Application: Credentials Evaluation
Service (CES) 3386536
CGFNS International, Inc. | 3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651 USA | +1 (215) 222-8454 | www.cgfns.org
(FOR YOUR RECORDS ONLY!) The following information is what was provided in the online application
process. If you need to make changes go to Applicant Options-> Order Status and click on "Edit Application
Data".
opy
I – Application Summary
3386536
CGFNS Id Number:
7544116
Program:
Credentials Evaluation Service (CES)
Service:
CES Professional Report Application
Created:
October 19, 2020 02:30:32 am
Submission Date:
October 19, 2020
Total Cost:
$ 365
Desired Profession:
REGISTERED NURSE
Status:
WAITING FOR REQUIRED ITEMS
Expiration Date:
October 19, 2021
nt c
Order Number:
Completed Date:
October 19, 2020 02:36:02 am
lica
Last Updated:
II – User Information - CGFNS Connect Login Credentials
User Key:
Username:
Password:
samjhana.nclex@gmail.com
yr*********sq
October 07, 2020 02:19:53 am
App
Created:
1449907
Last Updated:
October 19, 2020 02:32:48 am
III – Personal Information
Personal Information Key:
1246045
Name (First | Middle| Last | Suffix):
Samjhana | | Sherpa
Date of Birth:
October 7, 1993
Other Name(s):
Email Address:
samjhana.nclex@gmail.com
Text Message Number:
Can Receive Text Messages:
N/A
Sex:
Female
Marital Status:
Single (Never Married)
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 1 of 11
©2020 CGFNS International, Inc. All rights reserved
Country of Birth:
Nepal
Current Citizenship(s):
First Language:
NEPALI
Languages You Speak Fluently:
Languages You Write Fluently:
Passport(s):
Created:
October 07, 2020 02:19:53 am
Last Updated:
October 19, 2020 02:36:02 am
Has Background Check:
Background Check Agency:
IV - Marketing Information (As Applicable)
Marketing Key:
Receive CGFNS News Updates:
Yes
Intended US State of Practice:
N
Affiliated with Recruiter:
N/A
Recruiter Paid for Service:
N/A
Last Worked County:
Last Worked City:
Last Worked Profession:
Referral:
lica
Last Worked Duration (years):
nt c
Has a United States Social Security Number?:
opy
Background Check Date:
CGFNS may Discuss Transition:
N/A
V- Nurses Only Information (Visa Screen service only)
App
Nurses Only Key:
Occupational Visa Selection:
Passed NCLEX-RN Exam:
N/A
Passed NCLEX-PN Exam:
N/A
Passed SBTPE Exam:
N/A
Passed CGFNS Qualifying Exam:
N/A
VI – Recipients Overview (CES / CAP / eDas services only)
Recipient Key:
647292
Recipient / Organization Name:
COLORADO BOARD OF NURSING
Purpose:
Licensure
Profession:
REGISTERED NURSE
Passed NCLEX:
N/A
English Proficiency:
No
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 2 of 11
©2020 CGFNS International, Inc. All rights reserved
Type:
Country:
United States of America
Contact Name:
ROBERTA HILL
Title:
NURSE EDUCATION SPECIALIST
Street Address 1:
Street Address 2:
State / Province:
Postal Code:
Created:
October 19, 2020 02:30:32 am
Last Updated:
October 19, 2020 02:31:00 am
VII – Contact Information - Mailing Addresses
1250303
Address Type:
Applicant Mailing Address - Preferred
Country:
Nepal
Street Address 1:
Block 'D' 2nd floor, New Baneshwor Plaza
Street Address 2:
New Baneshwor
Street Address 3:
P. O. Box:
Postal Code:
Created:
Last Updated:
Mailing Address Key:
Address Type:
Country:
Street Address 1:
Street Address 2:
Street Address 3:
P. O. Box:
City:
44600
October 07, 2020 03:46:58 am
1250304
Alternate Address
Nepal
Block 'D' 2nd floor, New Baneshwor Plaza
New Baneshwor
Kathmandu
App
State / Province:
Kathmandu
nt c
State / Province:
lica
City:
opy
Mailing Address Key:
Postal Code:
44600
Created:
October 07, 2020 03:46:58 am
Last Updated:
Mailing Address Key:
Address Type:
- Recruiter
Country:
Nepal
Street Address 1:
Block 'D' 2nd floor, New Baneshwor Plaza
Street Address 2:
New Baneshwor
Street Address 3:
P. O. Box:
City:
Kathmandu
State / Province:
Postal Code:
44600
Created:
October 07, 2020 03:46:58 am
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 3 of 11
©2020 CGFNS International, Inc. All rights reserved
Last Updated:
VIII – Contact Information - Telephone Numbers
Telephone Number Key:
1066115
Phone Type:
HOME
Phone Number:
(977) 9813782122
Created:
October 07, 2020 03:46:58 am
Last Updated:
opy
IX – Education Overview
School Key:
1969572
Type of School:
Primary and Lower Secondary Education
Country:
Nepal
School Name:
Shree Pragati Higher Secandary School
Street Address:
Pashupatinagar 9, Hetauda
State / Province:
Postal Code:
Professional Title of Degree Obtained:
nt c
PO Box:
