LTC Clinical Shift Supervisor Training Spring 2026 (English)

Please note: You can choose to complete the registration form in either French or English. Please select your language at the right of the form.
Course Application Form

The Shift Supervisor Course will be offered in the late spring of 2026 in English instruction only
Student Name*

First NameLast Name
Provincial Nursing Registration Number*
Work Phone Number
Format: (000) 000-0000.
Mobile Phone Number*
Format: (000) 000-0000.
Work E-mail
example@example.com
Personal E-mail*
example@example.com
Current Employer*
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?*
Select your preferred class option (only English cohorts open of applications)*

Starting April/MAyStarting May/June
What is your preferred time for course delivery?

Afternoon (1:30PM - 3:00PM)Late Afternoon (3:30PM - 5:00PM)Evening (7:00PM - 830PM)
Agreement of Participation
We ask that you honor our agreements of participation for this online course:
- Confidentiality: Students are encouraged to share personal reflections and experiences to further their own learning and foster group participation. Such information will be considered confidential and will not be shared outside of this learning experience by students and/or instructors.
- Attendance: Mandatory to be awarded the certificate of “Long Term Care Shift Supervisor Course”.
- Be Stationary: Please be prepared to participate from a stationary spot. Participation from a moving vehicle, while on a walk, etc. is not ideal for this type of learning experience. 
- Full Engagement: Please have both your video and audio on through your computer, laptop, or mobile device and we encourage you to use headphones (not computer speakers) to enable the best experience for yourself and others.
- Full Presence: Please eliminate notifications, distractions, or anything that will take your attention from the experience. We do make an exception for lunch/snacks/drinks! Feel free to enjoy some nourishment as we chat together.  
- Course Grading: Participants are required to attend class and complete the homework assignments in order to be given credit for the course. The course is a pass/fail grading format. Upon successful completion of the course, students are awarded a certificate of completion. This course can be credited towards greater certifications within Beacon Clinical Group, including the Leadership in Person Centered Care credential.
I agree to honour the above agreement of participation:
Signature*
Date*

MonthDayYear
Date
If you have any questions, please do not hesitate to reach out.

Sam Stordy
info@beaconclinicalgroup.com
Phone: (506) 425-7495
Should be Empty:

Course Application Form

Agreement of Participation