National League for Nursing – Achievement Test Application Form
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Name: Last, First, M.I. |
Today's Date |
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_________________________ |
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Street Address |
Social Security # |
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_________________________ |
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City, State, Zip |
RN License # &
Expiration Date |
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_________________________ |
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Phone #: Day & Evening |
Date of Admission to UMB |
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Email Address |
Institution (if not UMB) |
Note: There is no application fee, simply calculate and submit payment for
cost of the exam(s) you choose.
Topic Offered |
# Credits |
Price |
Select/Fill-In Testing Date & Time |
Anatomy & Physiology I & II |
8 credits |
$50 |
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Microbiology |
4 credits |
$50 |
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| Diet Therapy and Applied Nutrition | 3 credits | $50 | |
Pharmacology |
3 credits |
$50 |
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Scheduled Examination Dates
| Exam Dates | Last date to Register | Exam Dates | Last date to Register |
| 4/4/2007 | Tuesday, August 21, 2007 | 08/03/2007 | |
| Tuesday, May 22, 2007 | 5/4/2007 | Tuesday, September 25, 2007 | 09/04/2007 |
| Tuesday, June 19, 2007 | 6/1/2007 | Tuesday, October 30, 2007 | 10/03/2007 |
| Tuesday, July 24, 2007 | 7/6/2007 | Tuesday, November 20, 2007 | 11/01/2007 |
DECLARATION OF AGREEMENT:
I ___________________________________________
the undersigned, agree to all the conditions outlined above regarding the
registration of any NLN Achievement Test.
I understand it is solely my responsibility to be ready for the examination
on the date/s and time/s I have indicated on the application form. I understand
that the fee for the NLN Achievement test is non-refundable in the event that
I am not present on the day and time of the examination for which I am registering.
_________________________________________ ______ Date: ________________
Signature of NLN candidate
The
completed application form, payment, and copy of current RN license must be
submitted in person or by mail to the NLN Test Coordinator. Your
registration cannot be completed without all of the above mentioned documents. Payment must be made in the
form of a money order or certified
check. No personal checks will be accepted. Please make out certified check or money order to: UMass Boston/NLN Testing Service.
| Mail to: Kristen Carlson,
NLN Test Coordinator, UMass Boston: CNHS Science, 100 Morrissey Blvd.
Boston, MA 02125. Application must be received no later than |