Call for Board Nominations - NL College of Nurses

Application Form for Board Nominations

This field is for validation purposes and should be left unchanged.

I am offering myself as a nominee for the following positions(Required)

Registered Nurse

Licensed Practical Nurse

Nurse Practitioner

Name(Required)

First Last

Licence Number(Required)

If you do not know your College Licence Number, please use the RN/NP Public Directory or LPN Public Directory to find it.

Address(Required)

Street Address City Province Postal Code

Phone (Work)(Required)

Phone (Home)(Required)

Email(Required)

By providing your e-mail address, you will receive a confirmation message when the form is submitted.

Employer(Required)

Position(Required)

Area of Practice (e.g.: Primary Care, Long-Term Care):(Required)

I have been in this position since(Required)

(Dates)

Graduate of(Required)

(school of nursing)

Graduation Year(Required)

Professional Development/Continuing Education(Required)

Professional Activities(Required)

Personal Statement(Required)

Include your relevant background, skills, and experience including any experience related to the following areas:

Registrant's Full Name(Required)

Date(Required)