Applications will be processed as they are received, and applicants will be notified soon after as to whether the application has been accepted.
Application
Please complete the following carefully. You will be contacted as soon as possible for further information.
Items marked with an asterisk (*) are required.
First Name *
Last Name *
Physical Address
Address 1 *
Address 2
City *
State *
Zip Code *
Mailing Address (if different from above)
Address 1
Address 2
City
State
Zip Code
Employer Address
Employer (Organization) Name *
Address 1 *
Address 2
City *
State *
Zip Code *
Contact Information
Email Address *
Home Phone *
Work Phone *
Cell Phone
What is the best method of inital contact for you?
What time of day is best?
Current Position/Title *
Number of Years in Nursing *
Number of Years in ED Nursing *
Number of Years Triage Experience *
Certifications Held (with expiration dates of each)
If applicable, when and where did you attend the Triage First Comprehensive ED Triage Course?
Month
Year
City
Size of Facility (visits per annum)
Does your facility have a pediatric department?
What triage acuity scale does your department use?
Triage Specialist Course you would like to attend:
How did you hear about the Triage Specialist Course?
What are your motivations or reasons for participating in this course?
What is your view of the role of the triage nurse in the emergency department?
What is the most significant challenge to implementing change in your ED?
Additional Requirements
