Nursing Pre-training Evaluation Form
Please complete this evaluation to help us assess your readiness for the upcoming nursing training program.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Highest Level of Nursing Education Completed
*
Please Select
Diploma in Nursing
Associate Degree in Nursing
Bachelor of Science in Nursing (BSN)
Master of Science in Nursing (MSN)
Other
Briefly describe any prior clinical or nursing experience
Which of the following basic nursing skills are you comfortable with?
*
Taking vital signs
Administering oral medications
Assisting with patient mobility
Basic wound care
None of the above
Other
How would you rate your confidence in performing basic nursing procedures?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
What are your main learning objectives for this training?
Are you able to commit to the full duration of the training program?
*
Yes
No
Submit Evaluation
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