National Council of Nurses and Midwives

Member Registration Form.

You must complete all relevant sections and sub-sections except where it is written ‘optional’
The NCNM may choose to ask you to supply documents relevant to your application

Member Information

Personal information

Nationality *

Addresses

Country *

Education & Work Experience

Secondary School (s), O Level, A Level & A2 Nursing *

The first row will appear as the table header. Leave the first row blank if you do not need a header.

1	School Name	Country	Course/Section	Level	Start Date	End Date	Results	Weight
2								Weight
3								Weight
4								Weight
5								Weight
6								Weight
7								Weight

Table description

This brief caption will be associated with the table and will help Assistive Technology, like screen readers, better describe the content within.

Nursing/Midwifery school(s) Attended(University ) *

The first row will appear as the table header. Leave the first row blank if you do not need a header.

1	Nursing/Midwifery school(s) Attended	From Month &Year	To Month &Year	Results/Grades	Weight
2					Weight
3					Weight
4					Weight
5					Weight

Table description

This brief caption will be associated with the table and will help Assistive Technology, like screen readers, better describe the content within.

Qualifications(professional/s) *

The first row will appear as the table header. Leave the first row blank if you do not need a header.

1	Educational institution	Country	Course	Level	Grade	Graduation date	Weight
2							Weight
3							Weight
4							Weight
5							Weight
6							Weight
7							Weight

Table description

This brief caption will be associated with the table and will help Assistive Technology, like screen readers, better describe the content within.

Employer details from now to ten years back *

The first row will appear as the table header. Leave the first row blank if you do not need a header.

1	Employer	Place of work	Job Title	Type of work(Department)	Category of Institution	Start Date	End Date	Weight
2								Weight
3								Weight
4								Weight
5								Weight
6								Weight
7								Weight

Table description

This brief caption will be associated with the table and will help Assistive Technology, like screen readers, better describe the content within.

Registration/Licensure with Nursing Council or Board of Nursing *

Are you registered with Nursing Council or Board of Nursing? if yes, then fill the table below.

1	Council or Board name	Country	Prof. Title/	Reg / Lic. Number	Reg. Date	License Start Date	License End Date	Weight
2								Weight
3								Weight
4								Weight
5								Weight

Table description

This brief caption will be associated with the table and will help Assistive Technology, like screen readers, better describe the content within.

Current Employing Agency *

Account Info

Register

Username *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.

E-mail address *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password *

Confirm password *

Provide a password for the new account in both fields.

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