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Nurse Apprentice Program ARPA Grant – Salary Request
Galina Tolle
2023-10-03T16:57:44-08:00
Nurse Apprentice Program ARPA Grant Payment Request
Date Submitted
MM slash DD slash YYYY
Facility
(Required)
Please select your facility
Alta Skilled Nursing and Rehabilitation Center
Alpine Skilled Nursing and Rehabilitation Center
Banner Churchill Community Hospital
Battle Mountain General Hospital
Boulder City Hospital
Carson Tahoe Hospital
Carson Tahoe Continuing Care Hospital
Carson Tahoe Transitional Rehabilitation Center
Carson Valley Health
College Park Rehabilitation Center
Desert View Hospital
Gardnerville Health and Rehabilitation Center
Green Valley Health & Wellness Suites
Grover C Dils Medical Center
Harmon Hospital
Hearthstone of Northern Nevada
Highland Manor of Elko - SNF
Highland Manor of Fallon - SNF
Highland Manor of Mesquite – SNF
Horizon Health and Rehabilitation Center
Horizon Specialty Hospital of Las Vegas
Horizon Specialty Hospital of Henderson
Humboldt General Hospital
Incline Village Community Hospital
Kindred Hospital Las Vegas-Flamingo Campus
Kindred Hospital Las Vegas-Sahara Campus
Las Vegas Post Acute and Rehabilitation
Las Vegas AMG Specialty Hospital
Las Ventanas Retirement Community
Marquis Centennial Hills
Marquis Plaza Regency
Mesa View Regional Hospital
Mount Grant General Hospital
Mountain View Health and Rehabilitation Center
NeuroRestorative Reno
North Las Vegas Care Center
Ormsby Post-Acute Rehab
Pahrump Health and Rehabilitation Center
Pam Specialty Hospital of Las Vegas
Pam Specialty Hospital of Reno
Pershing General Hospital
Renown Health
Rosewood Rehabilitation Center
Royal Springs Healthcare and Rehab
Sandstone Spring Valley
South Lyon Medical Center
St. Rose Dominican Siena Campus – Dignity Health
St. Rose Dominican San Martin Campus – Dignity Health
St. Rose Dominican Rose de Lima Campus – Dignity Health
Southern Nevada Adult Mental Health Services (SNAMHS)
Sierra Ridge Health and Wellness Suites
Spanish Hills Wellness Suites
White Pine Care Center
William Bee Ririe Hospital
Wingfield Skilled Nursing and Rehabilitation Center
If your facility is not listed, please contact us. An established Nursing Apprentice Program is required.
Requestor
(Required)
First
Last
Requestor Email
(Required)
Month Submitted
(Required)
Choose Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
(Required)
year
2023
2024
2025
2026
2027
2028
Nurse Apprentice Name
(Required)
First
Last
Is the student an RN or LPN apprentice?
(Required)
Please select RN or LPN
RN
LPN
Name of Nursing School
(Required)
Please choose the nursing school
Antelope Valley College
Arizona College - Las Vegas Campus
Carrington College - Reno
Carrington College - Las Vegas
Chamberlain University
College of Southern Nevada (CSN)
Dixie Technical College (Utah)
EDP University of Puerto Rico
Great Basin College (GBC)
Great Basin College - Pahrump
Grand Canyon University
Joyce University
Las Vegas College
Mojave Community College
Nevada Carrer Institute
Nevada State College
Nightingale College
Roseman University
Southern Utah University
Truckee Meadows Community College
Unitek College
University of Nevada, Reno (UNR)
University of Nevada, Las Vegas (UNLV)
University of Portland
Utah Tech University
Western Governors University
Western Nevada College (WNC)
Other
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.
Apprentice worked in which type of setting?
(Required)
Acute Care
Skilled Nursing (SNF)
Acute Hours
(Required)
SNF Hours
(Required)
Total Monthly Hours
(Required)
Upload Timesheet
(Required)
Required for validation
Drop files here or
Select files
Max. file size: 20 MB.
Have you provided NRHP with a current copy of the student's skills list from their school?
(Required)
No - I need to provide an updated list
Yes - I have already provided one for the current term
Upload Skills List
(Required)
Please upload a copy of the recent skills checklist provided by the nurse apprentice's school.
Drop files here or
Select files
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Enrollment Status
(Required)
By checking this box, you attest that the nurse apprentice is actively enrolled and in good standing in an accredited nursing program. This is a mandatory requirement.
YES
Clinical Skills Checklist
(Required)
By checking this box, you attest that the nurse apprentice has provided a clinical skills checklist from their nursing program and an updated copy is on file. This is a mandatory requirement.
YES
CAPTCHA
Hidden
LPN
(Required)
LPN
Hidden
LPN State Facility
(Required)
LPN
Hidden
RN
(Required)
RN
Hidden
RN State Facility
(Required)
RN
Hidden
LPN Total
Hidden
RN Total
Hidden
Total Salary Requested ($)
(Required)
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