IPAC Canada Novice ICP Course Application

Online application form for the 2019-2020 IPAC Canada Online Novice ICP Course
Please complete all information in this form, and upload your Application Form and current C.V. (ensure you have both files saved and ready to upload before proceeding).

1. Download and complete the course Application Form from https://ipac-canada.org/ipac-canadas-novice-online-ipac-course

Adobe Acrobat is required to fill in the Application Form. Save your completed form as a PDF using the file name format LASTNAME_FIRSTNAME_APPLICATION.pdf

2. Save your current C.V. using the file name format LASTNAME_FIRSTNAME_RESUME (in Word or PDF)

Applications must be received by no later than March 17, 2019. A course overview and requirements can also be seen at the above link. Applicants will be advised of their acceptance in June.

Title

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*

Email Address*

Country*

Phone*

Are you currently a practicing infection control practitioner?*

Yes

What is your current work environment? Choose one from the drop-down menu:*

If work environment is 'other' please specify:

25 Characters Remaining

The course includes a 12 hour practicum component; would you be able to arrange to have an appropriate mentor?*

Yes

Are you currently a member of IPAC Canada?*

Yes

Upload your completed Course Application Form in the format LASTNAME_FIRSTNAME_APPLICATION.pdf*

Upload your resume using the file format LASTNAME_FIRSTNAME_RESUME*

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