1
Demographic
2
Education
3
Exams
4
Work Experience
5
Documents
6
Payment
7
Submit
Demographic
Please enter your demographic and contact information below.
First Name
Middle Initial
Last Name
Social Security Number
Date of Birth
Phone Number
Email Address
Mary
L
Fanning
000-00-0000
05/27/1995
123-123-1234
mfanning@jdsoft.com
Education
Please add a new entry for each level of education completed.
ADD EDUCATION
Education #1
Name of Institution
Date of Graduation
Degree
Salem State University
05/25/2020
Bahelor’s Degree
Education #2
Name of Institution
Date of Graduation
Degree
Tufts University
06/02/2022
Master's Degree
Exams
Have you completed the National Licensure Exam?
Yes
No
Please enter your past exam information below.
Exam Level
Exam Date
Exam State
Exam Result
Exam Score
Master’s Level
05/15/2022
Massachusetts - MA
Pass
215
Work Experience
Please enter your supervised work experience below.
ADD WORK EXPERIENCE
Supervised Work Experience #1
Facility Name
Facility Address
Supervisor Title
Supervisor Name
Supervisor Email
Your Title
Start Date
End Date
05/25/2022
05/25/2022
McCormick Hospital
23 Hospital Ave Salem, MA 01970
Intern
Lead Clinical Psychologist
Robert White
rwhite@jdsoft.com
Documents
Please upload your required documents to your application.
Drag document or click here
M_Fanning_Resume_2024.pdf
Academic_Director_Form.pdf
Academic_Director_Form.pdf
M_Fanning_Resume.pdf
Category:
Professional Experience
Category:
Education
Remove
Upload
Remove
Upload
Drag document or click here
Alexa Doe
Uploaded By:
02/01/2024, 12:30:02 PM
Upload Date:
Professional Experience
Document Category:
M_Fanning_Resume.pdf
Document Name:
Alexa Doe
Uploaded By:
02/01/2024, 12:30:02 PM
Upload Date:
Education
Document Category:
Academic_Director_Form.pdf
Document Name:
Payment
Please make a payment online with a credit or debit card or an e-check by clicking the “Pay Fee” button.
Amount Due: $150.00
PAY FEE
Amount Paid: $150.00
Remaining Amount: $0.00
Submit
Please review your Psychologist License Application below. If all information is accurate, click the “Submit” button.
Demographic
First Name: Mary
Name of Institution: Tufts University
Date of Graduation: 06/02/2022
Date of Graduation: 05/25/2020
Degree: Master’s Degree
Degree: Bachelor’s Degree
Social Security Number: 000-00-0000
Phone Number: 123-123-1234
Email Address: mfanning@jdsoft.com
Date of Birth: 05/27/1995
Middle Initial: L
Last Name: Fanning
Education
Education #1
Facility Name: McCormick Hospital
Facility Address: 23 Hospital Ave Salem, MA 01970
Supervised Work Experience #1
Name of Institution: Salem State University
Education #2
Exams
Exam Level: Master’s Level
Work Experience
Documents
Exam Date: 05/15/2022
Exam Result: Pass
Exam Score: 215
Exam State: Massachusetts - MA
Supervisor Title: Lead Clinical Psychologist
Supervisor Name: Robert White
Supervisor Email: rwhite@jdsoft.com
Supervisor Title: Intern
Start Date: 01/11/2022
End Date: 07/12/2022
Alexa Doe
Uploaded By:
02/01/2024, 12:30:02 PM
Upload Date:
Education
Document Category:
Academic_Director_Form.pdf
Document Name:
Alexa Doe
Uploaded By:
02/01/2024, 12:30:02 PM
Upload Date:
Professional Experience
Document Category:
M_Fanning_Resume_2024.pdf
Document Name:
Payment
Amount Paid: $150.00
Remaining Amount: $0.00
Amount Due: $150.00
Submit Application
Go T o Pr e vious P age
Registered Nurse License - New Application | Mary Fanning | Application #: RNNE10000
Pending
Created Date: 09/01/2024 Submitted Date: 09/04/2024 Application Workflow Status: Application Received
Initial Review
Background Check
Education Review
Exam Review
Document Review
License Issued
Thank you for submitting your Registered Nurse - New Application! You will recieve an email confirmation that your application has been received. Please note that you may sign in and check your application status at any time in the system.
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Registered Nurse License Application
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Group:
Board of Nursing
License Type:
Registered Nurse
Application Type:
Initial Application
Workflow Status:
Executive Review
RNNE1001
RNNE1002
RNNE1003
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RNNE1006
RNNE1007
RNNE1008
RNNE1009
RNNE1010
RNNE1011
RNNE1012
Registered Nurse
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Initial Application
Initial Application
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Initial Application
Initial Application
Initial Application
Initial Application
Initial Application
Initial Application
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Initial Application
Initial Application
Jane B Smith
Joe H Hoover
Sami Qasim
Mary S Fanning
Ciaran L Friel
John Smith
Julia Doe
Karthik Patel
Marisol C Cortez
Alexa Checkey
Nora K Jones
Meredith G Wycoff
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// Application Record Page
Demogaphic - Name & Personal Identifiable Information
First Name:
Jane
Middle Initial:
B
Last Name:
Smith
SSN:
Show
Date of Birth:
Show
License & Nursing School Type
Type of License:
Registered Nurse License
Nursing School:
U.S. or Canadian Nursing School
Education Information
Background Information
Demographic Information
Documents
Application Data
Events
Notifications
Payments
Archives
Registered Nurse License - New Application
Name:
Jane B Smith
Date of Birth:
Show
Social Security Number:
Show
Email Address:
info@jdsoft.com
Phone Number:
123-123-1234
Mailing Address:
27 Congress Street Salem, MA 01970
Workflow Status:
Review
Application Number:
RNNE1001
License Number:
RN4321
Original Submission Date:
12/06/2024
Submission Date:
12/06/2024
Created Date:
12/05/2024
Payment Received:
$600.00
Pending
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