NCLRP Application Mental Behavioral Health FY19 Questions Screenshot

Application Information

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*required field

Important Note: Please be very careful to choose the correct options below according to the Application and Program Guidance. Failure to correctly select your application type may result in your application not being selected for funding.

Applicants who are registered nurses (RN), working full-time (as defined by his or her employer) as a nurse faculty member at an accredited public or private nonprofit school of nursing should select Nurse Faculty below.

Application Type *

 Registered Nurse

 Nurse Practitioner

 Clinical Nurse Specialist

 Nurse Mid-Wife

 Nurse Anesthetist

 Nurse Faculty

1. Are you a licensed Psychiatric Nurse Practitioner?

• If yes, please upload your credentials in the Supporting Documents section

• no

2. Do have another Behavioral Health training or certification?

• If yes, please upload your credentials in the Supporting Documents section

• No

3. Will you have substance use disorder training or certification by September 30, 2019?

• Yes

• No

OMB No. 0915-0140 Expiration Date: 05/31/2021