Please do not complete a registration form until you have received confirmation from a specialty manager that you are supported to participate in a program.
You are required to upload your resume and cover letter at time of registration.
Once you complete this registration form and click “submit” you will be prompted to upload your resume, cover letter and any other supporting documents (BLSC, ACLS etc.).
Have you received approval from a specialty manager to register for the program?
If yes, please provide manager's name:
First Name (as it will appear on all correspondence and or official documents):
Last Name (as it will appear on all correspondence and or official documents):
County: (Please choose a county from the dropdown below)
Preferred Contact Number: (Please provide the phone number we can best contact you)
Work Phone Number:
Work Number Extension:
Email: (Please provide the email address that you check most frequently. This is our most frequent method of correspondence.)
Please Confirm Your Email:
Professional Designation: (Please choose a designation from the dropdown below)
Current License Registration Province:
Please enter N/A if the following is not applicable
Current License Registration Number:
Current License Registration Expiry Date: (mm/yyyy)
Month of Graduation (mm)
Year of Graduation (yyyy)
Health Authority: (Please choose a health authority from the dropdown below)
Current Employer - Hospital / Agency:
Specific Unit - Floor / Designation:
Immediate Manager Phone Number:
Supervisor Ext. Number:
Immediate Manager Email:
Program: (Please choose a program from the dropdown below)
Program Study Option:
Program Start Date: (Please choose a date from the dropdown below)
Registrations will only be processed upon receipt of a fully completed registration form.
Learners who are not residents of Nova Scotia must submit a photocopy of registration in another province or a letter of professional association stating eligibilty for NS registration.
I confirm my intent to participate in the program listed above. I understand that I am required to pay all fees owning to the finance department of Nova Scotia Health Authority. I agree to be bound by all regulations and policies of the program. (See website for policy)
A reference from your immediate manager is required as part of the registration process. The referee can fax or submit the form to the RNPDC or return it to you in a sealed envelope for your submittal.