Nurse Apprentice Program ARPA Grant – Salary Request

Date Submitted

Facility(Required)

If your facility is not listed, please contact us. An established Nursing Apprentice Program is required.

Requestor Email(Required)

Month Submitted(Required)

Year(Required)

Is the student an RN or LPN apprentice?(Required)

Name of Nursing School(Required)

Other Nursing School

Please tell us where your student nurse is attending school so we can add it to the list.

Hours Worked

For those facilities that have both SNF and Acute - please report the hours worked in each department.

Acute Hours(Required)

SNF Hours(Required)

Total Monthly Hours(Required)

This field is auto-calculated. Enter hours in the adjacent "Acute Hours" and/or "SNF Hours" field(s).

Upload Timesheet(Required)

Required for validation

Drop files here or

Max. file size: 20 MB.

State Facilities Only(Required)

The Nurse Apprentice Program ARPA Grant provides reimbursement of an hourly rate of $3.00 for the Registered Nurse supervising the Nurse Apprentice. This is included in the hourly reimbursement calculations based on the hours worked by the apprentice.

If your hospital elects not to receive this reimbursement, please indicate your decision below.

Upload Skills List(Required)

Please upload a copy of the recent skills checklist provided by the nurse apprentice's school.

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 20 MB.

When is the apprentice expected to graduate?(Required)

CAPTCHA

LPN Rate (BASE)(Required)

LPN Rate (STATE OPT IN)(Required)

LPN Rate (STATE OPT OUT)(Required)

RN Rate (BASE)(Required)

RN Rate (STATE OPT IN)(Required)

RN Rate (STATE OPT OUT)(Required)

LPN Total(Required)

RN Total(Required)

Total Salary Requested ($)(Required)

FISCAL YEAR CLOSED
We’re sorry, but requests from the previous fiscal year (ending June 30th, 2023) are no longer eligible for submission.
Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

FISCAL YEAR CLOSED
We’re sorry, but requests from the previous fiscal year (ending June 30th, 2024) are no longer eligible for submission.
Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

Nevada Nurse Apprentice Program