Earned Diploma / Degree:
Yes
Name of Diploma Certificate:
Lower Secondary Education
Name When Attending:
April 1999
Date Completed:
March 2006
School Closed or Merged:
Name of New School:
Created:
Last Updated:
School Key:
No
October 07, 2020 03:46:58 am
1969571
Higher Secondary Education
App
Type of School:
lica
Date Admitted:
Country:
Nepal
School Name:
Shree Pragati Higher Secendary School
Street Address:
Pashupatinagar 9, Hetauda
PO Box:
State / Province:
Postal Code:
Professional Title of Degree Obtained:
Earned Diploma / Degree:
Yes
Name of Diploma Certificate:
School Leaving Certificate
Name When Attending:
Date Admitted:
April 2006
Date Completed:
March 2009
School Closed or Merged:
No
Name of New School:
Created:
October 07, 2020 03:46:58 am
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 4 of 11
©2020 CGFNS International, Inc. All rights reserved
Last Updated:
School Key:
1969569
Type of School:
Tertiary Professional (Healthcare) Education
Country:
Nepal
School Name:
NATIONAL MEDICAL COLLEGE NURSING CAMPUS
Street Address:
Office of the Principal
PO Box:
Office of the Principal
State / Province:
Postal Code:
Earned Diploma / Degree:
Yes
Name of Diploma Certificate:
Proficiency certificate level
Name When Attending:
-1
Date Admitted:
November 2009
Date Completed:
October 2012
School Closed or Merged:
No
Name of New School:
Created:
October 07, 2020 03:46:58 am
nt c
Last Updated:
opy
Professional Title of Degree Obtained:
School Key:
1969570
Type of School:
Tertiary Professional (Healthcare) Education
Country:
Nepal
School Name:
NEPALESE ARMY INSTITUTE OF HEALTH SCIENCES
Street Address:
COLLEGE OF NURSING
PO Box:
COLLEGE OF NURSING
Postal Code:
lica
State / Province:
Professional Title of Degree Obtained:
Earned Diploma / Degree:
Yes
Name of Diploma Certificate:
Post Basic Bachelor of Nursing (PBBN)
Name When Attending:
-1
Date Admitted:
November 2015
December 2018
App
Date Completed:
School Closed or Merged:
No
Name of New School:
Created:
October 07, 2020 03:46:58 am
Last Updated:
X – Licenses Overview
Not License Explanation:
License Key:
1348315
Country:
Nepal
State / Province:
Professional Title:
Registered Nurse
Lifetime Practice:
Yes
License Issued Date:
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 5 of 11
©2020 CGFNS International, Inc. All rights reserved
License Expiration Date
License Number:
21934
Name when License Issued:
Diploma Give Right to Practice:
N/A
Diploma Number:
License By:
NATIONAL/PROVINCAL/STATE EXAM
License Status:
ACTIVE
Country Require License Registration:
N/A
Created:
October 07, 2020 03:46:58 am
Last Updated:
October 09, 2020 04:59:01 pm
opy
License Restriction Explanation:
XI - Professional Employment Overview (CAP Service Only)
No Employment Explanation:
340400
Employer Name:
National Medical college and teaching hospital
Country:
Nepal
Street Address 1:
Parsa
nt c
Employer Key:
PO Box:
Street Address2:
City:
Parsa
Postal Code:
Supervisor Name:
Supervisor Title:
Job Title or Position Held:
Employment Started:
Still Employed:
Dr S.N. Singh
Acting prinipal
Staff Nurse
February 01, 2013
No
November 01, 2015
App
Employment Ended:
lica
State / Province:
Name When Employed:
Samjhana Sherpa
Language Spoken at Work:
Language Patient Population:
NEPALI
Created:
October 07, 2020 03:46:58 am
Last Updated:
Employer Key:
340399
Employer Name:
Nidan Hospital PVT.LIT
Country:
Nepal
Street Address 1:
Pulchowk
PO Box:
Street Address2:
City:
Lalitpur
State / Province:
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 6 of 11
©2020 CGFNS International, Inc. All rights reserved
Postal Code:
44700
Supervisor Name:
Shanti Maharjan
Supervisor Title:
Nursing Inharge
Job Title or Position Held:
Staff Nurse
Employment Started:
January 01, 2019
Still Employed:
Yes
Employment Ended:
Name When Employed:
Samjhana Sherpa
Language Spoken at Work:
Language Patient Population:
NEPALI
Created:
October 07, 2020 03:46:58 am
opy
Last Updated:
XII - Specialty Education Information (CAP service only)
nt c
No Continue Education Explanation:
XIII - Test Information (CES / CP services only)
Selected Credential Key:
Category:
Name:
Type:
1916764
License
Nepal - 21934 - #1348315
Registered Nurse
October 19, 2020 02:30:32 am
App
Created:
lica
XIV - Selected Credentials (CES / CAP / eDas)
Last Updated:
Selected Credential Key:
1916767
Category:
Transcript
Name:
Shree Pragati Higher Secendary School April 2006 - March 2009 #1969571
Type:
SECONDARY
Created:
October 19, 2020 02:30:32 am
Last Updated:
Selected Credential Key:
