Province of Manitoba

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Internationally Educated Nurses in Manitoba Project

Please complete this form if you are interested in supports that could help you become a nurse in Manitoba. Read the FAQs prior to completing the form.

Please answer the following questions to the best of your ability/memory. There are no “correct” answers.

Your responses will help the project team to determine what opportunities may be available for you. Supports may include referral to language classes, assistance navigating the licensing pathway, financial assistance to support the costs associated with the licensing process, and referral to other services. Please note there is no guarantee of financial support or becoming a nurse in Manitoba.

You will be contacted about next steps within three weeks of submitting this form.

Personal Information Given/First Name: Family/Last Name: Mailing Address: Postal Code: Phone #: (Home) Phone #: (Cell) Email: Date of arrival in Canada: Date of arrival in Manitoba:

Are you a: Permanent Resident Canadian Citizen Other

Please specify:

Nursing Education Please provide information on your nursing education:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

Institution/School: Credential (Diploma, Bachelor Degree, Masters Degree, Refresher, etc.): Date of completion:

The Process to Become a Nurse in Manitoba

Have you completed an English language assessment or proficiency test in Canada? Yes No

Which tests have you completed? Check all that apply.

Official CELBAN (Canadian English Language Benchmark Assessment for Nurses) Academic IELTS (International English Language Testing System) Tef (Test d’évaluation de Franҫais) CanTest WELARC Canadian Language Benchmark Placement Test Other

Please Specify:

Date of your most recent English Language test

What were your most recent test scores?

Listening

Reading

Writing

Speaking

Have you applied to the National Nursing Assessment Service (NNAS)? Yes No

When did you apply?

Have you ever applied to the CRNM (College of Registered Nurses of Manitoba)? Yes No

When did you apply?

Do you currently have an open file with the CRNM? Yes No Unsure

Have you ever applied to the CLPNM (College of Licensed Practical Nurses of Manitoba)? Yes No

When did you apply?

Do you currently have an open file with the CLPNM? Yes No Unsure

Have you ever applied to the CRPNM (College of Registered Psychiatric Nurses of Manitoba)? Yes No

When did you apply?

Do you currently have an open file with the CRPNM? Yes No Unsure

Do you currently have an open file with another nursing regulator in another province? Yes No

Have you written the NCLEX? Yes No

How many times?

Have you written the CPNRE? Yes No

How many times?

Have you been referred for a Clinical Competence Assessment (CCA) by the CRNM? Yes No

Have you completed a CRNM CCA? Yes No

Have you been referred for a Clinical Competence Assessment (CCA) by the CLPNM? Yes No

Have you completed a CLPNM CCA? Yes No

Current Employment

Additional Information

If there was a special program to help you become a nurse in Manitoba, is there anything that would prevent you from studying?
Please describe / explain.

Do you have a valid Manitoba driver’s licence? Yes No

Do you have access to a vehicle? Yes No

Important:

Please note that submission of this form does not guarantee access to resources or supports to become a nurse in Manitoba.

We will contact you to discuss possible career options.

Please complete the following consent form.

PERSONAL INFORMATION SHARING CONSENT FORM

I consent to the disclosure of my personal information that I have submitted for the purposes of the IENs In Manitoba Project to the following organizations, (collectively “the Organizations”):

College of Registered Nurses of Manitoba
College of Licensed Practical Nurses of Manitoba
College of Registered Psychiatric Nurses of Manitoba
Red River College
Assiniboine Community College
Manitoba Health and Seniors Care
Manitoba Economic Development and Jobs
Prairie Mountain Health
Interlake Eastern Regional Health Authority
Southern Health – Santé Sud
Northern Regional Health Authority
Winnipeg Regional Health Authority

I understand and consent that my information will be disclosed strictly for the purposes of assisting with assessment and career planning, and possibly with education, training, and program evaluation.

I understand and consent that my personal information may be shared with the Organizations for as long as I am a participant in the IENs In Manitoba Project.

I understand that my information will be kept private and confidential in accordance with The Freedom of Information and Protection of Privacy Act (FIPPA), and will only be used or disclosed for the purposes of the IENs In Manitoba Project, except where authorized or required by FIPPA or another enactment of Manitoba or Canada.

By checking this box I declare that I have read, understand and consent to the above statements.

If you have any questions about the IENs In Manitoba Project or if you wish to withdraw consent for the use and disclosure of your information, please contact:

Healthcare Recruitment
Economic Development and Jobs
800 Portage Avenue, Winnipeg, Manitoba R3G 0N4
healthrec@gov.mb.ca