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The following information will be used to select participants for the MCIRN Fellowship Program. We reserve the right to select applicants based on the stated criteria and those who, based on the information presented, may make the biggest impact on the nursing workforce

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* 1. Name

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* 2. Email address

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* 3. Phone Number

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* 4. Address:

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* 5. City of Employment

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* 6. State of Employment

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* 7. Are you a nurse?

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