1916765
Category:
Transcript
Name:
NATIONAL MEDICAL COLLEGE NURSING CAMPUS November 2009 - October 2012 #1969569
Type:
PROFESSIONAL
Created:
October 19, 2020 02:30:32 am
Last Updated:
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 7 of 11
©2020 CGFNS International, Inc. All rights reserved
Selected Credential Key:
1916766
Category:
Transcript
Name:
NEPALESE ARMY INSTITUTE OF HEALTH SCIENCES November 2015 - December 2018
#1969570
Type:
PROFESSIONAL
Created:
October 19, 2020 02:30:32 am
Last Updated:
XV - Attestation
XVI - Terms
lica
nt c
opy
I agree to the Terms and Conditions of the CGFNS services and programs.
I certify that all information which CGFNS International has received as part of this order or in the past, from me or from a third party on my behalf is true
and complete.
I also certify that all documents which have been submitted to CGFNS for any purpose have not been falsified, altered or tampered with by any person.
I understand that CGFNS and others will rely on this order and on the documents and information submitted, and that if any of it is falsified, altered or
tampered with, or if I alter a CGFNS Certificate or a CGFNS Report or misrepresent a copy as an original, CGFNS may take such disciplinary action
against me as it deems appropriate including bar me from future examinations or from participation in any CGFNS programs. The consequences could
adversely affect my professional license, immigration status, employment and other matters, from which I release CGFNS from all liability.
I authorize CGFNS to disclose the information and documents in this order, the status of my CGFNS Certificate, any Reports or evaluations prepared by
CGFNS, any other information obtained by CGFNS and the results and reasons for any adverse action taken against me by CGFNS, to any person or
organization I designate in writing or to any other recipient which CGFNS may determine has a legitimate interest in receiving the same, such as
government agencies or potential employers.
I understand that unauthorized use of test materials, giving or receiving aid during an examination, or violating instructions at the examination site may
be grounds to expel me from the examination, or bar me from future examinations or from participation in any CGFNS programs, or to otherwise
discipline me as appropriate.
Applicants should refuse any requests by third parties, i.e. friends, recruiters or employers to memorize questions or give them details regarding the
content of the tests. Such activities will result in the applicant's test being voided and may prevent them from being eligible for all future exams.
In addition, I authorize the board of nursing of the state in which I take the licensing examination in the future to release my NCLEX-RN results to
CGFNS for statistical studies.
I also agree to send CGFNS my NCLEX-RN results.
I understand that the CGFNS Certificate and all copies of it remain the property of CGFNS and must be returned to CGFNS if CGFNS determines that
the holder of the certificate was not eligible to receive it or that it was otherwise issued in error.
In submitting this order electronically, I affirm that by selecting the appropriate button below, my electronic signature is intended to be legally binding.
App
Please note that before CGFNS can complete the review of an applicant's file we must receive full payment and all the necessary documents. This
includes all documents that are to be submitted by the applicant themselves as well as the documents which are to come directly to CGFNS from
schools, licensing authorities and testing agencies. It is the applicant's responsibility to provide the appropriate authorization forms that will enable
CGFNS to obtain educational transcripts and license validations. CGFNS makes every effort to promptly complete the review of a file, however, the
greatest delays in reviewing a file are often the result of not receiving an applicant's documents in a timely manner. With this in mind, as well as the
complexity of certain applicants' particular situations, some services may take a matter of weeks to complete, while others may take several months to
complete.
Terms and Conditions of the CGFNS services and programs
You may use this online service 24 hours a day, seven days a week to check the status of your order as well as the status of your required documents.
CGFNS may choose to authenticate / evaluate only the materials that it considers relevant for this program or service.
