PART 1: APPLICATION DETAILS - PROGRAM FOR ASSESSMENT ADDRESS OF PROVIDER: HEAD OFFICE: PROGRAM TITLE: APPLICANT NAME & TITLE: ( ) TELEPHONE MOBILE: NUMBER: FACSIMILE NUMBER: ( ) EMAIL ADDRESS: THEORETICAL EXPERIENTIAL – HOURS HOURS – COURSE/ COURSE/UNIT TITLE LECTURES & LABORATORY CLINICAL UNIT CODES TUTORIALS & PLACEMENTS SIMULATION OFF CAMPUS
PART 1: APPLICATION DETAILS - PROGRAM FOR ASSESSMENT PROVIDER: ADDRESS OF HEAD OFFICE: PROGRAM TITLE: APPLICANT NAME & TITLE: TELEPHONE NUMBER: ( ) MOBILE: FACSIMILE NUMBER: ( ) EMAIL ADDRESS: – COURSE/ UNIT CODES COURSE/UNIT TITLE THEORETICAL HOURS – LECTURES & TUTORIALS EXPERIENTIAL HOURS LABORATORY & SIMULATION CLINICAL PLACEMENTS OFF CAMPUS
application%20pack%20for%20education%20providers%20-%20registered%20nurses%20re-entry%20v5.docx