Professional Reference

Dear Colleague,

You are completing a professional reference for an educator requesting to teach Foot Canada Training's Foot Care Nurse Clinical, Clinical Refresher and Advanced Skills Workshop Curriculum. To be eligible, this educator must have 750 hours of nursing foot care practice in the past 5 years.

The purpose of this form is to confirm the educator meets this requirement. The educator may have more than one professional reference complete this form if each reference can only validate a portion of the total years of nursing experience or total hours of nursing foot care required. For example, if 300 hours are completed with one employer and 450 hours are completed with another, both employers will need to complete this form for the hours they are able to confirm. The total hours of both references would then be used to validate the applicant has met the prerequisite.

Note: Nurses cannot complete their own professional reference form. This form must be completed by a current or former employer or by a foot care health professional colleague. 

Professional Reference Details

I am:*

the applicant's employer (or former employer).

a foot care health professional.

Please provide your professional title and contact information below.

Title*

First Name*

Last Name*

Address*

City*

State/Province*

Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip/Postal Code*

Email Address*

Phone*

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Educator Details

Name of the educator for which you are providing a professional reference:*

In the last 5 years, I can confirm that the educator has practiced as a Foot Care Nurse for:*

less than 750 hours

750 hours or more

If you have selected 'less than 750 hours', please specify the total number of Foot Care Nursing hours you are able to confirm:

Enter the code displayed*