pearson Vue’s system results in an ATT e-mail about 48 hours after the eligibility is sent to Pearson.

ERES: Educational Records Evaluation Service, an alternative credentialing service used for the purposes of international nurse licensure by the nursing board in Texas.

FIS: Foundation on International Services, an alternative credentialing service used for the purposes of international nurse licensure. Accepted only by the Utah Board of Nursing.

IELTS: International English Language Testing System, a paper-based exam which awards candidates a score from 1-9 in the four focus areas of English fluency: speaking, listening, writing, and reading.

IERF: International Education Research Foundation, an alternative credentialing service used for the purposes of international nurse licensure by the nursing board in Texas.

Licensure by Endorsement/Reciprocity: the process of obtaining a second US license on the merits of having taken the NCLEX-RN and obtained an initial US state license. ONLY candidates who are licensed in a US state/territory may apply for licensure by endorsement, and ALL applications for licensure after the initial state licensure must be applications by endorsement. Thus, the National Council Licensure Examination (NCLEX) need not be taken again in order to endorse an initial license into another state, and any client who has not yet taken the NCLEX cannot endorse.

Licensure by Examination: the process of obtaining an initial US state license. Licensure by examination can be conferred only after successful completion of the NCLEX. A candidate’s first US license will always be secured via licensure by examination, and all other will always be secured by endorsement/reciprocity into other states.

NCLEX: National Council Licensure Examination, which is absolutely required by every US state board of nursing for licensure. All nurses, foreign-educated and US-educated, must take the exam before being issued any sort of US license. The NCLEX has two types: NCLEX-RN and NCLEX-PN (for practical nurses).

Nursys®: an electronic license verification system that allows for instant verification of certain US state licenses to other US states. This streamlines the endorsement process between two state boards which are both members of the system.

ROs: Recognising Organizations for the purposes of the IELTS. ROs can check candidate scores via an online system. Only state boards, external licensing agencies and governmental agencies may apply and be accepted as ROs.

TOEFL: Test of English as a Foreign Language, devised by the Educational Testing Service (ETS), which offers paper-based and internet-based English testing in speaking, listening, writing and reading.
TOEFL pBT: paper-based test, now being phased out except in a few last countries in which technology is a little behind.
TOEFL cBT: computer-based test, phased out with the 2006 roll out of the TOEFL iBT.
TOEFL iBT: internet-based test, which is the first ETS English exam to combine a speaking section with the reading, writing and listening sections.
TSE: Test of Spoken English, which complemented the TOEFL pBT and cBT before roll out of the iBT. The TSE is now offered abroad so that those candidates who have completed the pBT or cBT but cannot yet access the iBT may still complete the spoken English requirement of the VisaScreen. Basically, TSE + pBT = TOEFL ibt. And, TSE + pBT = IELTS.

VisaScreen: a CGFNS service required for immigration purposes. Fulfills section 212(a)(5)(C) of the Immigration and Nationality Act, as specified in Title 8, Code of Federal Regulations section 212.15(f) (RN).

WES: World Education Service, an alternative credentialing service accepted by the Florida Board of Nursing.


BY:

Patrick Curran, Director
Mary Helen Kennerly, Director, International Recruitment
Kennedy Healthcare Recruiting, Inc.
16 Center Street, Suite 211
Northampton, MA 01060
(413) 517-0063
www.kennedyhealthcare.com

Kennedy Healthcare Recruiting, Inc. is a full service international nurse recruiting firm.
 
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