---
title: Certified Pediatric Nurse (CPN) Application Form Template | Paperform
description: Professional CPN certification application form with pediatric clinical hours tracking, family-centered care competency assessment, and exam registration. Streamline your pediatric nurse certification process.
url: "https://paperform.co/templates/certified-pediatric-nurse-cpn-application"
type: static
generatedAt: "2026-03-28T00:43:16.933Z"
---

[← Back to free form templates](/templates/)    ![Certified Pediatric Nurse (CPN) Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-pediatric-nurse-cpn-application.png)
    [Preview](https://_preview.paperform.co/ai-template/certified-pediatric-nurse-cpn-application) [Use this template for free](/create?ai-template=certified-pediatric-nurse-cpn-application)    [Application Forms](/templates/category/applications/) [Healthcare](/templates/industry/healthcare/) [Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Advance Your Career with Certified Pediatric Nurse (CPN) Certification

Are you a registered nurse specializing in pediatric care ready to validate your expertise and advance your career? Our **Certified Pediatric Nurse (CPN) Application Form** simplifies the certification process, making it easier than ever to demonstrate your pediatric nursing competencies and register for the CPN certification exam.

#### Why Use Paperform for Your CPN Application?

Healthcare certification bodies, nursing associations, and professional development organizations trust Paperform to streamline complex application processes. Unlike rigid traditional forms or clunky survey tools, Paperform's doc-style editor lets you create professional, on-brand applications that guide candidates smoothly through multi-step requirements—from clinical hours verification to competency assessments and exam registration.

This template is specifically designed for pediatric nurse certification programs and can be customized to match your organization's branding, specific competency frameworks, and eligibility requirements. Whether you're a nursing board, healthcare institution, or professional certification body, this form handles the complexity while keeping the experience simple for applicants.

#### What This Template Includes

This comprehensive CPN application template captures everything needed for certification eligibility verification:

 - **Professional credentials and nursing license verification** with state/jurisdiction tracking
 - **Pediatric clinical hours documentation** including setting types, patient age groups, and verification
 - **Family-centered care competency self-assessment** across key practice domains
 - **Educational background and continuing education** in pediatric nursing
 - **CPN exam registration** with preferred testing dates, locations, and accommodation requests
 - **Professional references** from supervisors or pediatric nursing colleagues
 - **Payment processing** for application and exam fees using Stripe, PayPal, or Square

The form uses conditional logic to show relevant sections based on applicant status, employment settings, and special circumstances, ensuring each nurse completes only the sections that apply to their situation.

#### Perfect for Healthcare Certification Bodies and Nursing Organizations

This template serves multiple audiences within the pediatric nursing certification ecosystem:

**Nursing Certification Boards** can use this form to standardize CPN applications, verify eligibility requirements, and maintain consistent documentation across all applicants while reducing manual review time.

**Healthcare Institutions** offering certification preparation programs can guide their pediatric nursing staff through the application process, track team certification progress, and support professional development initiatives.

**Nursing Professional Associations** can streamline member certification applications, offer bundled exam registration with membership, and maintain accurate records of certified pediatric nurses.

**Continuing Education Providers** can help course participants apply for certification after completing pediatric nursing education programs, with automatic population of completed coursework.

#### Streamline with Stepper Workflow Automation

Once a CPN application is submitted through Paperform, [Stepper](https://stepper.io) can automate your entire certification workflow:

 - **Automatically verify nursing licenses** by checking state board databases or sending verification requests to licensing authorities
 - **Route applications to eligibility reviewers** based on applicant location, clinical setting, or special circumstances
 - **Send clinical hours verification requests** to supervisors with pre-populated forms and tracking
 - **Update your certification database** in Airtable, Google Sheets, or your membership management system
 - **Schedule exam appointments** by integrating with testing center booking systems
 - **Trigger personalized email sequences** for exam preparation resources, study materials, and countdown reminders
 - **Generate certification certificates** automatically upon exam passing and send via Papersign for digital delivery

This automation transforms certification management from a manual, time-intensive process into a smooth, automated workflow that scales with your organization.

#### Designed for Compliance and Professional Standards

Pediatric nurse certification requires careful documentation and verification. This template includes:

 - Structured clinical hours tracking by practice setting and patient population
 - Competency assessment aligned with family-centered care principles
 - Secure reference submission with confidential feedback options
 - Professional development documentation for continuing education
 - Disability accommodation requests compliant with ADA requirements
 - Clear terms acknowledgment for certification standards and code of ethics

All submissions are stored securely with **SOC 2 Type II compliance**, ensuring sensitive healthcare professional information is protected according to industry standards.

#### Collect Payments Seamlessly

Process application fees, exam registration fees, and late submission penalties directly within the form. Connect your preferred payment processor (Stripe, PayPal, Square) and use Paperform's calculation engine to:

 - Apply member discounts automatically based on association membership status
 - Add rush processing fees for expedited applications
 - Calculate different exam fees for initial certification vs. recertification
 - Offer payment plans for candidates who need them
 - Generate automatic receipts and confirmation emails

#### Customize to Your Certification Program

While this template is built for Certified Pediatric Nurse applications, Paperform's flexible editor lets you adapt it to any pediatric nursing certification:

 - **Pediatric Nursing Certification Board (PNCB)** standards and competencies
 - **Certified Pediatric Emergency Nurse (CPEN)** with emergency-specific clinical hours
 - **Certified Pediatric Oncology Nurse (CPON)** with specialty competencies
 - **Neonatal Intensive Care Nursing Certification** with NICU-specific requirements
 - **Pediatric Primary Care Nurse Practitioner** certification pathways

You can add or remove competency domains, adjust clinical hours requirements, modify eligibility criteria, and incorporate your organization's specific certification standards—all without touching a single line of code.

