EPIQ-RN Application | Bridging Program for Nurses

In order to successfully complete this application form, please be ready with the following documents:
AHPRA Decision Letter, Passport Copy, English proficiency Certificate, Current Registration Certificate, Academic Documents, Signed Resume
(All documents should be in pdf, doc or docx format and the file size less than 1 MB)

PERSONAL DETAILS

Title

^* First Name

Middle Name

^* Last Name

Gender

Male Female Others

Date of Birth (dd-mm-yyyy)

Mobile

^*Email

Country of Birth

MAILING ADDRESS

^* Address Line 1

Address Line 2

Address Line 3

^* State / Territory

^* Country

^* Zip / Postal Code

Telephone

Email

PERMANENT ADDRESS

Copy mailing address to permanent address

Address Line 1

Address Line 2

Address Line 3

State / Territory

Country

Zip / Postal Code

Telephone

INTAKE AND VISA DETAILS

Do you have a valid Australian VISA?
Yes No

AHPRA DECISION LETTER

^* Do you have a valid AHPRA Decision Letter?
Yes

ENGLISH LANGUAGE PROFICIENCY

^* English Test
IELTS TOEFL OET PTE Others

Test Expiry Date (dd-mm-yyyy)

Institution

Test Score Achieved:

Overall

Reading

Writing

Speaking

Listening

^*Upload English Proficiency Test Result Documents (Less than 1 MB size each)

DISABILITY

Please indicate if you have a disability
Yes No

FINANCIAL SUPPORT

Please indicate your source of financial support. Attach details of person or organization extending financial support (for invoicing purpose)

PREFERRED CAMPUS

Choose a campus

PREVIOUS QUALIFICATION ACHIEVED (Bachelor of Nursing / Other Equivalent)

Type of Certificate/Award & Institution

Country of Qualification & Language of Instruction

Duration From

Duration To

^* Upload Certificate (Less than 1 MB size)

^* Upload Transcript (Less than 1 MB size)

PREVIOUS EXPERIENCE

Employer

Position Held

Area of Experience

Duration From

Duration To

Upload Documents (Less than 1 MB size)

Add More

REGISTRATION

a) ^* Are you currently registered?
Yes

Country

Registering Authority

Registration Number

Date of Registration

^*Upload Nursing Registration Certificate (Notarized document) (Less than 1 MB size)

b) Have you ever been registered in Australia?
Yes No

OTHER RELEVANT PROGRAMS, TRAINING OR STUDIES UNDERTAKEN

(Maximum 1000 characters)

^* Upload Signed Resume (Less than 1 MB size)

^* Upload Passport (Notarized document) (Less than 1 MB size)

Other Documents, if any (Less than 1 MB size each)

Submitting your Enquiry. Please don't refresh or leave this page.

If the documents are not notarized / attested, you may have to resubmit it*

EPIQRN Application

A HCI Group Company

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EPIQRN Application

A HCI Group Company