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Triage Specialist Course Application Prerequisites

  1. Must have at least two years of experience as a registered nurse in the Emergency Department.
  2. Must have at least 18 months of experience at triage.
  3. Must have one letter of recommendation – from your ED nurse manager.


Please complete the following carefully. You will be contacted as soon as possible for further information. There are a limited number of spaces available for each course. Participant acceptance will be based on a combination of factors. 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)


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?




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

  • Letter of Recommendation

    Please provide the name, contact number, and email address of your ED nurse manager, who will be contacted by Triage First and asked to provide a letter of recommendation.

    Nurse Manager's First Name


    Nurse Manager's Last Name


    Nurse Manager's Contact Number


    Nurse Manager's Email Address


  • Mail photocopies of certification cards (both sides copied) to:
    Triage First, Inc.
    P.O. Box 1924
    Fairview, NC 28730
    Or fax them to the attention of "Triage Specialist Course" at (828) 628-8025.






© 2008 Triage First, Inc.