All documents submitted, including transcripts, become the property of CGFNS and cannot be returned to you. Do not send originals of diplomas,
degrees, certificates, registrations or licenses.
No verification / evaluation is conducted until CGFNS receives a completed application and full payment. Please calculate the payment correctly and
include payment with each Application or request for a service. Please refer to the Fees Schedule.
All Certificates are valid only when the official (embossed) CGFNS seal is affixed and as applicable, until the expiration date.
All Reports are valid only when there is an official document water mark.
All Reports issued to U.S. State Boards of Nursing are accessed online directly by the Boards of Nursing. An applicant copy of the report is located in
your online account and will be available for one year from when the report was first issued. Non-State Board of Nursing recipients are sent via First
Class mail (within the U.S.) or airmail (outside of the U.S.).
If your application includes any forged, altered, or falsified documents or information, CGFNS will not issue a Certificate or issue an evaluation report,
and no refund is issued.
Fees as published are subject to change. Please refer to the Fees Schedule.
Any payment you send to CGFNS will be applied first to any unpaid balance from previous orders before it is applied as payment for a newer application
or service.
NO refund is given after an application is submitted.
All applications are subject to pre-determined expiration dates. Applicants who do not meet the requirements of a program within the expiration date of
their order may have the opportunity to continue the application within 12 months after expiration by applying to Re-Process and paying the associated
fee.
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 8 of 11
©2020 CGFNS International, Inc. All rights reserved
App
lica
nt c
opy
XVII -Photo
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 9 of 11
©2020 CGFNS International, Inc. All rights reserved
XVIII –Advocate OR Family
XIV –Explanations
opy
CGFNS Connect - All Time History Summary
Snapshot I – Correspondence History (Emails / Letters)
Description
Custom tailored email CGFNS International Welcome to the
Credential Evaluation Service - Employee: SYSTEM
GENERATED
Snapshot II – Order History
Order Date
Order Detail
October 19, 2020
Credentials Evaluation Service (CES)
CES Professional Report Application
REGISTERED NURSE
lica
Order
Number
3386536
Order
3386536 CES Professional Report Application
Credentials Evaluation Service (CES)
nt c
Date Sent
October 19,
2020
Status
Expiring
WAITING
FOR
REQUIRED
ITEMS
October
2021
Key
9683012
Completed
Submitted
Yes
App
Snapshot III – Order Requirements
Order Number
3386536
3386536
3386536
3386536
3386536
3386536
3386536
3386536
Requirement
SECONDARY SCHOOL DIPLOMA - Shree Pragati Higher Secendary
School April 2006 - March 2009
LICENSE VALIDATION FORM - Nepal Nursing Council 21934
TRANSCRIPT VALIDATION FORM - NATIONAL MEDICAL COLLEGE
NURSING CAMPUS November 2009 - October 2012
TRANSCRIPT VALIDATION FORM - NEPALESE ARMY INSTITUTE OF
HEALTH SCIENCES November 2015 - December 2018
APPLICATION
SIGNED ATTESTATION
ISSUED REPORT
PAYMENT IN FULL
Status
Waiting for Initial Documentation
Key
7130184
Waiting for Initial Documentation
Waiting for Initial Documentation
7130178
7130179
Waiting for Initial Documentation
7130180
Ready for Evaluation
Ready for Evaluation
Waiting For Approval
Paid in Full
7130181
7130182
7130185
7130183
Snapshot IV – Account Balance
Date
October 19, 2020
Order
3386536
Amount
$ 365
October 19, 2020
3386536
$ -365
Transaction
Fee CREDENTIAL EVALUATION
SERVICE PROFESSIONAL REPORT
Payment
Payment
Keys
2567823
VISA 365 CENTER XXXX-XXXX-XXXX-
2567824
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 10 of 11
©2020 CGFNS International, Inc. All rights reserved
Date
Order
Amount
Transaction
Payment
6536 May 2022 1104739
Keys
Snapshot V – eSaved - Storage for Authenticated and Verified Electronic Documents
Your documents are scheduled to be deleted on October 19, 2024. The eSAVED service can extend the
electronic storage of your documents, if purchased before the date your documents are scheduled to be
deleted.
Scanned
Category
Description
Form
Key
Barcode
Additional Barcodes Codes (For Internal CGFNS Official Use Only)
opy
For CGFNS Internal Use Only
Internal Code
App
lica
nt c
let9683012, log9689565, log9735132, log9735133,
Questions?: Contact CGFNS International at +1 (215) 222-8454 Monday through Friday from 9:30 am to 3:00 pm (EST).
Samjhana Sherpa | Order #:o3386536 | October 19, 2020 | Rev E:Nov. 2019 | Page 11 of 11
©2020 CGFNS International, Inc. All rights reserved