Transcultural Nursing Basic Certification Application - JotForm

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  • Transcultural Nursing Basic Certification Application Transcultural Nursing Basic Certification Application MANY CULTURES ONE WORLD
  • Applicant Information
  • Are you a current member of the Transcultural Nursing Society* YesNo
  • Name* PrefixFirst NameLast NameCredentials
  • Address* Street Address Street Address Line 2 CityState Zip Code Please Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country
  • Phone Number Country CodeArea CodePhone Number
  • Employer and Job Title*
  • Primary Contact Email For Communications from regarding this application* Confirmation EmailConfirm email address
  • Secondary Email Contact [email protected]
  • Birthdate* MonthDayYear

  • Eligibility Criteria

    To become certified, candidates must meet all five of the eligibility criteria listed below at the time of application.  Complete the application form, submit all fees, and successfully pass the certification examination with a score of 70% or higher.  No persons shall be excluded from the opportunity to participate in the Certification in Transcultural Nursing program on the basis of race, color, national origin, religion, sex, age, affiliation, or disability.  To be eligible to participate in the examination, all criteria listed below must be completed prior to the application being submitted.   

    Basic Level CTN (CTN-B) Criteria

    • 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.
    • Hold a diploma, an associate, or BSN degree from a program accredited by the Commission on the Collegiate of Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC) if the school is in the US; or legally recognized equivalent in another country.
    • Currently employed in nursing, either full- or part-time, at the time of application.
    • Completed at least one course (didactic and/or clinical) in cultural diversity and promotion of cultural competence for a minimum of 3 credits (or equivalent 42 Contact Hours).
    • Completed 2400 hours of transcultural nursing practice as a registered nurse in an administrative, teaching, research, or clinical capacity, either full- or part-time during the five years prior to submitting your application.

    Description of Practice

    The CTN-B practices in diverse settings including primary care, acute 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.

  • Application Criteria

    All five criteria below must be met in order to sit for the transcultural nursing basic certification exam.
  • 1. Do you 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?* YesNo
  • RN License State/Country*
  • RN License Number*
  • 2. Do you hold a a diploma, an associate, or BSN degree from a program accredited by the Commission on the Collegiate of 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?* YesNo
  • 3. Are you currently employed in nursing, either full- or part-time, at the time of application?* YesNo
  • 4. Have you completed at least one course (didactic and/or clinical) in cultural diversity and promotion of cultural competence for a minimum of 3 credits (or equivalent 42 Contact Hours).* YesNo
  • 5. Have you completed 2400 hours of transcultural nursing practice as a registered nurse in an administrative, teaching, research, or clinical capacity, either full- or part-time during the five years prior to submitting your application.* YesNo

  • Privacy Policy

    The Transcultural Nursing Society (“TCNS”) respects you and understands how important the privacy of your personal information is to you. We are committed to honoring your privacy. In addition, TCNS is committed to developing or utilizing technology that gives you the most powerful and secure online experience. Personal information collected by TCNS will only be used to conduct business with its members and will not be sold. TCNS will not share with others except as identified in our privacy policy. Use of our website, membership application forms, and event registrations indicates understanding and agreement with this policy. Read the full policy https://tcns.org/privacy-policy/ here. 

  • I agree to the privacy and communications policy of the Transcultural Nursing Society* YesNo

  • Testing Site Information

    Applicants may sit for the transcultural nursing society basic certification in either an in-person proctored testing site (University Testing Service) or in a proctored online testing environment (terms apply). In-Person certification examinations are administered by a computer-based testing system at various Consortium of College Testing Centers (CCTC) approved sites across the US and Canada. CCTC is a free referral service provided by the National College Testing Association (NCTA) to facilitate distance learning. For more information regarding testing standards, please go to:  http://www.ncta-testing.org/cctc/find.php If an NCTA testing site is not close to your location please contact us.  We will be happy to help you make arrangements to take the exam at a formal testing site (University based or testing service) closer to your location.  All costs associated with the testing site/service are the responsibility of the applicant.
  • What type of testing environment do you wish to use? In-person exam at a testing center in a local area? Please complete field below for in-person location.Online proctored testing, please provide details
  • Name of In-Person Testing Location:
  • Testing Location Address Street Address Street Address Line 2 CityState / Province Postal / Zip Code Please Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country
  • Name of Testing Site Contact:
  • Testing Site Contact Email [email protected]
  • Proposed Date and Time Examination (Please use the Easter Time Zone for your time selection)* Examination dates must be at least five weeks from the examination date and no more than eight weeks.
  • Do you require any special accommodations for your exam?* YesNo
  • If yes, please described
  • Do you agree to follow all testing location policy and procedures?* YesNo
  • Please verify that you are human*

  • 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)

    (MY SIGNATURE) INDICATES THAT I HAVE DOCUMENTED EVIDENCE AND WILL SUBMIT IT AS REQUIRED IN A  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 IDENTIFIED.

  • Application Signature* Clear
  • Select Certification Type for Payment prevnext( X ) Current Member of The Transcultural Nursing SocietyCurrent Member of the Transcultural Nursing Society$325.00    Non-Member of the Transcultural Nursing Society$450.00    Total $0.00

    Payment Methods

    creditcardCredit Card Apple Pay After submitting the form, you will be redirected to Apple Pay to complete the payment. Google Pay After submitting the form, you will be redirected to Google Pay to complete the payment. Cash App Pay After submitting the form, you will be redirected to Cash App Pay to complete the payment.
  •  PrintPrint and Mail FormProcess Payment Now Clear Form
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