#### Built for Busy Nurses and Administrators

Nurses applying for certification are managing patient care, continuing education, and professional development simultaneously. This form respects their time by:

 - **Auto-saving progress** so applicants can complete the form across multiple sessions
 - **Mobile-friendly design** that works perfectly on any device
 - **Clear section organization** with progress indicators in multi-page mode
 - **Helpful descriptions and examples** for complex fields like clinical hours verification
 - **File upload capabilities** for supporting documentation, transcripts, and certificates

For certification administrators, Paperform's **results page** makes reviewing applications efficient with filtering, sorting, and exporting to Excel or Google Sheets for eligibility review committees.

#### Join 500,000+ Teams Using Paperform

Healthcare organizations, professional associations, and certification bodies worldwide trust Paperform for their application and certification workflows. With 30,000+ designer templates, no-code customization, and enterprise-grade security, Paperform gives you the flexibility of a custom-built solution with the simplicity of a form builder.

Whether you're processing ten CPN applications or ten thousand, this template scales with your certification program—helping pediatric nurses advance their careers and helping your organization maintain the highest standards of pediatric nursing practice.

Start streamlining your Certified Pediatric Nurse certification applications today with Paperform.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Certified Aesthetic Nurse Specialist (CANS) Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-aesthetic-nurse-specialist-cans-application.png)

### Certified Aesthetic Nurse Specialist (CANS) Application

Apply for Certified Aesthetic Nurse Specialist certification. Submit your credentials, cosmetic procedure experience, injectable competency records, and register for the CANS examination.](/templates/certified-aesthetic-nurse-specialist-cans-application/)
[![Certified Bariatric Nurse (CBN) Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-bariatric-nurse-cbn-application.png)

### Certified Bariatric Nurse (CBN) Application

Apply for Certified Bariatric Nurse (CBN) certification. Submit your credentials, bariatric nursing experience, nutritional counseling competencies, and register for the CBN examination.](/templates/certified-bariatric-nurse-cbn-application/)
[![Certified Cardiac Rehabilitation Nurse Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-cardiac-rehabilitation-nurse-application.png)

### Certified Cardiac Rehabilitation Nurse Application

Apply for cardiac rehabilitation nurse certification with exercise physiology training verification, cardiac monitoring competency assessment, and CCRN exam registration.](/templates/certified-cardiac-rehabilitation-nurse-application/)
[![Certified Case Manager (CCM) Certification Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-case-manager-ccm-certification-application.png)

### Certified Case Manager (CCM) Certification Application

Apply for CCM certification with this comprehensive application form covering care coordination experience, transitions of care competency, and exam registration requirements.](/templates/certified-case-manager-ccm-certification-application/)
[![Certified Clinical Nurse Specialist (CNS) Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-clinical-nurse-specialist-cns-application.png)

### Certified Clinical Nurse Specialist (CNS) Application

Apply for CNS certification with advanced practice experience verification, specialty population focus, and exam registration. Streamline your professional certification application process.](/templates/certified-clinical-nurse-specialist-cns-application/)
[![Certified Continence Care Nurse Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-continence-care-nurse-application.png)

### Certified Continence Care Nurse Application

Professional certification application for continence care nurses specializing in bladder and bowel management, pelvic floor competency, and CWOCN exam preparation.](/templates/certified-continence-care-nurse-application/)
[![Certified Dermatology Nurse Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-dermatology-nurse-application.png)

### Certified Dermatology Nurse Application

Apply for dermatology nursing certification with comprehensive assessment of clinical experience, phototherapy competency, and exam registration.](/templates/certified-dermatology-nurse-application/)
[![Certified Diabetes Care and Education Specialist (CDCES) Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-diabetes-care-and-education-specialist-cdces-application.png)

### Certified Diabetes Care and Education Specialist (CDCES) Application

Apply for CDCES certification with comprehensive documentation of practice hours, diabetes self-management training experience, and exam registration in one streamlined application.](/templates/certified-diabetes-care-and-education-specialist-cdces-application/)
[![Certified Flight Registered Nurse (CFRN) Certification Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-flight-registered-nurse-cfrn-certification-application.png)

### Certified Flight Registered Nurse (CFRN) Certification Application

Apply for CFRN certification by documenting your air medical transport experience, critical care competencies, and registering for the certification exam.](/templates/certified-flight-registered-nurse-cfrn-certification-application/)
[![Certified Healthcare Simulation Educator (CHSE) Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-healthcare-simulation-educator-chse-application.png)

### Certified Healthcare Simulation Educator (CHSE) Application

Apply for CHSE certification with this comprehensive application form. Submit your simulation program details, debriefing competency evidence, and register for the certification exam.](/templates/certified-healthcare-simulation-educator-chse-application/)
[![Certified Hospice and Palliative Nurse (CHPN) Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-hospice-and-palliative-nurse-chpn-application.png)

### Certified Hospice and Palliative Nurse (CHPN) Application

Professional certification application for registered nurses seeking CHPN credential, including end-of-life care experience verification, symptom management competency assessment, and exam registration.](/templates/certified-hospice-and-palliative-nurse-chpn-application/)
[![Certified Nurse Midwife Certification Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-nurse-midwife-certification-application.png)

### Certified Nurse Midwife Certification Application

Apply for Certified Nurse Midwife (CNM) certification. Submit your graduate nursing education credentials, clinical practice hours, and register for the AMCB certification exam.](/templates/certified-nurse-midwife-certification-application/)