Nurse Practitioner Residency Program Application

Please complete this application and submit all required materials to be considered for a position in the Sea Mar Nurse Practitioner Residency Program 2024-2025 cohort.

Applications for the Psychiatric NP Post-graduate training program will be accepted until the positions have been filled.

The FNP residency application closed on February 4th. Applications submitted after the deadline will be considered at the discretion of the Program Director.

Full Name:

First Name

Last Name

Personal Statement: Please attach a personal statement no longer than two pages that addresses each of the following topics:

Goals for future practice, and how our program will help you achieve them

Goals for the residency program, which can include specific areas of interest

Experience with Spanish language and/or working with underserved, vulnerable populations

Strengths and weaknesses, and how these will help you succeed in a residency program and in future practice at a FQHC

References

- Two references (one academic, one professional). Please submit contact information (including a current email address) for two references (one academic, one professional).

Academic Reference Full Name

Title and Institution

Reference Email

Phone

Professional Reference Full Name

Title and Company

Reference Email

Phone

What is your expected date of graduation?

Please mark your level of Spanish language proficiency using the scale below.
0 – No Proficiency. Knows a few words only.
1 – Elementary Proficiency. May be able to speak a few sentences. Unable to conduct patient visit without assistance.
2 – Limited Working Proficiency. May be able to have basic conversation, understand routine questions. Unable to conduct patient visit without assistance.
3 – Professional Working Proficiency. Able to have more robust conversation. Has fairly extensive vocabulary, and can speak at normal speed. Able to conduct standard patient visit, but may need assistance with more advanced communication, such as having a sensitive conversation with a person, or understanding subtle or nuanced phrases.
4 – Full Professional Proficiency. Able to have advanced discussions on multiple topics. Extensive vocabulary. Does not require assistance with communication.
5 – Native / Bilingual Proficiency. Fluent.

Any	Aberdeen	Battleground	Bellevue	Bellingham
Burien	Concrete	Des Moines	Elma	Everett
Everson	Federal Way	Kent	Lacey	Lynnwood
Marysville	Monroe	Mount Vernon	Ocean Shores	Olympia
Puyallup	Seattle	Tacoma	Tillicum	Vancouver
White Center	Yelm	Other

Nurse Practitioner Residency Program Application

Thank you for your interest in the Sea Mar Nurse Practitioner Residency Program. We look forward to reviewing your application.