Contact Us, Native Nurses Career Opportunity Program in the School of Nursing at the University of Minnesota

Information_Request_Form

By mail:	Native Nurses Career Opportunity Program University of Minnesota School of Nursing 5-140 Weaver-Densford Hall 308 Harvard Street SE Minneapolis, MN 55455
By telephone:	612-624-4644
By FAX:	612-626-3255
By E-mail:	NativeRN@umn.edu
In person:	Maps, driving directions, parking information

If you have questions or would like more information sent to you, please fill out the form and we will quickly respond to your inquiry!

First Name:	Last Name:

Street Address:

City:	State:	Zip Code:

Home/Mobile Phone Number:	Work Phone Number:

E-mail Address:

Your answers to the following questions help determine your eligibility for this scholarship. Thank you!
1. Do you have an RN degree? 2-year? 4-year? Other?

2. Do you have bachelor's degree? If yes, major?

3. Tribal Affiliation:

4. Do you have an advanced degree? If yes, major?

5. Are you currently attending college? If yes, where?

6. Are you interested in Public Health Nursing? Nurse Midwifery? Nurse Anesthesia? Other?

7. Are you interested in distance learning? In-person classes?

8. How did you hear about NNCOP?

9. Are you a commissioned corp officer? Yes No
10. Are you currently working in a health care related field? If so, state where and what setting you work in.

11. Any other training relevant to your nursing career that you want to tell us about?

By submitting this form, I understand that NNCOP will contact me.

©2002 Regents of the University of Minnesota. All rights reserved.

The University of Minnesota is an equal opportunity educator and employer.

Last modified on Friday Apr 29, 2005

This page is located at http://www.nursing.umn.edu//NNCOP/ContactUs/home.html