Nurse Practitioner Training in HIV Prevention and Treatment - Program Registration

Exit and clear survey
 
Program Registration
DisclaimerNurse Practitioner Training in HIV Prevention and Treatment is available to nurse practitioners who hold practicing registration in British Columbia with the College of Registered Nurses of BC.

The BC Centre for Excellence in HIV/AIDS (BC-CfE) is subject to the Freedom of Information and Protection of Privacy Act of BC. We are committed to safeguarding the security and privacy of your personal information. The BC-CfE collects your personal information via this form in order to provide you with this educational service. We only collect the personal information required for this purpose and will not use it for any other purpose than the provision of educational and clinical services, including program monitoring and evaluation and research. We will not share your information without your consent unless required by law.


1. Which program are you registering for?

     





2. Have you previously completed the BC-CfE Intensive Preceptorship Training program?

     


     In what year did you complete the program? 



3. Last Name


     




4. First Name


     




5. CRNBC Registration No.


     




6. MSP Billing No.


     




7. Phone number


     




8. Email address


     




9. Who are you employed by?


     




10. Please provide your current employment information:







11. Is your employer aware of your application for additional training?

     





12. Please provide employer contact information






13. Please provide employer “Bill To” information






14. Do you work with at-risk populations?

     





15. Is there at least one physician treating HIV positive patients at your practice?

     





16. Do you work in an underserved or remote area?

     





17. Comment below if there is any additional information that is relevant to your application.