• Application to Community Healthcare Network's Psych NP Fellowship Program

    Please fill in the form carefully and make sure all information is accurate

  • Applicant Information

  • Gender*
  • Format: (000) 000-0000.

  • Additional Information

    for federal reporting purposes
  • Ethnicity*
  • Active or Retired Military Personnel*

  • Nurse Practitioner Information

  • Expiration Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Expiration Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • If not certified, have you been accepted by the board to take the examination and are you actively in the board certification process?*
  • If yes, indicate planned examination date. *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Have you ever taken and failed a certification examination?*
  • From*
     - -
    2 digit month, 2 digit day, 4 digit year
  • To*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Essay Questions

  • Please answer either Questions 1-3 OR Questions 4-6. Respond to each question individually. Combined responses should not exceed two single-spaced pages.

    1. Describe a specific personal, educational, clinical, or community experience that shaped your understanding of health inequities or barriers to care. How has that experience influenced the type of Nurse Practitioner you hope to become, and how would it contribute to CHN’s mission of providing high-quality, culturally responsive, community-based healthcare?

    2. Part of the goal of the CHN NP Fellowship is to address the healthcare disparities that face NYC. How do you foresee yourself helping to address the healthcare challenges that affect communities in NYC?

    3. Fellowship training requires continuous learning, feedback, and adaptability. Describe strengths you would bring to the CHN NP Fellowship, as well as one area of professional growth you hope to develop during the program. How do you typically respond to constructive feedback?

    4. While providing healthcare as a Nurse Practitioner is often a rewarding career, it is also a profession that entails addressing constant challenges. What do you see as the most significant issues the NP profession will face in the next 20 years, and what are some potential solutions for these problems?

    5. Describe your short-term (1-3 years) and long-term (5-10 years) professional goals. How does fellowship training fit into those goals, and what role do you hope community health, primary care, or psychiatric care will play in your future career?

    6. Describe a patient encounter, clinical experience, or life experience that challenged your assumptions or changed the way you think about patient care. What did you learn, and how has it influenced your approach to caring for patients from backgrounds different from your own?
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  • Required Documentation

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  • If not board certified at the time of application, please provide 3 professional letters of recommendation. If board certified at the time of application, 2 letters of recommendation. Letters must:

    • Be dated, signed and addressed to Dr. Taisha Benjamin, Chief Medical Officer.
    • Include 1 letter from a nursing education program, 1 letter from employment, and 1 of your choosing. One recommendation must be from a clinical instructor.*

    * If more than 5 years post-graduation, 1 letter can be from your current supervisor (in lieu of education program), and 1 from your general employment.

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      Registration Fee
      $50.00$50.00
        
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