CCP Audit: Verify completion of CLPNNS modules

To confirm you have completed a learning plan AND an online learning course, please follow these steps:

  1. Complete all fields in the ‘Personal Information’ section.
  2. Indicate which modules(s) you completed by clicking on the checkbox next to the module.
  3. Check the buttons to verify that you have completed a learning plan, understand your participation in online modules will be verified by CLPNNS staff, and CCP committee will not be able to verify CCP participation if staff cannot confirm your online participation.
  4. Complete all remaining fields.
  5. Click Submit.

Required fields indicated by an asterisk (*).

Personal Information

Name*:

Registration #*:

Email Address*:

Phone Number*:

Verify Online Learning

Please indicate which CLPNNS on-line module(s) you have completed in the last licensing year (October 31-Novemebr 1).*

Yes*: I declare I have completed a learning plan in the last licensing year in addition to completing the above on-line learning modules. DO NOT SUBMIT YOUR LEARNING PLAN UNLESS INSTRUCTED BY CLPNNS STAFF TO DO SO.
Yes*: I understand CLPNNS staff will verify that I have completed the CLPNNS online learning modules as I have indicated and may be required to submit the certificate of completion from the online learning module. DO NOT SUBMIT YOUR CERTIFICATE UNLESS INSTRUCTED BY CLPNNS STAFF TO DO SO.
Yes*: I understand if CLPNNS staff is unable to verify that I have competed the CLPNNS online learning modules, the CCP committee will be unable to verify my participation in CCP.

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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