Black Nurses Leadership Institute

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Welcome to the Black Nurses Leadership Institute.
Please complete the following online application form to officially apply for admission to our program.
There is no fee to apply or to participate in the program - all materials are included.

The Winter Cohort will be meeting on Thursdays from 6-7:30pm for any synchronous components (ie. workshops, some modules, Speaker Series).
Thursday January 12th - April 27th

We truly look forward to working with you and we know that you will have a wonderful experience.
If you have any questions, please feel free to contact us at info@blacknursesli.ca

Name *

First and last name

Email *

Phone number *

Are you currently a member of the Ontario Black Nurses' Network? *

Yes

Do you currently reside in Canada? *

Yes

Are you one of the following: *

Registered Nurse

Registered Practical Nurse

Nurse Practitioner

Nursing Student

What leadership topics are you most interested in? (check all that apply) *

Communication

Teamwork

Job Searching and Interviewing

Learning about your leadership style

Problem-solving/Conflict Resolution

Managing Change

Required

How will participation in the Black Nurses Leadership Institute help you with your professional/personal growth as a nurse/nursing student? (200 -300 words) *

Please submit a current CV/resume (it will assist us with personalizing activities, mentor matching, etc.) - this MUST be done along with the submission of application form to be considered complete. Send document to info@blacknursesli.ca *

Yes, by CHECKING THIS BOX, I will submit my CV/resume to info@blacknursesli.ca and understand that my application will only be considered complete once this is received.

Required

USE OF IMAGE/NAME FOR PROMOTION - please note that your response to this question does not impact or influence the review or outcome of your application to the program *

I DO consent to the use of my picture and/or name to promote the Black Nurses Leadership Institute and its program - if I am a successful recipient

I DO NOT consent to the use of my picture and/or name - if I am a successful applicant

Other:

YES, by CHECKING THIS BOX, I hereby affirm that all the stated information provided in this form is true and correct to the best of my knowledge.

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