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)