CGFNS certification is the credential evaluation and immigration screening process that internationally educated nurses and other healthcare professionals need before they can pursue licensure and an occupational visa in the United States. There’s an important update most guides on this topic still miss: CGFNS International officially renamed itself TruMerit in 2025, and the rebrand rolled out across its website, applicant portal, and certificates through the course of that year. The organization, its services, and its requirements are the same. Only the name and branding changed, so if you see “TruMerit” on an official document or login screen instead of “CGFNS,” you’re in the right place.
This guide walks through what CGFNS (TruMerit) actually does, the three separate services it offers that most articles blur together, which one you actually need, what each costs, and how long the whole process realistically takes.
CGFNS Is Now TruMerit: What Actually Changed
In February 2025, CGFNS International announced it would rebrand as TruMerit, a decision its board approved in late 2024. The name change reflects the organization’s move to broaden its focus toward global healthcare workforce development, but its core function for internationally educated nurses hasn’t shifted: it remains the primary credentials evaluation and immigration screening body for foreign-educated healthcare professionals seeking to work in the United States. The rollout touched the organization’s public website, applicant portal, and even its issued certificates, so a certificate issued in late 2025 or 2026 may carry the TruMerit name and logo rather than CGFNS, even though the acronym CGFNS (Commission on Graduates of Foreign Nursing Schools) still appears in the organization’s legal name and in almost everyone’s everyday conversation about the process.
Practically, this means older guides, forum posts, and even some state Board of Nursing pages may still reference “CGFNS” exclusively, while newer official communication increasingly says “TruMerit.” Both refer to the same organization and the same services described in this guide.
The Three Services That Get Confused With Each Other
This is where most competing guides genuinely fall short: they treat “CGFNS certification” as one single thing, when it’s actually three distinct services, each solving a different problem. Getting the wrong one wastes real money and time.
Credentials Evaluation Service (CES): An academic and professional credential evaluation, typically used to satisfy a state Board of Nursing’s requirement that your foreign nursing education be assessed as equivalent to a U.S. nursing program before you’re allowed to sit the NCLEX or apply for licensure. This is an education review, not an immigration document.
VisaScreen (Visa Credentials Assessment): A federally mandated screening required for most foreign healthcare workers, other than physicians, seeking an occupational visa such as an EB-3, H-1B, or TN status. It’s mandated under Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, and it’s an immigration requirement, not a state licensing requirement. Most nurses need this at some point, generally after passing the NCLEX, and it typically runs around $740.
CGFNS Certification Program: A qualifying exam plus credential review, used by only a small number of states, such as Connecticut, that require it before an applicant can even sit the NCLEX. If your target state doesn’t require it, purchasing it is an unnecessary cost, commonly $495 or more, since passing the NCLEX already satisfies the nursing-knowledge component that this program is designed to test.
Confusing these three, especially buying the Certification Program when your state only needs CES or VisaScreen, is one of the most common and avoidable mistakes internationally educated nurses make early in this process.
Which Service Do You Actually Need?
The honest answer is that it depends entirely on which state’s Board of Nursing you’re applying to, since credential evaluation requirements are set at the state level in the U.S., not federally. A few patterns worth knowing:
- Some states, including Texas, Florida, and Nevada, accept alternative evaluators such as Josef Silny & Associates, which are sometimes faster to process than CES.
- California and Arizona commonly accept detailed course-by-course evaluators such as ERES or IERF, in addition to or instead of CES, and California in particular applies strict evaluation standards.
- New York uses a specific verification pathway, CVS, handled exclusively through CGFNS (TruMerit), meaning applicants to New York don’t have the option of using an alternative evaluator the way Texas or Florida applicants sometimes do.
- Regardless of which evaluator your state accepts for licensure, VisaScreen is a separate federal requirement tied to your visa category, not your state license, so most applicants still need it even if their state accepted a different evaluator for CES purposes.
Before paying for anything, confirm directly with your target state’s Board of Nursing which specific credential evaluation service they accept, since applying through the wrong one can mean redoing the entire evaluation with an accepted provider later.
Step-by-Step: How the Process Actually Works
1. Create a CGFNS Connect account. All current applications, whether for CES, VisaScreen, or the Certification Program, run through this online portal, and the system detects which service type applies once you start an order.
2. Confirm which service (or services) you actually need. Check your target state Board of Nursing’s requirements, and confirm your visa category’s screening requirement separately, since these are answered by two different bodies (the state board and U.S. immigration requirements) rather than one single source.
3. Submit your documents. This includes your secondary school certificate, nursing education transcripts, and validation of your professional license or registration, all typically sent directly from the issuing institutions to CGFNS (TruMerit) rather than submitted by you directly, which is why this stage often takes the longest.
4. Meet the English language proficiency requirement, if applicable. Most VisaScreen applicants need to demonstrate English proficiency through an approved exam such as IELTS, TOEFL, or PTE Academic, unless they qualify for an exemption, most commonly for applicants who completed their professional education entirely in English.
