PLA Student Applicant Information
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Mailing Address
Emergency Contact
Please provide an emergency contact in the event that we are unable to contact you during the program.
Admission Questions
How did you first learn about our program?
Google Instagram Facebook LinkedIn Website Friend Referral Other
Please select the option below that best represents being a holistic nurse to you.
Providing care that acknowledges and incorporates things such as the individual’s lifestyle, mindset, worldview and/or beliefs, religious and/or spiritual ideologies, and more. Both providing care that acknowledges and incorporates things such as the individual’s lifestyle, mindset, worldview and/or beliefs, religious and/or spiritual ideologies, etc., as well as living and embodying a holistic lifestyle and mindset as a nurse
Please select the option below that best represents why you want to take the Comprehensive Holistic Nurse & Nurse Coaching Certificate Program.
Use my enhanced knowledge and skills at the bedside Use my enhanced knowledge and skills at the bedside and in independent practice Use my enhanced knowledge and skills in independent practice
Choose the one self-care practice or approach that you most hope is discussed and/or practiced in the program:
Breathwork Guided Imagery & Visualization Emotional Freedom Technique (EFT) aka Tapping Essential oils Energy healing Mindfulness Culture (i.e. Indigenous) Cannabis
Education & Experience (Optional for CIINDE Graduates)
Please attach a current copy of your CV/Resume (2MB max file size)
Nursing Registration Information
Please upload a copy of your current registration (2MB max file size)
Note: If you are unable to upload documents, please forward via email attachment to info@theciinde.com . Your application will be processed when received.
Eligibility
I have read and understand the Eligibility Requirements (link opens in a new window).
Yes No
I have read and understand the Tuition Payment & Refund Policy (link opens in a new window).
Yes No
I have read and understand the Course Agreements (link opens in a new window).
Yes No
Prior Learning Assessment Details
Please upload a copy of your certificate from the nurse coaching program attended (2MB max file size)
Please upload an official letter of graduation and confirmation of supervised coaching hours (2MB max file size)
Note: If you are unable to upload documents, please forward via email attachment to info@theciinde.com . Your application will be processed when received.
For non CIINDE alumni, please provide a brief description of the applicable course.
Website link.
Coming Soon!
TheCIINDE has been working diligently to provide additional content and educational opportunities. We are excited to share what is coming up and the potential streams that will be offered in the near future. Please check off any that you are interested in exploring and we will share details in the upcoming months.
Select all that apply.
Business Development Program-LIVE program-expands on current Business Development Course Holistic Nurse Reiki Practitioner - LIVE Program & Attunement Foundations of Holistic Nutrition - LIVE Program Overcoming Adversity; Applied Self-Compassion for Health & Wellness - LIVE Program Emotional Freedom Technique/Tapping The heART of Cannabis Care & Coaching for Nurses - LIVE Program None of the above? Share below what you would like to see!
Additional Offerings of Interest
Please share what would peak your interest in the future in terms of courses or other offerings.
(i.e. a membership that offered live self-care classes; a course in essential oils; a conference and retreat, etc.)
Course Start Date
September 2022 April 2023 (Start date to be listed in Fall 2022)
I have read and understand the Terms & Conditions (link opens in a new window).
Yes No
Permission Statement
We like to capture special moments! These may be in the form of photographs, testimonials or poignant statements or testimonials shared by students in writing or in open discussion. Having said this, we would not share something personal in nature or that would be considered confidential (e.g. a personal story or struggle shared by a student).
An example of a statement we would share is "developing a deeper sense of self-awareness was the missing piece in truly caring for myself", or "I have seen the magic that can happen when nurses use a holistic approach in the palliative care setting". The intention is to celebrate and showcase the important work you are all doing and the importance of holistic nursing and nurse coaching for both the nurse and their clients. Places we post are on our social mediaplatforms and in our newsletters, quarterly journals, website, etc. To give credit where credit it due, we like to add your name or initials.
I agree to the use of my photo, testimonial and full name I agree to the use of my photo, testimonial and initials I disagree
Acknowledgement
By signing your name below, and clicking YES, you acknowledge that you have fully read this agreement and agree with the terms and conditions presented.
Yes No
Payment for registation fee ($50 CAD)
Pay with your major credit card