2017 Nurse Residency - Application

*** PLEASE NOTE - All fields are required ***

General Information

Today's date:

General Information

Work Phone:
Cell Phone:
Preferred: Work | Cell
I am easiest to reach (days, times, etc):
Preferred Email:
I check my email: Weekly | Daily | Hourly
How do you prefer to be contacted?


1. What is your primary goal for participating in SRHC's Nurse Residency program?

2. What top three strengths do you bring to the Nurse Residency relationship that would lead to its success??

3. What are you looking for in a nurse residency?

4. Describe your communication style.

5. What would you like your Nurse Residency to know about you?

6. What interests do you have outside of work?

7. What are your expectations of the Nurse Residency?