How to Complete and Submit California’s PHN Academic Program Verification Form

The PHN Academic Program Verification form is a two-part document in your California Public Health Nurse certification application: you complete Section A with your personal and school details, then route the form to your nursing program, which completes Section B to confirm your enrollment dates and degree. The California Board of Registered Nursing (BRN) uses the finished form, together with an official transcript sent separately by your school, to verify you meet the education requirements for PHN certification.¹

What You Fill Out in Section A

Section A is yours. The fields are simple, but the BRN’s instructions warn in bold that any missing information causes the application to be returned as incomplete, so treat every blank as required.¹

Full legal name (last, first, middle), plus any previous names such as a maiden name or prior married name.
Mailing address: street, city, state, ZIP.
Social Security Number or ITIN. Disclosure is mandatory under Business and Professions Code Section 30 and federal law; the BRN will not process the form without it.
Date of birth.
Home and work phone numbers.
Full name of the nursing school you attended (BSN, entry-level MSN, or specialized PHN program).
Years attended, start to end.
School location: city, state, and country if outside the United States.
Year graduated.
Your signature and date.

Use the exact name that appears on your California RN license. If your name has changed since licensure and you have not updated the BRN’s record, update it first. A mismatch between the verification form and the license file creates an avoidable processing snag.

What Your School Fills Out in Section B

Once Section A is complete, send the form to your nursing program. Section B must be completed by a school official who can attest to your academic record, typically the Nursing Program Director or an authorized designee. The school supplies three facts:

Entrance date (when you enrolled).
Date the degree was awarded (the conferral date).
Type of degree awarded (BSN, MSN, or other applicable degree).

If you graduated from a program outside California, Section B has additional accreditation questions that only out-of-state graduates need to answer. The school official indicates whether the program held CCNE or NLN (now ACEN) accreditation, and whether that accreditation was in place when you graduated. The official then signs and dates the form, printing their name, title, and phone number.¹

Build in time. The form has to leave your hands, reach the right office at the school, come back signed, and then travel to the BRN with the rest of your package. Program offices move at their own pace, especially around graduation.

The Transcript Is a Separate Document

One detail trips up a lot of applicants: the verification form is not a substitute for your transcript, and your transcript is not a substitute for the verification form. The BRN requires both, and the official transcript must be sent directly from your school. Transcripts submitted by the applicant are not accepted.¹

Request the transcript early. Processing by a registrar can take a week or more, and your application sits in incomplete status until it arrives. Coordinate the timing so the transcript and your paper package land at the BRN in roughly the same window, not months apart.

What Goes in the Complete Package

The Academic Program Verification form is one piece of the submission. The complete PHN application package consists of:

The PHN application form (the main application, which is separate from the verification form).
The Academic Program Verification form with Section A and Section B both completed.
The official transcript, sent directly from your school.
The $300 application fee.

If you need to begin work before the permanent certificate is issued, a temporary PHN certificate costs an additional $150. The BRN charges a $30 penalty on dishonored checks, so confirm your payment method before mailing.²

One eligibility boundary worth confirming before you spend time on the form: you need an active California RN license. If your California RN license has lapsed, renew or reactivate it before submitting the PHN application, because the BRN will not process a PHN certification against an inactive license.¹

Where to Send It

Mail the completed application package to:

Board of Registered Nursing
PO Box 944210
Sacramento, CA 94244-2100³

The BRN also uses the BreEZe online portal for license management, and some advanced practice certifications allow document uploads through the “submit additional documents” feature in BreEZe.⁴ If you already have a BreEZe account linked to your RN license, log in to see whether the PHN application accepts digital uploads; the interface displays the option when it is available for your application type. Your school’s official transcript still has to be sent separately by the school either way.

What Happens After You Submit

The BRN’s posted target for PHN certification is four weeks from receipt of a complete application. As of early 2026, the Board was processing PHN items received in mid-to-late February.⁵ Volume spikes during graduation season, so summer submissions often run longer than the posted target.

If anything is missing, the BRN rejects the file as incomplete rather than holding it open while you fix the gap. You then resubmit a corrected package and lose the time you already waited. The most common reasons the BRN sends applications back: the transcript never arrived from the school, the fee payment bounced, or the SSN/ITIN field was left blank on the verification form.

Check your status through your BreEZe account. The BRN asks applicants not to call before the posted processing timeframe has passed, because inquiries inside that window can slow the review down.⁶

1
Board of Registered Nursing. General Instructions and Application Requirements for Public Health Nurse (PHN) Certification
2
Board of Registered Nursing. Fee Schedule
3
Board of Registered Nursing. Contact Information
4
Board of Registered Nursing. Advanced Practice and Public Health Nurse Certification
5
Board of Registered Nursing. Processing Times
6
California Board of Registered Nursing. Applicant Frequently Asked Questions