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First Name
   
Last Name
   
 
 
 
Gender
 
Male
 
Female
 
Decline to specify
 
 
 
Mobile
   
Home
   
 
 
 
In what THR facility are you currently employed?
 
 
 
If employed, what is your non-UTA College of Nursing Employment status?
 
 
 
Name of THR Entity(ies) teaching APBSN Students:

 
 
 
If you have a Master's in Nursing degree, select your speciality.
 
 
 
If you have a BSN and a Non-Nursing Master's degree, list the name of the Non-Nursing Master's degree.
   
 
 
 
Do you currently teach in a different prelicensure nursing program that is not the UTA APBSN program?
 
Yes
 
No
 
 
 
Please identify the prelicensure nursing program in which you teach.
 
Associates degree in Nursing (ADN)
 
Baccalaureate degree in Nursing (BSN)
 
 
 
Would you like more information about the University of Texas at Arlington College of Nursing Graduate Nursing Education Certification Program?
 
Yes
 
No
 
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