Refresher Lite Cohort Registration

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

Please review your state's Board of Nursing requirements with regards to the Refresher Lite Course prior to registering.

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.

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?
About Your Status
Which course are you registering for?

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

In which state are you applying for licensure? Colorado Arizona Wyoming Nevada Utah Minnesota Oregon Other Other
What is the status of your license?
Please enter your License # or N/A

Please enter your License Number. If you do not have a License, please enter "N/A"
In which state do you hold your previous or current license?
I have reviewed my state's Board of Nursing requirements.

I have reviewed my state's Board of Nursing requirements. Yes
Does your state require clinical hours to re-instate your license?

Does your state require clinical hours to re-instate your license? Yes No
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 Post Card 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
Licensure Note: By checking the box below I acknowledge that completion of this course is not a guarantee of re-licensure. I understand that receipt of my license is determined at the sole discretion of the Colorado State Board of Nursing. I will need to certify that I have completed and understood all material in the 40-hour course.

Licensure Note: By checking the box below I acknowledge that completion of this course is not a guarantee of re-licensure. I understand that receipt of my license is determined at the sole discretion of the Colorado State Board of Nursing. I will need to certify that I have completed and understood all material in the 40-hour course. Yes
How will you be paying for the course?
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
Pre-assessment questions: Please rate your level of agreement to the following questions, with 1 meaning "Do Not Agree" 2 meaning "Somewhat Agree" and 3 meaning "Strongly agree".

Please give yourself an honest assessment.
I am prepared to respond to changes in my patient’s condition.

I am prepared to respond to changes in my patient’s condition. 3- Strongly Agree 2- Somewhat Agree 1- Do Not Agree
I have a good understanding of the pathophysiology.

I have a good understanding of the pathophysiology. 3- Strongly Agree 2- Somewhat Agree 1- Do Not Agree
I have recently had the opportunity to practice my clinical decision-making skills

I have recently had the opportunity to practice my clinical decision-making skills 3- Strongly Agree 2- Somewhat Agree 1- Do Not Agree
I am confident in using evidence-based practices to provide care

I am confident in using evidence-based practices to provide care 3- Strongly Agree 2- Somewhat Agree 1- Do Not Agree

Refresher Lite Cohort Registration

Refresher Lite 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

Pre-assessment questions: Please rate your level of agreement to the following questions, with 1 meaning "Do Not Agree" 2 meaning "Somewhat Agree" and 3 meaning "Strongly agree". Please give yourself an honest assessment.

Pre-assessment questions: Please rate your level of agreement to the following questions, with 1 meaning "Do Not Agree" 2 meaning "Somewhat Agree" and 3 meaning "Strongly agree".

Please give yourself an honest assessment.