Application for Valencia’s RN Refresher 1 RN REFRESHER1 Application
INSTRUCT IO NS: Upon completion, email to cmillenson@valenciacollege.edu as an attachment.
Date of Application: Click here to enter a date. Name: Click here to enter text. Address: Your address. Home Phone: Your phone Other Phone: Cell or work Email Address: Your email
Pleaseanswer the following questions: 1. Why are you interested in taking this course? Your answer 2. Do you have an active Florida RN license? Your answer 3. What is your Florida RN license number? Your answer 4. Have you had at least two years of licensed nursing experience in a medical surgical setting? Your answer 5. How many years have you been absent from medical surgical nursing? Your answer
7. Are you in good health and able to perform the demanding nursing tasks required in a medical surgical setting including 12 hour shifts? Your answer.
8. How would you qualify your computer skills? Your answer c:\documents and settings\cmillenson\desktop\shortcuts\forms\course\application_rnrefresher1.do/mnt/conversion/splitting/120404014536e13df90f5a5a45fba6c29dba4f31b7e1.file
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6. The clinical portion of the program, RN Refresher 2, is coordinated by the college with Florida Hospital and included any one of their seven Central Florida campuses(Orange, Osceola, and Seminole Counties). Will this create a geographical hardship for you?
Application for Valencia’s RN Refresher 1 9. Do you own a computer or have regular and easy accessto one? Your answer 10. Your computer’s accessto the internet is (1) high speed or (2) dial up Your answer
I understand that I must successfully complete RN Refresher 1 before I can register for RN Refresher 2 clinical practicum and be eligible to complete a 96 hour hospital clinical rotation. Please sign your name below.
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Signature (type name above)
c:\documents and settings\cmillenson\desktop\shortcuts\forms\course\application_rnrefresher1.do/mnt/conversion/splitting/120404014536e13df90f5a5a45fba6c29dba4f31b7e1.file