NursE Apprentice Program ARPA Grant Retention Request Form Facility(Required)Choose your faciityBanner Churchill Community HospitalAlpine Skilled Nursing and Rehabilitation CenterAlta Skilled Nursing and Rehabilitation CenterBattle Mountain General HospitalBoulder City HospitalCarson Tahoe HospitalCarson Valley Medical CenterDesert View HospitalGardnerville Health and Rehabilitation CenterGrover C. Dils Medical CenterHighland Manor of Elko - SNFHighland Manor of Fallon - SNFHighland Manor of Mesquite – SNFHumboldt General HospitalIncline Village Community HospitalMesa View Regional HospitalMt. Grant General HospitalMountain View Health and Rehabilitation CenterPershing General HospitalPahrump Health and Rehabilitation CenterOrmsby Post-Acute Rehab,Renown HealthRosewood Rehabilitation CenterSouth Lyon Medical CenterSouthern Nevada Adult Mental Health Services (SNAMHS)St. Rose Dominican Siena Campus – Dignity HealthSt. Rose Dominican San Martin Campus – Dignity HealthSt. Rose Dominican Rose de Lima Campus – Dignity HealthWilliam Bee Ririe HospitalCollege Park Rehabilitation CenterHarmon HospitalHearthstone of Northern NevadaHorizon Health and Rehabilitation CenterNorth Las Vegas Care CenterSierra Ridge Health and Wellness SuitesSpanish Hills Wellness SuitesWingfield Skilled Nursing and Rehabilitation CenterDate MM slash DD slash YYYY Authorized Signer(Required) First Last Email address(Required) Nursing Apprentice Name(Required) First Last Date retention offered(Required) MM slash DD slash YYYY Retention Amount Requested(Required)Nursing License Number(Required) Copy of the retention check / contract(Required)Max. file size: 16 MB.Required for validationAdditional DocumentationMax. file size: 16 MB.Upload any additional documentation for this requestName of Nursing School(Required)please choose the nursing schoolArizona College/Las Vegas CampusAntelope Valley CollegeCarrington CollegeChamberlain UniversityGreat Basin CollegeGreat Basin College - PahrumpMojave Community CollegeNightingale CollegeSouthern Utah UniversityTruckee Meadows Community CollegeUniversity of Nevada, Reno (UNR)University of Nevada, Las Vegas (UNLV)Western Nevada CollegeOtherOther Nursing School Please tell us where your student nurse is attending school so we can add it to the list.CAPTCHA