Remedial Course Registration RN & PN
PLEASE READ: Payment plan
Payment #1 = $830.00 (Registration fee $100.00 + Online Theory $730.00 (First payment)
Second Payment: $750.00
Online Pay in Full: Total Full Payment $1580.00
Blended Live Instructor-led Theory: $1980.00 ($1230 + $750)
Office Address: 11300  4th Street North, #130, St Petersburg, FL 33716
Contact us at 727-656-0077 or assist@rophem.com 
After completing this form, complete payment for course at https://rophem.com/register
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Email *
Notification of Social Security Number Collection and Usage - In compliance with Section 119.071(5), Florida Statutes, Rophem Nursing Academy issues this notification regarding the purpose for the collection and use of your Social Security Number (SSN). Rophem Nursing Education collects and uses your SSN only to perform education duties and responsibilities. To protect your identity, Rophem Nursing Academy will maintain the privacy of your SSN and never release it to unauthorized parties in compliance with state and federal laws. Rophem Nursing Academy will use the SSN for the Remedial Course completion letter.  
First & Last Name (As it appears on your BON application) *
Phone number *
Course descriptions - Details and grading system are available on each course item on our website at rophem.com *
Required
Course desired *
How do you want to take the theory part (See full schedule online at rophemhealth.com/remedial-course/)  *
Select the date you will start Theory Online - complete payment on rophem.com (half/full), and start the theory.
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NOTE: START YOUR THEORY at least 2 weeks before start of clinical training.
You do not have to finish theory before clinical.
If you wish to arrange your own Clinical training and Preceptorship for your hours, select the option below. NOTE: Clinical facility must be located in Florida. Please contact us at 727-656-0077 to confirm details and request the forms. (Preceptor-Request form & Facility Affiliation Agreement). 
Live Clinical - Select your preferred clinical dates by groups. Please note this is Face to Face, St Petersburg, FL. (All fees & documents are due 3 weeks prior to start of clinical training) - Time 7:30 AM to 6 PM EST. Part 2 *
If you would like to change your clinical group dates, Contact us, then complete this form again. Please allow your request for Clinical transfer to another group to be 30 days or more before the dates you select to avoid a clinical transfer fee.
Reason you need the Remedial/Refresher course (#C - the letter from the BON is required before endorsement candidates can participate in clinical training. Submit this letter by email to assist@rophem.com) - Candidates with inactive licenses, Please Call first before you pay!  *
Which State BON do you want us to send your completion letter? (e.g. Florida) Note: Completion letter will go to the specific BON that asked you to complete the Remedial course.  *
What is the name of the nursing school you graduated from?  *
**All fees must be paid before clinical start date. If you want payment plan, let us know by email. Fee balances are due 10 days before start of clinical dates you selected above.  *
Required
If you want payment plan different from what we have set up, or make payments more than 3 times, 3rd party transaction fee will be added with each payment, on the invoice. *
Required
A Negative COVID-19 Test is needed within 7 days before start of clinical training. Submit by email on the day before or bring with you on first day. PCR ONLY not quick test. *
OTHER NOTES: Clinical Uniform: WHITE SCRUB TOP ON BLACK PANTS
Background check
Immunization report
Liability Insurance: $40 (pay before clinical starts)
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