Fillable F2 Additional Page Instructors Fillable L (Arizona State Board of Nursing)

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F2 Additional Page Instructors Fillable L (Arizona State Board of Nursing)

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Instructor has had 1500 hours or one year full time employment as an RN providing direct care (R4-19-802(C)(1)
USE ADDITIONAL PAGES AS NEEDED
Name (as it appears on license):
RN License #:
Telephone:
Email:
Instructor has had 1500 hours or one year full time employment as an RN providing direct care (R4-19-802(C)(1)
Name (as it appears on license):
RN License #:
Telephone:
Email:
Instructor has had 1500 hours or one year full time employment as an RN providing direct care (R4-19-802(C)(1)
Name (as it appears on license):
RN License #:
Telephone:
Email:
Instructor has had 1500 hours or one year full time employment as an RN providing direct care (R4-19-802(C)(1)
Name (as it appears on license):
RN License #:
Telephone:
Email:
Telephone:
Email:
Instructor has had 1500 hours or one year full time employment as an RN providing direct care (R4-19-802(C)(1)
Name (as it appears on license):
RN License #:
Telephone:
Email:
Name (as it appears on license):
RN License #:
Telephone:
Email:
Instructor has had 1500 hours or one year full time employment as an RN providing direct care (R4-19-802(C)(1)
Name (as it appears on license):
RN License #:
Instructor has had 1500 hours or one year full time employment as an RN providing direct care (R4-19-802(C)(1)
Please provide the following information for each instructor.
Name (as it appears on license):
RN License #:
Telephone:
Email:
Instructor has had 1500 hours or one year full time employment as an RN providing direct care (R4-19-802(C)(1)
INSTRUCTOR R4-19-802(C)(1)
Program instructor qualifications include: a. Holding a current, registered nurse license that is active and in good standing under A.R.S. Title 32, Chapter 15 and provide documentation of a minimum of one year full time or
1500 hours employment providing direct care as a registered nurse in any setting; and b. At a minimum, one of the following: i. Successful completion of a three semester credit course on adult teaching and learning concepts
offered by an accredited post-secondary educational institution, ii. Completion of a 40 hour continuing education program in adult teaching and learning concepts that was awarded continuing education credit by an
accredited organization, iii. One year of full-time or 1500 hours experience teaching adults as a faculty member or clinical educator, or iv. One year of full time or 1500 hours experience supervising nursing assistants, either
in addition to or concurrent with the one year of experience required in subsection (C)(1)(a).
PROGRAM PERSONNEL
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F2 Additional Page Instructors Fillable L (Arizona State Board of Nursing)

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Completed 12 August 2020

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