Program Registration

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.

Have you received approval from a specialty manager to register for the program? *For the Family Practice Nursing Education Program ONLY, please choose "Yes" whether you are sponsored or self-referred.

Yes

No. If no, please do not proceed with registering until you have received approval from a specialty manager. If you require more information about this process, please contact us at LearningInstitute@nshealth.ca

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):

Preferred Name:

Address:

City:

County: (Please choose from the dropdown below)

Province:

Postal Code:

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:

Employment Status:

Professional Designation: (Please choose a designation from the dropdown below)

Other:

Current License Registration Province:

Please enter N/A if the following is not applicable

Current License Registration Number:

License Type:

Active Practicing

Temporary

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)

Other

Current Employer - Hospital / Agency:

Specific Unit - Floor / Designation:

Immediate Manager:

Immediate Manager Phone Number:

Supervisor Ext. Number:

Immediate Manager Email:

Program: (Please choose a program from the dropdown below)

Program Study Option:

Accelerated Part Time

Full Time

Regular Part Time

Full time/Part time

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.

Yes

I am a self-referred learner, and as such, I understand that I am required to pay all program fees owing to the finance department of Nova Scotia Health.

Yes

(See website for policy)

I agree to be bound by all regulations and policies of the program.

Yes

(See website for policies)

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.

You are required to upload your resume, cover letter, and any other supporting documents (BLSC, ACLS etc.) at time of registration.

Please note, only Microsoft Word and PDF documents can be uploaded.

Attach Your Cover Letter

Attach Your Resume

Attach Supporting Document 1

Attach Supporting Document 2

Verify you are not a robot