LPN Refresher Retake Registration

Please fill out this form to request a retake of the Refresher Course.

Date Date / MM / DD YYYY
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
County
Phone Phone - ### - ### ####
Email
Age
Race
Hispanic / Latino
Gender
Are you from a rural or underserved area?

Are you from a rural or underserved area? Yes No Not Reported
About Your Status
What is the status of your license?
Please enter your License # or N/A

Please enter your LPN License Number. If you do not have an LPN License, please enter "N/A"
In which state are you licensed (N/A if none)
How long have you been out of clinical practice? (e.g. 3 months)
What is your education level? (Choose all that apply)

What is your education level? (Choose all that apply) Diploma/GED PN ADN BSN MSN PhD DNP Other
Photo/Video Release Statement
You consent to your voice and likeness being videotaped, photographed, and otherwise recorded, without compensation, for any purposes whatsoever in print media, on the internet, and all other media now known or later developed. You release the Colorado Center for Nursing Excellence from any liability due to this recording and use. If you have any questions or concerns, please contact Brittany Hill at Brittany@ColoradoNursingCenter.org

You consent to your voice and likeness being videotaped, photographed, and otherwise recorded, without compensation, for any purposes whatsoever in print media, on the internet, and all other media now known or later developed. You release the Colorado Center for Nursing Excellence from any liability due to this recording and use. If you have any questions or concerns, please contact Brittany Hill at Brittany@ColoradoNursingCenter.org I consent I do not consent
Do you need accommodations in order to complete this course? Send an email to brittany@coloradonursingcenter.org to securely begin our process.
Payment
Refund Policy: I understand that there are NO REFUNDS of the Course retake fee.

Refund Policy: I understand that there are NO REFUNDS of the Course retake fee. Yes
I understand that the Nurse Refresher Course is NOT an NCLEX Preparation course. While there are opportunities to practice for the NCLEX, and some of our students have used this course as part of their preparation, we cannot guarantee that students will pass the NCLEX exam after taking this course.

I understand that the Nurse Refresher Course is NOT an NCLEX Preparation course. While there are opportunities to practice for the NCLEX, and some of our students have used this course as part of their preparation, we cannot guarantee that students will pass the NCLEX exam after taking this course. Yes
Licensure Note: By checking the box below I acknowledge that completion of this course is not a guarantee of licensure. I understand that I will need to take and pass the final exam with an 80 percent or better in addition to completing this course and any other requirements of the State Board of Nursing to be eligible to receive my license.

Licensure Note: By checking the box below I acknowledge that completion of this course is not a guarantee of licensure. I understand that I will need to take and pass the final exam with an 80 percent or better in addition to completing this course and any other requirements of the State Board of Nursing to be eligible to receive my license. Yes
Payment Process

The fee for retaking this course is half of the current course tuition. Upon your acceptance of the performance plan, a member of our team will be in contact with you to arrange payment.

LPN Refresher Retake Registration

LPN Refresher Retake Registration

About Your Status

Photo/Video Release Statement

Do you need accommodations in order to complete this course? Send an email to brittany@coloradonursingcenter.org to securely begin our process.

Payment

Payment Process