Nursing for Reinstatement Application Form

Note: Items marked with an asterisk (*) must be completed.

Personal Information

First Name

Middle Name (optional)

Last Name

Date of Birth

Contact Information

Email Address

Email Confirmation

Home Phone Number

Cell Phone Number (optional)

Academic Information

George Brown Polytechnic Student ID Number (if you have one)

CNO Application Number

Type of Applicant

Registered Nurse (RN)

Registered Practical Nurse (RPN)

What is the purpose of your application?

(Check all that apply.)

I am a reinstatement nurse, and my safe practice requirement has expired.

I need to take the Transition to Practice for Nurses course.

I need evidence of my fluency in English.

I want Canadian nursing experience in a clinical setting.

How many clinical hours do you require to meet the CNO's evidence of safe practice?

200 hours

400 hours

600 hours

Declaration

By checking this box, I hereby declare that the information provided in this form is true and correct.

General Collection Notice: George Brown Polytechnic (the “institution”) collects personal information under the authority of the Ontario Colleges of Applied Arts and Technology Act and in accordance with the Freedom of Information and Protection of Privacy Act. The institution collects personal information for the purposes of administering its statutory objects/powers, programs, and activities and to carry out other services and functions. The institution will secure personal information and use for such purposes as set out in the George Brown Polytechnic Notice of Collection. If you have any questions about the collection, use, and disclosure of personal information at the institution, please visit the institution-wide Privacy Policy page. You may also contact the Privacy Office via email at privacy@georgebrown.ca.

Fee Waiver Eligibility Form