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Application For Approval As Continuing Education Provider - California
| Application For Approval As Continuing Education Provider Form. This is a California form and can be used in Board Of Registered Nursing Department Of Consumer Affairs Statewide . |
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BOARD OF REGISTERED NURSING PO Box 944210, Sacramento, CA 94244-2100 P (916) 322-3350 F (916) 574-8637 | www.rn.ca.gov Louise R. Bailey, MEd, RN, Executive Officer CONTINUING EDUCATION PROVIDER FACT SHEET ALL APPLICANTS MUST PROVIDE THE FOLLOWING: Application fee of $200 (check or money order) payable to the Board of Registered Nursing. Completed Application for Approval as a Continuing Education Provider, including the Course Information form (page 3) and Instructor Information form (page 4). · Be sure to provide your Federal Employer Identification Number (FEIN), if you are a business or corporation, or your Social Security Number (SSN), if you are an individual and do not have a FEIN number. Failure to include this will delay processing of your application. ALERT: Effective July 1, 2012, the Board of Registered Nursing is required to deny an application for licensure and to suspend the license/certification/registration of any applicant or licensee who has outstanding tax obligations due to the Franchise Tax Board (FTB) or the State Board of Equalization (BOE) and appears on either the FTB or BOE's certified lists of top 500 tax delinquencies over $100,000. (AB 1424, Perea, Chapter 455, Statutes of 2011). · If you are planning to offer an advanced pharmacology course to nurse practitioners and/or nursemidwives, contact CE Program staff to be sure your course meets BRN requirements. If you have any other questions about the Continuing Education Program, please call us at (916) 322-3350. A sample of the advertising flyer/brochure and the certificate of completion The time required to process a complete application is a minimum of four to six weeks. The application fee of $200 is an earned fee for evaluating your application. The fee is NOT refundable. ***IMPORTANT*** The Board of Registered Nursing requests that all BRN-approved continuing education (CE) providers permit persons whose licenses have been disciplined by the Board to attend continuing education courses because these persons may have difficulty finding approved CE courses within a geographic area or which meet certain time constraints. It has come to the Board of Registered Nursing's attention that, at times, persons whose licenses have been disciplined (had the license to practice registered nursing surrendered, revoked, suspended, or placed on probation) have been denied the opportunity to take continuing education (CE) courses. Please note that the Board, with some exceptions, permits any person who has a license issued by the Board and whose license has subsequently been disciplined, to take CE courses. The exceptions are when the course has a direct patient care component and the disciplined license is in a revoked status, or is currently suspended from practice, or the person is on probation and enrollment in the course must be approved by the BRN. Persons with disciplinary action may need to present documented evidence to the Board verifying completion of CE courses in order to demonstrate current nursing knowledge. Such documentation may be needed by a petitioner for reinstatement of a registered nursing license or by a nurse on Board-imposed probation. The certificate to be issued to persons who have a license revoked or suspended after successful course completion can contain the name of the person without the initials "RN" and without an RN license number. For registered nurses with a license on probation, the initials "RN" and the license number can appear on the certificate. American LegalNet, Inc. www.FormsWorkFlow.com CONTINUING EDUCATION PROVIDER FACT SHEET (Cont.) THE FOLLOWING IS PROVIDED AS AN EXAMPLE OF THE REASONS APPROVAL MAY BE DELAYED OR DENIED: FEDERAL TAX IDENTIFICATION NUMBER The Federal Tax Identification Number (FEIN) is missing. If you are a corporation, health facility, school, etc., use your FEIN; if you are not a corporation and do not have a FEIN, use your Social Security Number. COURSE INFORMATION The Course Information page is incomplete for the following reason(s): Title of the course is not stated. Objectives are not stated using behavioral terminology. Overview/description of the course is incomplete. Overview/description of the course is not stated. Type of offering (i.e. academic, workshop, in-service, home study, etc.) is not noted. Teaching methods are not indicated. The number of contact hours is not stated. Content is not presented in a comprehensive topical outline format. Course content does not reflect post RN licensure content. INSTRUCTOR INFORMATION Instructor information has not been submitted. Instructor information is incomplete. Instructor license number, expiration date, and type have not been provided. ADVERTISEMENT The sample flyer/brochure has not been submitted. The sample advertising flyer/brochure that you submitted is not in compliance for the following reason(s): Provider's name, as officially on file with the BRN, is different or missing. Provider statement, "Provider approved by the California Board of Registered Nursing, Provider # ______, for ___ Contact Hours" should appear verbatim. The refund/cancellation policy in the event of non-attendance by the licensee needs to be stated. A clear, concise description of the course content and/or objective(s) has not been provided. Delete the term CEUs. CEUs are given by colleges and universities only; the correct term is CE contact hours or contact hours. CERTIFICATE OF COMPLETION The sample certificate of completion has not been submitted. The sample certificate of completion that you submitted in not in compliance for the following reason(s): Provider's name, as officially on file with the BRN, is different or missing. Provider statement, "Provider approved by the California Board of Registered Nursing, Provider # ______, for ___ Contact Hours" should appear verbatim. The retention statement regarding RN retaining the document for a period of 4 years after the course concludes is missing. Delete the term CEUs. CEUs are given by colleges and universities only; the correct term is CE contact hours or contact hours. CEP App (rev 05/04) Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR APPROVAL AS A CONTINUING EDUCATION PROVIDER FEE $200 FOR OFFICE USE ONLY Be sure to complete the entire application, including the Course Information and Instructor Information forms. Please type or print all entries. Provider No: Cashier No: Approval Period: 1. Provider/Business Name: 3. Address: Cit
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