Current SANEs Seeking National Certification Survey

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* 1. Contact Information:

Name:

Address:

Email:

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* 2. Current education level:

ADN

MSN

PHD

DNP

BSN

Other (please specify)

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* 3. Education

School attended name:

Dates of completion (month/year):

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* 4. Place of Employment

Place of employment name:

Address:

Phone:

Contact Person:

Email:

Phone:

Full-time, part-time, or leave of absence

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* 5. Can you commit to taking the IAFN SANE-A Certification or SANE-P Certification exam in September of 2023 or April of 2024?

Yes

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* 6. Have you met the required qualifications to be eligible to take the International Association of Forensic Nurses SANE-A Certification or SANE-P Certification?

Yes

If no, when will the IAFN required qualifications be completed?

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* 7. Do you work as a SANE with underserved populations in CO OR NM WA or WY?

Yes

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* 8. Do you work as a SANE in a rural or frontier area of CO OR NM WA or WY?

Yes

Demographic Information: This project is grant funded by the Health Resources Service Administration (HRSA). Specific demographic data is required by HRSA.

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* 9. Race/Ethnicity:

Asian/Pacific Islander

African American/Black

Hispanic/Latinx

Native American/Indigenous

White

Other

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* 10. Year of Birth

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* 11. Sex/gender:

Male

Female

Other

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* 12. County and State where you reside:

Name

Zip code

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* 13. Ethnicity

Hispanic/Latino

Non-Hispanic/Non-Latino

N/A

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* 14. Are you a veteran?

Active Duty

Individual is not a veteran

National Guard

Reservist

Veteran - Prior Service

Veteran - Retired

Not Reported

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* 15. Are you from a rural residential background?

Yes

N/A

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* 16. Are you from a disadvantaged background

Yes

N/A

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* 17. County /State where you work as a SANE:

Name

Zip code

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* 18. Number of years employed/volunteered as a SANE

Please read the following statements and select that you acknowledge

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* 19. I acknowledge that I must have met all requirements put forth by the International Association of Forensic Nurses to be eligible to take the National Certification Exam

I acknowledge

I do not acknowledge

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* 20. I acknowledge that I am responsible for registering myself and completing all pre-exam requirements prior to taking the National Certification exam.

I acknowledge

I do not acknowledge

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* 21. I acknowledge that I am responsible for National Examination Fees prior to testing.

*If accepted Exam fees will be reimbursed after proof of Exam completion.

I acknowledge

I do not acknowledge

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* 22. I acknowledge I will submit all required documentation to the Colorado Center for Nursing Excellence as required for financial reimbursement.

I acknowledge

I do not acknowledge

CREATING A MORE INCLUSIVE CARE ENVIRONMENT

The Colorado Center for Nursing Excellence is focused on incorporating diversity, equity and inclusion as a component in all of our training programs. The goal is to build culturally inclusive teams and provide tools for courageous conversations.

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* 23. I acknowledge that as a SANE I commit to incorporating Diversity, Equity, and Inclusion as a participant in this program and moving forward as a certified, practicing SANE

I acknowledge

I do not acknowledge

Please answer the following questions:

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* 24. When do you plan to take the International Association of Forensic Nurses (IAFN) National Exam?

September 2023

April 2024

I completed the exam September of 2022

I completed the exam April of 2023

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* 25. Which IAFN National Certification Exam will you take?

SANE-A Certification

SANE-P Certification

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* 26. Are you currently a member of the IAFN?

Yes

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* 27. Was/is the cost of the IAFN National Certification Exam a barrier to acquiring this certification?

Yes

Somewhat

Please send to Aurea Cunanan: aurea@coloradonursingcenter.org and state “ Current SANE Exam Application” in the subject line or mail to the Colorado Center for Nursing Excellence, 7535 E Hampden Avenue, Suite 110, Denver CO 80231.

Questions? Call 720-699-7834.

Current SANEs Seeking National Certification

Question Title

* 1. Contact Information:

Question Title

* 2. Current education level:

Question Title

* 3. Education

Question Title

* 4. Place of Employment

Question Title

* 5. Can you commit to taking the IAFN SANE-A Certification or SANE-P Certification exam in September of 2023 or April of 2024?

Question Title

* 6. Have you met the required qualifications to be eligible to take the International Association of Forensic Nurses SANE-A Certification or SANE-P Certification?

Question Title

* 7. Do you work as a SANE with underserved populations in CO OR NM WA or WY?

Question Title

* 8. Do you work as a SANE in a rural or frontier area of CO OR NM WA or WY?

Question Title

* 9. Race/Ethnicity:

Question Title

* 10. Year of Birth

Question Title

* 11. Sex/gender:

Question Title

* 12. County and State where you reside:

Question Title

* 13. Ethnicity

Question Title

* 14. Are you a veteran?

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* 15. Are you from a rural residential background?

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* 16. Are you from a disadvantaged background

Question Title

* 17. County /State where you work as a SANE:

Question Title

* 18. Number of years employed/volunteered as a SANE

Question Title

* 19. I acknowledge that I must have met all requirements put forth by the International Association of Forensic Nurses to be eligible to take the National Certification Exam

Question Title

* 20. I acknowledge that I am responsible for registering myself and completing all pre-exam requirements prior to taking the National Certification exam.

Question Title

* 21. I acknowledge that I am responsible for National Examination Fees prior to testing. *If accepted Exam fees will be reimbursed after proof of Exam completion.

Question Title

* 22. I acknowledge I will submit all required documentation to the Colorado Center for Nursing Excellence as required for financial reimbursement.

Question Title

* 23. I acknowledge that as a SANE I commit to incorporating Diversity, Equity, and Inclusion as a participant in this program and moving forward as a certified, practicing SANE

Question Title

* 24. When do you plan to take the International Association of Forensic Nurses (IAFN) National Exam?

Question Title

* 25. Which IAFN National Certification Exam will you take?

Question Title

* 26. Are you currently a member of the IAFN?

Question Title

* 27. Was/is the cost of the IAFN National Certification Exam a barrier to acquiring this certification?

* 21. I acknowledge that I am responsible for National Examination Fees prior to testing.

*If accepted Exam fees will be reimbursed after proof of Exam completion.