Critical Care Screening Application Form
NUR470: Integrative Nursing Practicum 2019/2020Your 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 Wednesday November 13th at 4pm. Forms received after this time will not be accepted.
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 23rd and Saturday November 30th. You will receive a Doodle poll with timing options and preparation information following the medication quiz.
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.
The following information is collected on the Form:
Agree to personal information collection? (Yes/No)
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.
Other Data Collected
This data is collected for Information Technology administration, analysis and trouble shooting, as may be required.
Date and time of form submission
Your IP address (does not identify you)
Your browser type and version number
Your city/country (reported on aggregate level only and does not identify you)