APRN Education Verification Submission

We want to help ensure your request is processed without delay, please ensure the form is submitted in its original, fillable format.

For available state forms please see our website: https://www.uta.edu/academics/schools-colleges/conhi/academics/grad-nursing/aprn-verification/bon-education

DATE ALUMNI SUBMITTED TO BON (INTERNAL ONLY) DATE ALUMNI SUBMITTED TO BON (INTERNAL ONLY) / MM / DD YYYY
MavID
Must be 10 digits. Currently Entered: 0 digits.
Last Name

(please enter it exactly as it appears on your transcript so we can match your records)
First Name

(please enter it exactly as it appears on your transcript so we can match your records)
Please select the term that matches your official conferral date.

SP- May conferral date
FA- Dec conferral date
SU- Aug conferral date
Year Graduated
Must be a number between 1970 and 2030
Select the program that best matches your specialization.

Select the program that best matches your specialization. AGACNP AGPCNP FNP PACNP PPCNP NNP PMHNP DUAL DUAL

POST-Baccalaureate Clinical Track
Email Address

Alumni: Please provide your personal email so we can stay in touch regarding your request.
Current students: Please use your UTA email address so we can ensure you receive all communications securely and without delay. At this time, messages for enrolled students are sent only to UTA email accounts.
What is your degree level?

What is your degree level? MASTERS OF SCIENCE, NURSING POST MASTERS CERT

***Our office does NOT process requests for BSN, undergraduates. This site is for Nurse Practitioners who have earned a MSN or Post Masters Certification***
What state are you submitting this request for?

What state are you submitting this request for? Arizona California Florida Louisiana Minnesota New Mexico New York Pennsylvania Texas Other Other
Before submitting, please review the following to help avoid delays:

Before submitting, please review the following to help avoid delays: My form(s) are complete This is not an ANCC form My signature is included where required I understand that incomplete or duplicate forms may delay processing
Upload completed PDF here

Attach Files

Form should not be blank
Include your signature
Form should be fillable
Comments
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