* 1. Name:

* 2. Email:

* 3. What type of work or projects are you interested in?

* 4. Are you a veteran?

* 5. Desired time commitment:

* 6. Practice/Specialty

* 7. RN License Number:

* 8. Highest level of education:

* 9. Universities/colleges attended:

* 10. Do you belong to any professional nursing organizations? If so, please specify.

* 11. List of past professional roles, including job title and name of the organization:

* 12. List your unique skills (bilingual, bicultural, math skills, prior teaching, nursing practice, etc.):

* 13. Comments:

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