FCN Training Application

Foundations of Faith Community Nursing Training Application

This form is to be completed after your registration has been finalized, and prior to the start of the course.

Faith Community Nursing Application

First Name *

Last Name *

Email *

Work Position and Address

Place of Employment

Position Held

Employer Address

Line 2

City

State/Province

Zip/Postal

Country

Faith Community Affiliations

Name of Faith Community in which you anticipate serving as a Faith Community/Parish Nurse

Address of Faith Community

City

State/Province

Zip/Postal

Country

How long have you attended this faith community?

Names of any past faith community affiliations including approximate dates, city, and state

Attach your resume here, or complete the Education and Work Experience Fields below

Maximum file size: 104.86MB

Education: List formal programs, degrees, and certifications in chronological order. Including other pertinent educational experiences.

If you attached your resume, you may skip this field.

Work Experience: List all pertinent employed positions in chronological order. Briefly describe your duties and achievements.

If you attached your resume, you may skip this field.

Describe non-employed related projects/responsibilities that might contribute to your ability to be a Faith Community Nurse.

Briefly relate other life experiences that may contribute to your ability to be a Faith Community/Parish Nurse.

In a few words, describe your understanding of wholistic health, especially the role of the spirit. Give examples of how you have applied wholistic health concepts in your nursing practice.

In your own words, describe your understanding of Faith Community/Parish Nursing.

We strongly urge you to speak with your clergy and church leaders about Faith Community Nursing prior to the start of our class. Share with us their reaction and plans for this ministry.

Is there any other information you would like to include about yourself or your Faith Community Nursing journey?