Transcultural Nursing Basic Certification Application (CTN-B)

	Transcultural Nursing Basic Certification Application (CTN-B)
Date:
Transcultural Nursing Society(TCNS) Member:
TCNS Member Number:
NAME:
JOB TITLE:
ORGANIZATION:
HOME ADDRESS LINE 1:
HOME ADDRESS LINE 2:
CITY:
STATE/PROVINCE:
COUNTRY:
ZIP:
PRIMARY PHONE:
EMAIL: Required
ALTERNATE PHONE:
DATE OF BIRTH:
LAST FOUR SOCIAL SECURTY NUMBER:

I. BASIC ELIGIBILITY CRITERIA: Applicant must meet ALL FIVE of the criteria listed below. Please select yes or no to indicate if you meet each criteria listed below and provide any additional information requested. Each of the criteria listed below must have been met prior to applying for certification.
	1. Hold a current, active, unrestricted RN License in a state or territory of the United States or the professional, legally recognized equivalent in another country. PLEASE SUPPLY INFORMATION BELOW.
	STATE:	COUNTRY:	LICENSE NUMBER:

	2. Hold a diploma, an Associate, or BSN degree from a program accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC if school is in the US; or legally recognized equivalent in another country).

	3. Currently employed or self-employed in nursing, either full or part time, at the time of application.

	4. Completed at least one course (didactic and/or clinical) in cultural diversity and promotion of cultural competence with a minimum of 3 credits. (Equivalent of 42 Nursing Contact Hours/Units will also be accepted)

	5. Completed 2400 hours of transcultural nursing practice as a registered nurse in administrative, teaching, research, or clinical capacity, either full or part time within the previous five years. Description of practice: The CTN applicant may practice in diverse settings including primary care, community settings/rural/remote area nursing, and long-term care across the life span and is actively engaged in education (e.g. patient, staff, students, and colleagues), case management, clinical practice, consultation, research, and/or administration.

BASIC CERTIFICATION IN TRANSCULTURAL NURSING IS ACHIEVED BY NURSES WHO PASS AN EXAMINATION BASED ON THE CONTENT OUTLINE AND REFERENCE LIST PROVIDED IN THE EXAM GUIDE. I ATTEST THAT I WILL SUBMIT A PORTFOLIO OF EVIDENCE THAT SUPPORTS THE CRITERIA INDICATED ABOVE. (IF REQUIRED BY RANDOM AUDIT BY THE TRANSCULTURAL NURSING CERTIFICATION COMMISSION)

TYPING MY NAME IN THE BOX BELOW (MY SIGNATURE) INDICATES THAT I HAVE DOCUMENTED EVIDENCE AND WILL SUBMIT TO ANY RANDOM AUDIT AND THAT I AGREE TO FOLLOW ALL REQUIREMENTS AND POLICIES OF THE TRANSCULTURAL NURSING CERTIFICATION COMMISSION. I AM AWARE THAT THE TRANSCULTURAL NURSING CERTIFICATION COMMISSION MAY ANALYZE ALL DATA RECEIVED FROM THIS PROCESS/EXAM AND THAT IT WILL BE AGGREGATED SO THAT NO INDIVIDUAL CAN BE INDENTIFIED.

SIGNATURE:

TESTING SITE INFORMATION
You may select a testing site from the National College Testing Association sites http://www.ncta-testing.org/cctc/find.php . If you would like to test at another testing service or university based testing site please supply the contact information below and we will attempt to get the site approved for your exam. For more information on selecting an alternate testing site, please email Lisa Dobson at ldobson@tcns.org .
Name of Testing Site:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
Proposed Testing Date/Time: Exams are available Monday through Saturday 9am -4pm Eastern Time Zone. If needed a special time can be arranged. Email: Lisa Dobson: ldobson@tcns.org

Testing Site Contact Name:
Phone:
Email:

	1. Please select yes or no if you require special accommodations be made for your exam. Email documentation supporting your needs to Lisa Dobson at ldobson@tcns.org .

	2. Please select yes or no to indicate if testing site chosen is a member of the National College Testing Association sites http://www.ncta-testing.org/cctc/find.php .

	3. Please select yes or no to indicate that you agree to follow all testing site guidelines and exam guidelines as listed in the Transcultural Nursing Certification Exam Guide.

PAYMENT INFORMATION: Please check the appropriate payment amount and then click continue to review your application.
	$300 US DOLLARS FOR CURRENT MEMBERS OF THE TRANSCULTURAL NURSING SOCIETY
	$400 US DOLLARS FOR NON-MEMBERS

Click here to review your application before submitting and continuing on to the payment section:

Transcultural Nursing Basic Certification Application (CTN-B)

TESTING SITE INFORMATION