Get Name Change Attestation Form - Pncb

Changing your name officially can be a straightforward process when using the Name Change Attestation Form from the Pediatric Nursing Certification Board. This guide will provide you with detailed instructions to fill out the form correctly and efficiently online.

Follow the steps to complete your name change attestation online.

1. Click ‘Get Form’ button to obtain the Name Change Attestation Form and open it for editing.
2. Begin filling out the form by entering your new name as you would like it to appear on PNCB documents. Ensure this section is filled out clearly.
3. Next, provide your former name exactly as it appears on your existing certification documents. This ensures the PNCB can verify your past records.
4. Fill out your complete address, ensuring accuracy for correspondence related to your certification.
5. Add your home phone, work phone, and email address for PNCB to reach you regarding your submission.
6. Select your certification type by checking the appropriate box: CPNP or CPN, to indicate which certification you hold.
7. Indicate the legal process for your name change by checking the corresponding option: Marriage, Divorce, or Other.
8. Finally, enter the last four digits of your Social Security Number (SSN) for identity verification. Ensure this information is kept secure.
9. Review all entered information for accuracy, then sign and date the form where indicated.
10. Once you have completed the form, you can save changes, download, print, or share the document as needed.

Complete your Name Change Attestation Form online today and ensure your certification details are up to date.