APRN Education Verification Submission

To avoid processing delays, please ensure the form is submitted exactly as provided. Forms will not be processed if they are incomplete, incorrect, or altered. Submitting the form in its original, fillable format helps ensure accurate and timely processing.

MavID
Last Name

Please be sure this matches your transcript.
First Name
Term Graduated

SP- Spring
FA- Fall
SU- Summer
Year Graduated
Must be a number between 1970 and 2030
Maiden Name

Maiden Name NA Other Other
APRN- Nurse Practitioner Program

APRN- Nurse Practitioner Program AGACNP AGPCNP FNP PACNP PPCNP NNP PMHNP DUAL DUAL

POST-Baccalaureate Clinical Track
Email Address

Alumni- please provide personal email.
Current students- please provide your UTA email. We will NOT send communication to personal emails to ENROLLED students.
What is your degree level?

What is your degree level? MSN POST MASTERS CERT
What state are you making a request for?

What state are you making a request for? TX OTHER
I verify:

I verify: My form(s) is/are not blank This is NOT an ANCC form My signature is included where indicated This is my only request within the last 14 days I am the individual making this request; third-party submissions are not permitted
Upload form here

Attach Files

PDF files only
Form should not be blank
Include your signature