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RN Bridging/Re-entry Application

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First Name:

Middle Name:

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Last Name:

Prefered Name:

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Street:

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City:

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Province/Country:

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Postal Code:

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Home Phone:

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Work Phone:

Cell Phone:

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Email:

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Date of Birth (yy/mm/dd):

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Country of Origin:

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Country of Study:

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Name of Nursing School:

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Graduation Date from Nursing School (YYYY/MM):

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Highest Level of Nursing Education:

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Years of Experience as a Registered Nurse:

Currently Employed as:

RN LPN CCA Other N/A

Name of Current Canadian Employer:

Briefly describe most recent nursing position:

For Newcomers to Canada:

Arrival Date in Canada (yyy/mm/dd):

Temporary Resident:

 Visitor Permit
 Study Permit
 Work Permit

Permanent Resident:

 Economic Class
 Family Class
 Refugee Class

Canadian Citizen?

Yes No

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Languages:

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English First Language?

Yes No

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If English is not the first language, was a language proficency test completed?

Yes No N/A

If yes, name of language proficiency test:

Date of language proficiency test:

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Please indicate course(s) you are applying for:

 Professional Nursing in Canada
 Professional Communication for Nurses
 Pharmacology for Nurses
 Medication Administration for IENs
 Health Assessment
 Skills Course
 Clinical Course
 Maternal-Infant Health Theory
 Maternal-Infant Health Clinical
 Child Health Theory
 Child Health Clinical
 Psychiatric-Mental Health Theory
 Psychiatric-Mental Health Clinical
 Documentation Module
 Changes in Health and Therapeutic Interventions
 Changes in Health and Therapeutic Interventions II

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Have you ever been referred for or participanted in a competence assessment and/or education for initial RN registration in Canada?

Yes No

If yes, when and where?

Name of RN regulatory body you have applied for RN registration in Canada: 

Have you been given permission by the RN regulatory body to write the NCLEX-RN?

Yes No

Note: If you were referred for this education by a RN Regulatory Body (for example, the Nova Scotia College of Nursing) and have signed a Consent for Release of Information, then this completed application can be shared with the RN Regulatory Body.