FCN Educator Course Application

Prior to completing this application, please carefully read all information available on the FCNEd course page of the Foot Canada Training website, including the FCNEd Course Outline. By submitting this application you are confirming that you have read this information.

Please contact us should you have any questions. We endeavour to respond to all inquiries within 1-3 business days.

You are currently applying for the FCNEd SPRING semester course - FCNEd course dates: April 20, 2021 - June 29, 2021.

Registration for the fall semester FCNED course will open May 4, 2021.

Student Information

Student Declaration:*

I confirm that I have read the Online Foot Care Nurse Educator Course Outline.

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*

Email Address*

Phone*

Course Prerequisites

NURSING REGISTRATION

Nursing Title:*

If "Other", please specify

Nursing Registration Number:*

FCN TRAINING

Please provide the details of your most recent Canadian Foot Care Nurse course(s), which included both theory and onsite training.

Course title (as stated on your certificate of completion):*

Date of completion:*

Total combined number of hours for the theory portion and the onsite clinical/ practicum:*

Name(s) of the educator(s) &/or facility:*

Location (city and province):*

Payment Options

Please select the tuition rate based on the province/territory where you reside.*

DISCOUNT - The discounted tuition rate of $250 + tax is available to students meeting one or more of the criteria listed below. To be screened for this discount, please select the criteria applicable to you:

1. Returning student to Foot Canada Training's FCN Educator course (2019 or later)

2. Graduate of previous Foot Care Kingston FCN Educator Course (2012-2019)

If you selected one of the discount criteria above, please provide the month and year when you previously registered with Foot Canada Training (formerly Foot Care Kingston).

Please select your prefered method of payment. *

Interac E-Transfer

Credit Card

Money Order (an additional adminitrative fee of $50 + tax will be applied if requesting this option)

Sponsoring Organization

If your employer or sponsoring organization is paying your tuition, please provide the name, email and number of the person responsible for making the payment, as well as the company name and address. We will send them an electronic invoice, which gives them the option to pay by credit card.

Name

Title

Phone

Company Name

Address

City

Province

Postal Code

Keep in Touch

How did you first hear about Foot Canada Training's Foot Care Nurse Educator course?*

If "Other", please specify

Our quarterly e-newsletter is the best way to stay up to date on our available courses, curriculum and textbook, as well as receive information of interest to the foot care nursing community. Would you like your email address to be added to our mailing list? You can unsubscribe at any time.*

I have reviewed this application and can verify that all the information that I have provided is true and accurate.*

Yes

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