Foundations of Faith Community Nursing Course Application

Fall 2022

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'll then receive information on next steps to register for the course.

Question Title

* 1. Applicant name and contact information:

Name

Address

Address 2

City/Town

State

Zip/Postal Code

Email Address

Phone Number

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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 below).

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

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Foundations of Faith Community Nursing Course Application

Fall 2022

Question Title

* 1. Applicant name and contact information:

Question Title

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

Question Title

* 3. Current place of employment and position held:

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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 below).

Question Title

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

Question Title

* 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?