Foundations of FCN Course Application: Spring 2022

Question Title

* 1. Applicant Information and Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. State(s) of current nursing license and expiration year

Question Title

* 3. Current Place of Employment

Question Title

* 4. Name of Current Faith Community/Denomination if applicable

Question Title

* 5. Pastor/Leader of Faith Community or Agency

Question Title

* 6. Briefly describe your current and past volunteer or paid work at your local 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).

Question Title

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

Question Title

* 9. How did you learn about this course?