Step 1 of 7 14% ELIGIBILITYThis program is for Family Nurse Practitioners (FNP) only. Are you currently an FNP or graduating as an FNP in the next 1-3 months?* Yes No This program is for new and recent FNP graduates who have NOT previously worked as an FNP. Only graduates from 2024 or later may apply. Do you meet this criteria?* Yes No Do you currently reside in Los Angeles County or plan to move to Los Angeles County?* Yes No How did you hear about our FNP Residency Program?* Career/Job Fair Clinic/Employee Referral CCALAC Presentation Health Career Connection Idealist LinkedIn Internet Search Engine Referred by School/Program Unite LA Other CONTACT INFORMATIONName* First Last Email address* Enter Email Confirm Email Cell phone number*Provide your current address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you moving within the next 3-6 months?* Yes No Please describe any travel/commute restriction you may have.* DEMOGRAPHIC INFORMATIONWhat best describes your race/ethnicity?* Asian Black/African American White/Caucasian Hispanic/Latino/LatinX Native American Native Hawaiian or Other Pacific Islander Middle Eastern or North African Mixed Race/Multiracial Other What best describes your gender?* Male Female Queer Trans Non-Binary Other What are your preferred pronouns?* He/Him/His She/Her/Hers They/Them/Theirs What is your date of birth?* What School/FNP program did you graduate from or will graduate from?*When did you graduate or when will you graduate from your school/program?*Do you speak and/or write any languages other than English?* Yes No Please indicate each language and proficiency level (if none, put N/A):* Example: Spanish - Basic, Proficient, or Fluent or Cantonese - Basic, Proficient, or Fluent. DOCUMENTSThe following 4 documents must be submitted with this online application: 1) Resume/CV 2) Personal Statement 3) Proof of National Certification or form/document confirming test date 4) Unofficial graduate school transcriptsResume/Curriculum Vitae - REQUIRED Drop files here or Select files Accepted file types: pdf, pdf, tiff, jpg, jpeg, png, Max. file size: 32 MB. Personal Statement (see application details and instructions) - REQUIRED Drop files here or Select files Accepted file types: pdf, doc, docx, pdf, tiff, jpg, jpeg, png, Max. file size: 32 MB. Questions can be found in the Application Details and Instructions document. Proof of National Certification or document/letter confirming future test date - REQUIRED Drop files here or Select files Accepted file types: pdf, pdf, tiff, jpg, jpeg, png, Max. file size: 32 MB. Unofficial Graduate School Transcripts - REQUIRED Drop files here or Select files Accepted file types: pdf, doc, docx, pdf, tiff, jpg, jpeg, png, Max. file size: 32 MB. Current RNP license and prescriptive authority in CA - OPTIONAL Drop files here or Select files Accepted file types: pdf, pdf, tiff, jpg, jpeg, png, Max. file size: 32 MB. Current copy of malpractice insurance as RNP - OPTIONAL Drop files here or Select files Accepted file types: pdf, pdf, tiff, jpg, jpeg, png, Max. file size: 32 MB. SUPPLEMENTAL QUESTIONSRate your experience managing the following patient populations. Check the appropriate box for each. Neonatal* No experience Minimal experience Moderate experience Maximum experience In a few sentences, please elaborate on your experience managing Neonatal populations.*Pediatrics* No experience Minimal experience Moderate experience Maximum experience In a few sentences, please elaborate on your experience managing Pediatric populations.*Adolescent* No experience Minimal experience Moderate experience Maximum experience In a few sentences, please elaborate on your experience managing Adolescent populations.*Pregnant women* No experience Minimal experience Moderate experience Maximum experience In a few sentences, please elaborate on your experience managing Pregnant Women.*Adult Male Health* No experience Minimal experience Moderate experience Maximum experience In a few sentences, please elaborate on your experience with Adult Male Health.*Adult Female Health* No experience Minimal experience Moderate experience Maximum experience In a few sentences, please elaborate on your experience with Adult Female Health.*Older male health* No experience Minimal experience Moderate experience Maximum experience In a few sentences, please elaborate on your experience with Older Male Health.*Older female health* No experience Minimal experience Moderate experience Maximum experience In a few sentences, please elaborate on your experience with Older Female Health.*Which of the population(s) listed above (neonatal, pediatrics, etc.) do you prefer NOT to clinically manage and why?*SUPPLEMENTAL QUESTIONSWhat is your comfort and competency level with the following. Check the appropriate box for each.Contraceptive prescribing* Not comfortable/competent Minimal comfort/competency Moderate comfort/competency Completely comfortable and competent Breast exams* Not comfortable/competent Minimal comfort/competency Moderate comfort/competency Completely comfortable and competent Pap test* Not comfortable/competent Minimal comfort/competency Moderate comfort/competency Completely comfortable and competent Implanting contraceptives* Not comfortable/competent Minimal comfort/competency Moderate comfort/competency Completely comfortable and competent Provide any notes or comments regarding your responses to the rating and questions above (*Optional) Letters of Recommendation2 Letters of Recommendations are required for this application. Please have your references submit via e-mail directly to Alexander Gil in PDF Format. The letters must come from the person writing it only. Please email to agil@ccalac.org by the application deadline of 8/31/26. The letters should address how the writer knows you, your academic ability and the characteristics the writer feels qualify you for the residency program. One letter must be from a FNP preceptor (preferred) and the second from a FNP faculty person. If you did not have an FNP Preceptor, a letter from an MD Preceptor or other Physicians are permissible. Signature and Certification of ApplicationSignature (Please use your mouse or finger)*By signing, I attest that the above information on this application and supporting documents are true and valid to the best of my knowledge. Furthermore, with my signature I hereby grant CCALAC permission to share the contents of my application with its members and partners for the sole purpose of the FNP Residency Program.
