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- Begin by filling out your personal information in the 'APPLICANT/STUDENT INFORMATION' section. Include your name, email, address, and phone number.
- In the 'APPLICANT/STUDENT WORK EXPERIENCE' section, specify your current position and organization. Select your credential type from the options provided: LPN/LVN, Paramedic, or Military.
- Indicate the hours worked in your nursing-related role within the past year. Provide a detailed description of the patient care you deliver.
- Sign and date the form in the 'APPLICANT/STUDENT SIGNATURE' section to confirm that all information is accurate and that you meet program requirements.
- Ensure your supervisor completes their section by signing and providing their credentials, confirming your employment and experience.
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