Maintaining your de Souza Designation

Thank you for applying to renew your de Souza Designation. The designation maintenance requirements are described on this page. If you have any questions about maintaining your Designation, please contact us at support@desouzainstitute.com and we'll be glad to provide additional information.

Name
Date of Birth Date of Birth / MM / DD YYYY
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Employer's Name
Primary Email Address
Work Email
Nursing Education Background (indicate all degrees obtained)

Nursing Education Background (indicate all degrees obtained) RPN RN (Diploma) RN (Degree) RN Master's or higher Other Other
Specialty Certification

Specialty Certification CNA oncology specialty CNA hospice palliative care specialty ONCC pediatric hematology specialty Other Other
Attach a copy of the College of Nurses of Ontario Registration

Attach Files
Attach a Copy of CNA or ONCC Certification

Attach Files
Curriculum Vitae (CV)

Attach Files
What is the total number of DE SOUZA continuing education hours since obtaining your designation
What is the total number of NON de Souza continuing education hours since obtaining your designation
Please attach supporting documents or proof of your participation in continuing education (de Souza and Non de Souza activities)

Attach Files
Please write a short paragraph describing your career development since your de Souza designation, as well as your next steps in terms of your clinical practice or professional growth
By typing my information below I confirm that the information provided in the application is complete and accurate. The provision of false information may result in the termination of the de Souza designation and entitlement of eligibility for future de Souza awards or funding

This is the description of your section break.
Print Full Name Print Full Name First Last
Confirm Primary Email Address
Date of Submission Date of Submission / MM / DD YYYY

Maintaining your de Souza Designation

Maintaining your de Souza Designation

By typing my information below I confirm that the information provided in the application is complete and accurate. The provision of false information may result in the termination of the de Souza designation and entitlement of eligibility for future de Souza awards or funding