SANE Fellows Application July 2025

Before applying for the SANE fellowship, please review the following requirements and their dates:

All times are in Mountain Standard Time

SANE Fellowship Orientation: September 15th, 2025, 6:00 pm - 7:30 pm MST
Bias and Mental Health in SANE Training: September 29, 2025, 6:00 pm - 8:00 pm MST
Resiliency and Retention Workshops: Mondays 6:00 pm - 7:30 pm MST
October 13th, 2025
November 10th, 2025
December 8th, 2025
January 12th, 2026
February 9th, 2026

* For states without their own clinical skills lab, please make sure you can attend ONE of the offerings in Idaho (DVSAC):
During your interview and acceptance, you will select the dates you will attend with your interviewer

September 2025 TBD
November 2025 TBD
November 2025 TBD
December 2025 TBD

If you have any further questions, please contact Cheynna Naito at Cheynna@coloradonursingcenter.org

Name Name First Last
Phone Number Phone Number - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email Address
Current Employer
What state are you applying for your SANE training in?

What state are you applying for your SANE training in? Colorado Idaho New Mexico Washington Wyoming
Current education level

Current education level ADN BSN MSN PHD DNP Other (please specify) Other (please specify)
What best describes your Primary Discipline/Specialty

What best describes your Primary Discipline/Specialty Advanced Practice Nursing Clinical Nurse Leader (CNL) Clinical Nurse Specialist (CNS) Community Health Nursing Forensics Nurse Administrator Nurse Anesthetist Nurse Educator Nurse Midwife Nurse Practitioner (NP) Nurse Informatics Public Health Nurse Registered Nurse (RN)
Initial Date of nursing licensure (Month/Year)
What is your NPI number? (N/A if you don't have one)

Required by HRSA
What is your employment location setting?

What is your employment location setting? Medically underserved communities National Health Service Corp (NHSC-Approved Site) Primary care setting Rural Area None of the above N/A
What is your current employment status?

What is your current employment status? Full-time Part-time On leave of absence
Please select the option that best describes the your place of employment from the list below:
If other, please specify below:
Upon completion do you plan to serve a rural or an underserved area?

Upon completion do you plan to serve a rural or an underserved area? Yes No
Are you interested in becoming nationally certified as a SANE under IAFN?

Are you interested in becoming nationally certified as a SANE under IAFN? Yes No
Do you have 2 years of unrestricted RN licensure experience?

Do you have 2 years of unrestricted RN licensure experience? Yes No