Developing Nurse Scientists

Registration

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User Information

*First Name:

*Last Name:

*Email:

*Street Address:

*City:

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*Postal Code:

*Country:

*Highest Academic Degree:

Phone Number:

Fax Number:

Referral:

Primary Place of
Employment:

Primary Job Title:

If Other, specify:

Research Topic Area:

Definitions of Research Areas

If Other, specify:

Research Funding History:

Year
Dollar Amount
Source

Year
Dollar Amount
Source

Year
Dollar Amount
Source

Year
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Year
Dollar Amount
Source

What do you hope to accomplish by taking this course?

Optional Information

Gender:

Ethnicity:

Hispanic or Latino - a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Race:

American Indian or Alaska Native - a person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian - a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, or Vietnam.
Black or African American - a person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific islands.
White - a person having origins in any of the original peoples of Europe, the Middle East, or North America.

Course Accreditation

*Course Credit Options:

Completion Certificate only, no continuing education credits.
Completion Certificate and Continuing Nursing Education credit towards ANA/CEU (for licensed nurses only).

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