Lawrence S. Bloomberg Faculty of Nursing

Critical Care Screening Application Form

Form

Process

Personal Information

Data Collected

• Form

  NUR470: Integrative Nursing Practicum 2020/2021

  Your GPA MUST be 3.3 (B+) or above for you to be eligible to go to a critical care placement. Please format the name of your file as lastname_firstname. Do not include any special characters such as apostrophes within the file name or you will get a system error. Please complete the application form no later than Thursday, November 12th at 4pm. Forms received after this time will not be accepted.

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  • Personal Information Statement - Please Provide Your Consent*
    Please refer to the Personal Information tab above on this page and provide your consent.
    
    I agree to have the information in this form plus my IP address and browser version be collected and stored electronically and I understand it will be protected in accordance with the Freedom of Information and Protection of Privacy Act. I understand that the information will be shared and viewed only by those who need to know. I also understand this form will be retained based on the University’s best practice guidelines for student records retention, after which it will be destroyed in accordance with Information Technology Security best practices.
    
    If you select No, you will not be able to continue with this form and you can discuss your options by contacting Kong Ng, Student Placement Co-ordinator at nursingplacementoffice@utoronto.ca.
    • No
    • Yes, I agree with the statement above
  • You cannot continue with this form, please contact Kong Ng, Student Placement Co-ordinator at nursingplacementoffice@utoronto.ca. to discuss your options.
  • Student First Name*
  • Student Last Name*
  • Student Email*
    Enter Email Confirm Email
  • Placement Requested*
    • Emergency
    • Critical Care Units (e.g. CVICU, PACU, NICU, PICU, Cardiac CCU, etc)
    • Transplant Unit @TGH
  • Placement location if known
  • Are you applying for a paediatric placement?*
    • Yes
    • No
  • Are you applying for an out-of-town placement?*
    • Yes
    • No

  • List your previous and current clinical placements

  • NUR360-LS1 Clinical placement agency
    For example: Mt Sinai, UHN, TGH etc.
  • NUR360-LS1 Unit/Placement type
    Be specific
    For example: 11S orthopedic surgery/ENT, 5C – neurotrauma)
  • NUR360-LS2 Clinical placement agency
    For example: Mt Sinai, UHN, TGH etc.
  • NUR360-LS2 Unit/Placement type
    Be specific
    For example: 11S orthopedic surgery/ENT, 5C – neurotrauma)
  • NUR371 Clinical placement agency
    For example: Mt Sinai, UHN, TGH etc.
  • NUR371 Unit/Placement type
    Be specific
    For example: 11S orthopedic surgery/ENT, 5C – neurotrauma)
  • NUR372 Clinical placement agency
    For example: Mt Sinai, UHN, TGH etc.
  • NUR372 Unit/Placement type
    Be specific
    For example: 11S orthopedic surgery/ENT, 5C – neurotrauma)
  • NUR373 Clinical placement agency
    For example: Mt Sinai, UHN, TGH etc.
  • NUR373 Unit/Placement type
    Be specific
    For example: 11S orthopedic surgery/ENT, 5C – neurotrauma)
  • NUR460 Clinical placement agency
    For example: Mt Sinai, UHN, TGH etc.
  • NUR460 Unit/Placement type
    Be specific
    For example: 11S orthopedic surgery/ENT, 5C – neurotrauma)
  • NUR 461Clinical placement agency
    For example: Mt Sinai, UHN, TGH etc.
  • NUR 461 Unit/Placement type
    Be specific
    For example: 11S orthopedic surgery/ENT, 5C – neurotrauma)
  • Please upload a screen shot of your current academic transcript*
    Please format the name of your file as lastname_firstname. DO NOT INCLUDE ANY SPECIAL CHARACTERS SUCH AS APOSTROPHES within the file name.
    Max. file size: 8 MB.

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• Process

  Once your application form has been reviewed, you will be invited to do a medication quiz as the first step of the selection process. You must obtain 100% on this quiz in order to be eligible for the interview. The medication quiz will be held on Monday November 18th, 4:30-5:30 pm in HS610.

  The quiz will be marked and students will be notified as to whether or not they will move on to the next step. Please note that this is a pass or fail quiz and there will be no opportunities to review the results.

  During the final stage of the critical care selection process, you will be invited to participate in a brief interview. Interviews will be held on Saturday November 23^rd and Saturday November 30^th.  You will receive a Doodle poll with timing options and preparation information following the medication quiz.

• Personal Information Statement

  The University of Toronto respects your privacy. The information on this form is collected pursuant to section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose of administering admission, registration, academic programs, university-related student activities, activities of student societies, financial assistance and awards, graduation and university advancement, and for the purpose of statistical reporting to government agencies. Your IP address and browser version are collected for Information Technology troubleshooting, as may be required. At all times, all data is protected in accordance with the Freedom of Information and Protection of Privacy Act. If you have questions, please refer to www.utoronto.ca/privacy OR contact the

  University’s Freedom of Information and Protection of Privacy Office at 416 946-5835,
  Room 104, McMurrich Bldg.,
  12 Queen’s Park Crescent West,
  Toronto, ON, M5S 1A8.

  I agree to have the information in this form plus my IP address and browser version be collected and stored electronically and I understand it will be protected in accordance with the Freedom of Information and Protection of Privacy Act. I understand that the information will be shared and viewed only by those who need to know. I also understand this form will be retained based on the University’s best practice guidelines for records retention, after which it will be destroyed in accordance with Information Technology Security best practices.

• Data Collected

  The following information is collected on the form

  Agree to personal information collection? (Yes/No)

  First Name

  Surname

  UTOR email address

  Placement request choice (Emergency, Critical Care Units (e.g. CVICU, PACU, NICU, PICU, Cardiac CCU, etc., Transplant Unit @TGH)

  For Emergency and Critical Care Units, Location if known.

  Are you applying for a paediatric placement? (Yes/No)

  Are you applying for an out-of-town placement? (Yes/No)

  List your previous and current clinical placements – include placement agency, specific unit and placement type

  Required – Screen Shot upload of current academic transcript that includes your cumulative GPA from year 1 and your name. Please format the name of your file as lastname_firstname. DO NOT INCLUDE ANY SPECIAL CHARACTERS SUCH AS APOSTROPHES within the file name or you will get a system error.

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  Other Data Collected 

  This data is automatically collected by the system for the purpose of Information Technology administration and trouble shooting, as may be required and for summary-level only website statistical reporting:

  Browser Type

  Browser Version

  IP Address (does not identify you)

  Hardware and operating system (reported on an aggregate level)

  Country/city of origin (reported on an aggregate level)

  Session duration (reported on an aggregate level)