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Verification of Theory and Clinical Instruction Form - CT.gov 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your name and social security number in the designated fields at the top of the form.
- Fill in the name of your school and country, followed by the enrollment dates indicating when you started and completed your program.
- In the section for educational institutions, ensure that the total months and hours of your practical nursing program are accurately recorded, including supervised direct client care experiences.
- Indicate whether you received a degree, diploma, or certificate in nursing by selecting 'Yes' or 'No'. If applicable, provide an explanation if you did not complete the program in good standing.
- Finally, have an authorized representative from your educational institution sign and date the form, along with their contact information.
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