“Growing the next generation of primary care providers”
Now Accepting Applications for: 2013-2014
Community Health Care Family & Community
Nurse Practitioner Residency
CHC’s Family & Community Residencies’ mission is to train up highly effective, competent, &
autonomous inter-professional primary care providers in the FQHC setting.
Our goal for new graduate Family Nurse Practitioners is to provide with the depth, breadth,
volume & intensity of clinical training necessary to serve as primary care providers in the
complex setting of the country’s health care safety net.
Criteria:
 Registered Nurse license with at least 3 years experience.
 Graduate of Master’s or Doctoral Graduate Nurse program in good standing.
 Family Practice board certification eligibility confirmed with estimated test date.
 Washington state ARNP licensure eligible.
 Federal DEA certificate eligible.
 Written commitment to practice as a primary care provider in a Federal Qualified Health
Center.
 Bilingual preferred
Application Requirements:
 CV (must show five year work history)
 Please submit essay responses to the following questions. This is an opportunity to reflect
upon and communicate to CHC your personal statement of qualifications, interest, and
motivation in acceptance to this Residency.
1. What personal, professional, educational and clinical experiences have led you to
choose nursing as a profession, and the role of a family nurse practitioner as a
specialty practice? What are your aspirations for a Residency program? Please
comment upon your vision and planning for your short and long-term career
development.
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2. What are the goals that you are looking to accomplish during your residency at
CHC? Please identify specific areas of interest by lifecycle, age, or setting that
you would like to develop increased mastery, competence or confidence in.
3. CHC’s Residency is a unique Inter-Professional Residency with physicians, nurse
practitioners, dentists & pharmacists learning and working alongside each other.
The first classes of residents will be, in essence, “co-creators” of this program.
Please comment on your personal qualities and strengths that you think will
contribute positively to this experience. What apprehensions, concerns, and
hesitations might you have? Please feel free to be straightforward!
 Please submit three letters of reference. Letters should include:
1. 1 letter from either an employer or clinical preceptor.
2. 1 letter from an advisor/NP Faculty/Program Director providing a brief
assessment of your capabilities for this Residency.
3. 1 letter from the Associate Dean indicating your cumulative GPA, academic
standing and verifying graduation criteria will be fulfilled by June 8, 2013.
Please have the reference letters mailed directly to you with a designated seal as indicated by a
sealed envelope taped, and signature across the taped back flap by the individual providing the
reference.
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Application for 2013-2014 Family &
Community Nurse Practitioner Residency
Name: ________________________________________________________________________
Last
First
Middle
DEGREE
Address: ______________________________________________________________________
Street
Phone: (____)_____-________ (home)
City/State
Zip
(____) _____-_________ (cell)
Email: _________________________________ Proficient Language(s)___________________
CLINICAL ROTATIONS/FELLOWSHIPS/PRECEPTORSHIPS
List in chronological order—include month/year of attendance, clinical hours, full mailing
address of clinical institution & preceptor/attending provider’s name/title. (Attach additional
page if needed)
Clinical Institution: _____________________________________________________________
Dates _____/_____/_____ to _____/_____/_____
Hours Completed: ___________________
Address: ______________________________________________________________________
Street
Specialty: _______________________________
City/State
Zip
Preceptor: __________________________
******************************************************************************
Clinical Institution: _____________________________________________________________
Dates _____/_____/_____ to _____/_____/_____
Hours Completed: ___________________
Address: ______________________________________________________________________
Street
Specialty: _______________________________
City/State
Zip
Preceptor: __________________________
******************************************************************************
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Clinical Institution: _____________________________________________________________
Dates _____/_____/_____ to _____/_____/_____
Hours Completed: ___________________
Address: ______________________________________________________________________
Street
City/State
Specialty: _______________________________
Zip
Preceptor: __________________________
******************************************************************************
Clinical Institution: _____________________________________________________________
Dates _____/_____/_____ to _____/_____/_____
Hours Completed: ___________________
Address: ______________________________________________________________________
Street
City/State
Specialty: _______________________________
Zip
Preceptor: __________________________
******************************************************************************
POST GRADUATION/BOARD CERTIFICATION STATUS
1. Are you currently in good academic standing & expect to graduate ‘on time’? Y/N_____
2. What is your expected date of graduation?
DATE: _____/_____/_____
3. Have you been accepted to the Certification Body to take the FNP boards? Y/N_______
4. What is your expected date of board certification?
DATE: _____/_____/_____
5. Are you available to live & work in the Tacoma/Pierce County area for an intense oneyear professional residency?
Y/N________
6. Are you willing to practice as a primary care provider in a FQHC?
Y/N_________
Other Certifications & Memberships
Please note all professional certifications (ACLS, PALS, etc) and any memberships to
professional societies, etc
___________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________
Areas of Interest/Specialty: __________________ (Primary)/ __________________(Secondary)
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Permission to Release Information
I, _______________________________, give permission to_____________________________
(clinical supervisor, faculty member, advisor, associate dean, or chair/program director to
provide information about me for the purposes of a reference letter for the application to the
Community Health Care Family & Community NURSE PRACTITIONER Residency.
_______________________________
Signature
_____________________________
Date
(Please make appropriate copies of this page & distribute as needed)
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Please attach all required documentation to support your residency application in the order listed
below. Applications are due April 1, 2013.
o
o
o
o
o
o
o
2013-2014 Application
CV
Residency essay
Copy of Registered Nurse License
Written confirmation of eligibility of NP program graduation
ANCC/AANP certification or evidence of eligibility for certification
Three letters of reference
Community Health Care
NURSE PRACTITIONER RESIDENCY
Attn: NP Residency Program Director
101 East 26th Street
Tacoma, Washington 98421
Please email npresidency@commhealth.org or call 253-722-1775 for any questions.
Thank you for applying to Community Health Care:
Family & Community NURSE PRACTITIONER Residency.
Proud to be partnered with…
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