Please complete the following questions to give us some information about you and your goals that will be supported by participating in the Foundations of Faith Community Nursing course. Once submitted, the course faculty committee will respond to you with any questions and you will then receive information on the next steps to register for the course.

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* 1. Application name and contact information:

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* 2. State(s) where actively licensed as an RN, and expiration date of license(s):

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* 3. Current place of employment and position held:

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* 4. Name of current faith community and/or denomination (if applicable):

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* 5. Pastor/leader of current faith community or agency:

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* 6. Briefly describe your current or past work, either paid or volunteer in your faith community:

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* 7. Briefly summarize your current and past nursing education and career (schools of nursing attended/degrees/positions held/areas worked, or attach a current curriculum vitae/resume below).

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* 8. Attach a current curriculum vitae/resume in response to question 7 here if desired.

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* 9. Please explain briefly why you are applying for the course and how you plan to use the knowledge and experience you gain. 

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* 10. How did you learn about this course?

Sanford Health, the provider of this educational activity and responsible party for the adherence to ANCC criteria, has worked together with joint providers, Augustana University and Avera Health to design, implement, and evaluate this activity.

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