Clone of Health Assessment Review for RNs

Course Name

Course Access Dates

Course Code

Course Duration

Refund Deadline

{courseName}

{courseDates}

Course code: {courseCode}

Status

IO Number

Date

Registrant Information

First Name

Last Name

Email Address

Have you previously taken any courses at the University of Toronto

Note: New Students

As a new student to UofT you will be provided a user login called a UTORid.
The UTORid will provide you access to the online course materials and library access.

It is important to remember the spelling of your first and last name, gender and DOB you are registering with as our system
will use this to identify your UTORid for future courses.

Note: Current/Former Students

Current or former students of UofT will have an existing user login called a UTORid.

In order for our system to accurately identify your existing UTORid, you will need to provide the same spelling of your first and last name that you used when you previously enrolled into your courses with the University.

Optional: If you remember your exisiting UTORid, you can provide it below.

If you know your Existing UTORID, please enter it here:

Did you have a Former Name that your Existing UTORID may have been registered with that differs from the name provided above? If so, please provide it below.

Former Name(s)

First NameLast Name

Date of Birth

MonthDayYear

Gender

Gender is a required criteria to create or identify your UTORID

Address

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry

Phone Number

Format: (000) 000-0000.

Employment Information

Organization name:

Title/position:

What is your professional registration category?

What is your practice setting?

What is the main focus of your practice?

How did you hear about this course?

Which organization or association?

Which Social Media Platform?

Which conference or event did you attend?

Is this the first time you are taking a course with the Centre for Professional Development, Lawrence Bloomberg Faculty of Nursing at the University of Toronto?

Payment Information

Select Payment Type

Please enter your Invoice Code here:

Course Fee

BUNDLE - Online Course and In-Person Simulation Lab

Best Value!

$549.00 CAD

Online Course (Part 1 Only)

$349.00 CAD

Simulation Lab In-Person Session (Part 2 Only)

May be purchased separately up to 1 year after completing Part 1. Must complete ALL Modules in Part 1 prior to attending the in-person session.

$349.00 CAD

GROUP Rate - Bundle Online Course and Simulation Lab ( 3+ from the same site)

Enter your Group Code in the promotion box below to apply your group discount.

$549.00 CAD

Subtotal

Tax

Total

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Simulation Lab Date

Please schedule your sim lab session from the available date(s) below.

*Note: Dates may be subject to change. The Centre for Professional Developement reserves the right to cancel or re-schedule the simulation lab dates if there is low attendance.

Please select to confirm attendance for date below:

Total Amount Paid

Applicable taxes (13% HST) will be added to the registration fees.
Discounts cannot be combined.
This information is collected in accordance with the Privacy Policy.

Please Review the Following Before You Submit Your Registration:

{courseName}

{courseDates}

{courseDuration}

Total course fee including HST $ {courseFee:total}

Refund Deadline: {refundDeadline}

You will receive an email with your login details once access has been activated.
The university UTORiD (username) generally takes up to 5 business days for creation and activation.

Click the link to review: UTORid Conditions of Use

We will use the email address {emailAddress} for the following:

To send your confirmation and receipt. Within 15 minutes you will receive a message from Centre for Professional Development, Lawrence Bloomberg Faculty of Nursing (noreply@formresponse.com). You may need to check your Junk folder.
To send your course access instructions.
To add to our mailing list for upcoming courses. You may unsubscribe at any time.

{courseName}

Course Fee*

Please Review the Following Before You Submit Your Registration:

{courseName}

Course Fee