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Primary Instructor Application

Primary Instructor Applicant must:

Hold a current Oregon RN licenses
Have at least two years of RN experience
Have evidence of completion of a course on teaching adults, or one year of experience teaching adults.

Primary Instructor for MA Program: must have at least one year of long-term care experience.

Please upload a current resume and any other supporting documents.

Legal First Name

Middle

Legal Last Name

Suffix

Phone

Gender

Male Female Other

Address

City

State

Zipcode

RN License Information

License Number

Expires

Education Program Information

Program Name

Program Type Select the program type you are applying for. If you are applying for both NA and MA programs, please write a comment to let OSBN staff know. *Primary Instructor for MA Program: must have at least one year of long-term care experience.

Document Upload

Teaching certificate of completion if needed Upload a certificate of completion as supporting evidence of experience teaching adults.

Resume Upload a current resume.

Comment

Comment If you are applying for both NA and MA Programs, please write a comment to let OSBN staff know.

Affidavit

By Submitting

I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.