This document is an application form for the National Licensure Examination for Nurses (NLEN) in Nepal. It requests personal information about the applicant such as name, date of birth, address, and contact details. It also asks for information about the applicant's professional nursing education, including the name and address of the nursing school attended, the dates of entry and graduation, and the type of nursing program (e.g. Proficiency Certificate Level, Bachelor of Science in Nursing). The applicant must sign and date the form, and attach additional required documents as specified in the NLEN Test Guideline.

1. Examination Committee
Nepal Nursing Council
Dhumbarahi, Kathmandu
APPLICATION FORM FOR NATIONAL LICENSURE EXAMINATION FOR NURSES (NLEN)
Please fill up in CAPITAL LETTER in English or Type.
A. PERSONAL INFORAMTION
1. Full name of Applicant:
2. Father’s name:
3. Mother’s name:
4. Nationality:
5. Date of Birth: / /
Day Month Year
6. Completed age: year
7. Permanent Address:
District Zone
VDC / Municipality Ward No.
8. Temporary Address:
Telephone number: (Home) (Mobile)
E-mail address (if available):
Affix
applicant
photo
B. PROFESSIONAL EDUCATION
1． Name of Nursing School / Institute：
2． Address:
３．Telephone number:
４．Type of Program(Give tick  into the box  or specify it.)
 Proficiency Certificate Level of nursing (P.C.L.) in Nepal
 Bachelor Science in Nursing (B.Sc. N.)in Nepal
 Other: (country)
(program)
Date of Entry: / /
Day Month Year
Date of Graduation: / /
Day Month Year
Received by:
Name of NNC Staff : Signature of applicant:
Date : Date :
Note: Attach the documents as prescribed in Test Guideline (NLEN)