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Program Registration

Have you received approval from a specialty manager to register for the program? Note: For Family Practice Nursing Program (FPNP) or the Interprofessional Simulation Facilitation Course (Sim-IPE), please choose "Yes" whether you are sponsored or self-referred.

Yes

No. If no, please do not proceed with registering until you have received approval from a specialty manager. If you require more information about this process, please contact us at LearningInstitute@nshealth.ca

If yes, please provide sponsoring manager's name: (Please enter N/A if not applicable.)

If yes, please provide sponsoring manager's email: (Please enter N/A if not applicable.)

Given Name (as it will appear on all correspondence and or official documents):

Last Name (as it will appear on all correspondence and or official documents):

Preferred Name:

Address:

City:

Postal Code:

County: (Please choose from the dropdown below)

Province:

Preferred Contact Number: (Please provide the phone number we can best contact you)

Work Phone Number:

Work Number Extension:

Email: (Please provide the email address that you check most frequently. This is our most frequent method of correspondence.)

Please Confirm Your Email:

Employment Status:

Professional Designation: (Please choose a designation from the dropdown below)

Other:

Current License Registration Province:

Please enter N/A if the following is not applicable

Current License Registration Number:

License Type:

Current License Registration Expiry Date: (mm/yyyy)

Month of Graduation (mm)

Year of Graduation (yyyy)

Health Authority: (Please choose a health authority from the dropdown below)

Other

Current Employer - Hospital / Agency:

Specific Unit - Floor / Designation:

Immediate Manager:

Immediate Manager Phone Number:

Supervisor Ext. Number:

Immediate Manager Email:

Program: (Please choose a program from the dropdown below)

Program Study Option:

Program Start Date: (Please choose a date from the dropdown below)

Registrations will only be processed upon receipt of a fully completed registration form.

Learners who are not residents of Nova Scotia must submit a photocopy of registration in another province or a letter of professional association stating eligibilty for NS registration.

I confirm my intent to participate in the program listed above.

Yes

I am a self-referred learner, and as such, I understand that I am required to pay all program fees owing to the finance department of Nova Scotia Health.

Yes

(See website for policy)

I agree to be bound by all regulations and policies of the program.

Yes

(See website for policies)

You are required to upload your resume at time of registration.

Please note, only Microsoft Word and PDF documents can be uploaded.

Note: Not applicable for Interprofessional Simulation Facilitation Course (Sim-IPE).

Attach Your Resume

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The Nova Scotia Health Learning Institute for Health Care Providers offers education programming designed to meet the needs of learners across the province and strengthen our health care system. We are committed to delivering high-quality, evidence-informed programming that enables providers to develop and maintain foundational and specialty competencies.