Registration Forms

Gab-Nic Excelsior Nursing Tutoring Center

1. Name *

2. Address*

3. Phone Number*

4. Email address*

5. What degree are you pursuing? *

LPNRN

6. What nursing school did/do you attend?*

7. What is your current status

Considering Nursing SchoolMatriculating Nursing StudentNursing Graduate

8. How did you hear about this tutoring center*

9. Are you going to sit for an exam in the near future? If yes when?*

10. Have you failed any previous exams*

YesNo

11. Did you receive a diagnostic of which subjects you are strong and weak in? (If so please bring it on your next meeting)*

12. What do you need tutoring in*

Pre- RequisitsMedical surgicalPediatricsMaternityPsychologyPharmacologyDosage Calculation

13. What is your level of English?*

BeginnerEntermediatExpert

14. What time frame would you prefer to be tutored

15. What resources/materials have you used in the past for studying. (Please bring them on your next meeting)*

16. How would you like to be tutored*

One- on- OneGroup sessionPhone callZoomPre-recorded sessions

17. Have you had a fever or diagnosed with Covid-19 in the past week.*

NoYes

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