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Critical Access Hospital Learning Network

Administration

Enrollment Form

Hospital Name and Address
  1. A value is required.
  2. A value is required.
  3. A value is required.
  4. A value is required.
  5. A value is required.Invalid format.
Primary Contact
  1. A value is required.
  2. A value is required.
  3. A value is required.Invalid format.
  4. A value is required.Invalid format.
Number of Employees in Hospital
  1. A value is required.Invalid format.
  2. A value is required.Invalid format.
  3. A value is required.Invalid format.
  4. A value is required.Invalid format.
Statement
  1. The University of Southern Indiana College of Nursing will provide 12 one-hour presentations per year and will provide a quarterly activity report. The fee for participating is $500.