CCP Audit: Upload last year’s learning plan document

To submit a completed form as an attachment, please follow these steps:

  1. Complete all fields in the ‘Personal Information’ section.
  2. Click on the “Choose File” Button
  3. In the pop-up window that appears, locate your learning plan on your computer
  4. Double-click on your learning plan file name. This will close the pop-up window.
  5. Complete all remaining fields.
  6. Click Submit.

Required fields indicated by an asterisk (*).

Personal Information

Name*:

Registration #*:

Email Address*:

Phone Number*:

Upload Completed Form

Declaration and Signature

My electronic signature indicates the above information is accurate and true. I understand this information is reviewed by CLPNNS staff or designates & incomplete forms may be returned to me resulting in a delay in this time sensitive process & this questionnaire may be kept on file as confirmation of my participation in the CCP audit & I may be required, pursuant to the current LPN Act and Regulations, to perform additional self-assessments and/or complete and submit verification of additional learning at my own expense to meet the Continuing Competence Program requirements.

Name*:

Electronic signature*:
* I verify I am the CLPNNS member named above and submission of this document is considered my electronic signature.

Submit

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