Application for CDU PMHNP Students

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Do you have WhatsApp?

Once trainees sign up we make a group chat on WhatsApp so that our team members can work with you most directly and efficiently

Yes

I can download it

I prefer to avoid using WhatsApp if possible

Gender

Female

Male

Other

MD or NP preference

Do you prefer an MD or NP as preceptor?

Psychiatrist

PMHNP

Other (Therapist/Social worker)

Start Date for class

When will your class begin? For example, at Walden the Winter session for 2021 begins Nov. 29th, 2021

MM

DD

YYYY

I am open to doing part or all of my rotation as a tele-medicine experience during Covid-19

Many Universities are allowing 100% tele-medicine during Covid

Yes

No, I want to avoid tele-medicine learning

I have not decided but I am open to the possibility