Boston College William F. Connell School of Nursing
Continuing Education Program

This form is used for purposes of Continuing Education to provide documentation of an individual's expertise related to the program. Do not attach resume or curriculum vitae. Must be submitted for member(s) of the Planning Committee, presenter(s), and content specialist(s).

Check all that apply:

Please complete the following information:

We will use your cell phone number in an emergency only

Please complete your employer information:

Please complete your education (include basic preparation through highest degree held):

1st Institution

2nd Institution (if necessary)

3rd Institution (if necessary)

Use this space below to briefly describe your professional experience or areas of expertise (including publications) related to your involvement in continuing nursing education and your particular role, e.g., planner, presenter, peer reviewer, administrator, etc. Planners also describe your familiarity with the target audience.
*DO NOT ATTACH RESUME. Please summarize below.

By submitting this form, I state that the information above is correct to the best of my knowledge.