5. Complete the NCLEX, if you haven’t already. For most nurses, passing the NCLEX satisfies the nursing-knowledge component that VisaScreen and the Certification Program are otherwise designed to test, which is exactly why most nurses never need to sit the separate CGFNS Qualifying Exam.
6. Receive your certificate. A completed VisaScreen results in an official ICHP (International Commission on Healthcare Professions) certificate, which satisfies the federal screening requirement for your occupational visa petition.
Documents You’ll Typically Need
- Passport-size photograph
- Secondary school (high school) diploma or external exam certificate, waived only if you completed secondary education more than ten years ago
- Official nursing education transcripts, sent directly from your school
- Validation of your current professional license or registration, sent directly from the issuing licensing authority
- Proof of English language proficiency exam results, unless exempt
- NCLEX results, once available, for most applicants
What It Costs
| Service | What It’s For | Typical Cost |
|---|---|---|
| Credentials Evaluation Service (CES) | State Board of Nursing education equivalency review | Varies by state and applicant, confirm current pricing directly on your application |
| VisaScreen | Federal immigration screening for an occupational visa | Around $740 |
| CGFNS Certification Program | Required by only a small number of states before sitting the NCLEX | Around $495 or more, only needed if your target state specifically requires it |
| English proficiency exam (IELTS, TOEFL, or PTE) | Separate exam fee, paid to the testing body directly | Varies by exam and country |
None of these figures are permanently fixed, and CGFNS (TruMerit) periodically updates its fee schedule, so confirm the current amount directly on your CGFNS Connect application before budgeting around an older number found elsewhere.
Realistic Timeline
Document collection and verification is typically the longest stage, since transcripts and license validations have to come directly from your school and licensing authority rather than from you, and response speed depends heavily on how quickly those institutions reply. Once your documents are complete, VisaScreen processing itself commonly takes a matter of weeks rather than months, though this can extend if any document needs correction or a school is slow to respond to a records request. Because VisaScreen typically comes after the NCLEX, your total timeline from starting CES to holding a completed VisaScreen certificate is usually measured in months rather than weeks, particularly if you’re also completing NCLEX preparation and English proficiency testing in parallel.
Common Mistakes That Cost Time and Money
- Buying the Certification Program when your state doesn’t require it. This is one of the most frequently repeated, entirely avoidable expenses in this entire process, since most states only need CES and, later, VisaScreen.
- Assuming CES and VisaScreen are the same thing. They serve completely different purposes, one for state licensure eligibility, the other for federal immigration screening, and completing one doesn’t automatically satisfy the other.
- Not confirming your target state’s accepted evaluator before starting. Some states accept alternatives to CES that may process faster; applying through the wrong evaluator for your state means redoing the evaluation later.
- Requesting an English proficiency exemption without checking eligibility first. Exemptions are generally limited to applicants educated entirely in English, so confirm this before assuming you qualify.
- Waiting until after the NCLEX to start CES or VisaScreen. These processes can often run in parallel with NCLEX preparation rather than strictly after it, and starting document collection early is one of the most reliable ways to shorten your overall timeline.
Frequently Asked Questions
Is CGFNS the same as TruMerit?
Yes. CGFNS International officially renamed itself TruMerit in 2025. The organization, its services, and its requirements are unchanged; only the name and branding are different, and both names currently appear in circulation depending on how recently a document or webpage was updated.
Do I need CGFNS certification to become a nurse in the USA?
It depends on your specific state and visa category. Most internationally educated nurses need a credential evaluation (CES or an accepted alternative) for state licensure, and most also need VisaScreen for their occupational visa, but very few states require the separate CGFNS Certification Program.
What is the difference between CES and VisaScreen?
CES evaluates whether your nursing education is equivalent to a U.S. program, primarily to satisfy your state Board of Nursing before you can pursue licensure. VisaScreen is a separate federal immigration screening required for most occupational visa categories, independent of your state licensing process.
Do I need to take the CGFNS Qualifying Exam?
Almost certainly not, unless your target state is one of the small number that specifically requires the Certification Program. Passing the NCLEX satisfies the nursing-knowledge requirement for most applicants, making the separate qualifying exam unnecessary.
How much does VisaScreen cost?
VisaScreen typically costs around $740, though CGFNS (TruMerit) periodically updates its fee schedule, so confirm the current amount directly on your application before budgeting.
Can I be exempt from the English language proficiency requirement?
Yes, in some cases, most commonly if you completed your professional nursing education entirely in English. Confirm your specific eligibility before assuming an exemption applies, since requirements can vary by profession and circumstance.
About the Author
This guide was written by the team at Rahat Health Care Professionals Consultancy & Training Center, led by founder Rahat Zaman, a medical licensing consultant since 2018 with hands-on experience guiding healthcare professionals through DHA, MOH, DOH, and wider Gulf licensing processes. Our team has supported over 21000 healthcare professionals through DataFlow verification, exam registration, and license activation across the UAE and internationally.
Last updated: July 2026
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