Nurse Refresher Cohort Registration

Please fill out this registration form to start the Nurse Refresher enrollment process.

The Refresher course offers rolling admissions with a cohort design. Each cohort will begin the 2nd Tuesday of the calendar month following your registration. Payments for the cohort will come out of your selected payment method on the 1st of the month.

***Payments will be processed at midnight UTC. For example: April 1st payments will process at 5:00 pm MT on March 31st.

Today's Date Today's 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?
About Your Status
Which course are you registering for?

Which course are you registering for? RN Refresher LPN Refresher
In which state are you applying for licensure?

In which state are you applying for licensure? Colorado Arizona Wyoming Nevada Utah Minnesota Oregon Other (Enter state in the box below) Other (Enter state in the box below)
What is the status of your license?
Please enter your License #

Enter NA if you do not currently hold a license
In which state do you hold your previous or current license?
How long have you been out of clinical practice?

How long have you been out of clinical practice? 0 - 2 years 2 - 5 years 5 - 10 years 10 - 15 years 15+ years
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
Why are you taking this course?
How did you hear about us?

How did you hear about us? Colorado Center for Nursing Excellence Website Email Rotation or School Presentation Social Media Teacher/Counselor Word of Mouth State Board of Nursing Web Search Postcard in the Mail Other Other
Would you like to join the Colorado Center for Nursing Excellence mailing list to receive monthly newsletters?
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 for course tuition once the cohort begins. Refunds must be requested before the cohort start date.

- Refund received will be less a 35% Administration Fee that will be deducted from the full course tuition.

Refund Policy: I understand that:

- There are no refunds for course tuition once the cohort begins. Refunds must be requested before the cohort start date.

- Refund received will be less a 35% Administration Fee that will be deducted from the full course tuition. 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
The Center's Nurse Refresher Courses are approved by boards of nursing from multiple states. If your state's board of nursing requires successful completion of a refresher course prior to sitting for the NCLEX, understand that the Nurse Refresher Course is not an NCLEX Preparation course. While there are opportunities to practice for the NCLEX-type questions as well as clinical decision-making scenarios, you may want to consider also enrolling in an NCLEX preparation course prior to sitting for the NCLEX exam.

The Center's Nurse Refresher Courses are approved by boards of nursing from multiple states. If your state's board of nursing requires successful completion of a refresher course prior to sitting for the NCLEX, understand that the Nurse Refresher Course is not an NCLEX Preparation course. While there are opportunities to practice for the NCLEX-type questions as well as clinical decision-making scenarios, you may want to consider also enrolling in an NCLEX preparation course prior to sitting for the NCLEX exam. Yes, I Understand
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
How will you be paying for the course?
Today's Date Today's Date / MM / DD YYYY
Nurse Refresher Enrollment Survey

We are gathering this data to better understand our students employment status prior to enrollment.
Are you currently employed?

Are you currently employed? Yes No I prefer not to answer
What is your job/role/title?
What is your average hourly salary rate/tips?
On average, how many hours per week do you work?

On average, how many hours per week do you work? Less than 10 hours 20 hours 30 hours 40 hours more than 40 hours

Nurse Refresher Cohort Registration

Nurse Refresher Cohort 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

Nurse Refresher Enrollment Survey