| Application Date* Mandatory field |
| Please fill this required field. |
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| Personal information |
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| Full name in English* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Full name in Arabic* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Gender* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Name of Institution work / Department* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Job Title* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Mobile No* Mandatory field |
| Please fill this required field.Only numbers allowed |
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| E-mail Address* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Work phone* Mandatory field |
| Please fill this required field.Only numbers allowed |
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| Educational level: post-BCs * Mandatory field |
| Please fill this required field. |
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| Specialization level* Mandatory field |
| Please fill this required field. |
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| University name of specialization level earned* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Last Specialization Certificate Issue Date* Mandatory field |
| Please fill this required field. |
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| Specialization Certificate Validation Date* Mandatory field |
| Please fill this required field. |
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| Serial No of the specialization certificate* Mandatory field |
| Please fill this required field.Only numbers allowed |
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| Continuing Education Hours |
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| - For Nurse Specialist /midwifery Specialist: provide (36) continuing education hours, 60% of the hours in specialty area and 40% in other health fields.javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$MainContent$btnAddFields", "", true, "FieldsGroup", "", false, true)) |
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| - For Advanced Nurse Specialist/Advanced midwifery Specialist: provide (50) Continuing education hours, 60% of the hours in specialty area and 40% in other health fields. |
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Please fill below: Activity Title, Activity Date, Institution, and Contact hours ( Specialty 60%, General 40%)* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Clinical Hours |
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| Provide at least 250 practice days in specialization field during the three years of renewal for Nurse Specialist /midwifery Specialist & Advanced Nurse Specialist/Advanced midwifery Specialist). |
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| Please fill below: Description of working activity (Regular work, Part time, Independent work, Supervising of nursing students), Name of institution, unit, Date and Number of days)* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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| Additional requirements for Advanced Nurse Specialist/Advanced midwifery Specialist) |
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| Please Fill below: Name of the requirements (Participation in nursing project based on Evidence Based, Hold a Lecture in specialization field and be the main speaker for five hours continuing education at least,Publish a research or an article in nursing), Title, Institution, Contact hours and Date* Mandatory field |
| Please fill the correct format.Please fill this required field. |
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