2025 RISHI Power of Nursing Faculty Development Workshop

1. Name and Education History *This question is required.

First Name
Last Name
Preferred Name
Degree
Nursing School
Year of Graduation
License #
State of Issue

2. Pronouns?

Would you like your pronouns printed on your name tag?

3. Nursing School/Health Care Institution where you will implement The Power of Nursing *This question is required.

Name
Address
City
State, Zip
Country

5. Professional Specialty *This question is required.

6. Professional Nursing Position *This question is required.

University or Organization
Title
Professional Role
Years in Position

Professional Position (if more than one held concurrently)

University or Organization
Title
Professional Role
Years in Position

7. Work Contact Information *This question is required.

Name
Address
City, State, Zip
Country
Work Phone
Work Fax
Work Email

8. Home Contact Information

Address
City, State, Zip
Country
Home Phone
Cell Phone
Home Email

9. Which is your preferred email? *This question is required.

Work
Home

10. How did you hear about The Power of Nursing? *This question is required.

Please enter an 'other' value for this selection.

11. What courses do you teach at your Nursing school? *This question is required.

12. When do you plan to implement The Power of Nursing at your nursing school? *This question is required.

Pilot Start Date
Full Course Start Date

13. What institutional support including financing (if any) do you have for this plan? *This question is required.

14. What obstacles do you anticipate in implementing this course? *This question is required.

15. Approximately how many nursing students would participate in the course at your school?

16. What are the unmet needs of your nursing students that you hope to address with The Power of Nursing or with other work you are planning to do? *This question is required.

17. What draws you personally to teaching this course? What would you like to gain from it? Please describe briefly. *This question is required.

18. Do you have any experience leading small groups or workshops? Please describe. *This question is required.

19. Please tell us one way that being a nurse has enriched your life. *This question is required.

20. In preparation for the on-site training, do you have any health care or dietary needs that our staff should know about? Please describe. *This question is required.

21. Is there anything else you would like us to know?

CONTINUING EDUCATION CREDIT FOR NURSES:

CA BRN CE APPROVAL: The Remen Institute for the Study of Health & Illness. Provider approved by the California Board of Registered Nursing, Provider Number 10064, for 27.0 Contact Hours.

California BRN continuing education credits are accepted by most state nursing boards; please verify with your state professional regulatory agency if they will accept a California CE certificate.

Financial Information
Registration Fee: Due within 30 days of the acceptance of application.

Nursing Faculty:
$1800 - 4 ½ day Retreat and Training Workshop (Wednesday - Sunday)

Note: Registration fee includes breakfast and lunch, daily. Lodging and evening meals are the responsibility of the participant.

Cancellation & Refund Policy:
60 days or greater to the first day of Workshop = full registration fee refunded, less $100 administrative fee.
59 – 31 days or greater to the first day of Workshop = 50% of registration fee refunded, less $100 administrative fee.
30 days or less prior to the first day of Workshop = forfeit of full registration fee (100%).