AlphaFIM® Credentialing 2019-20

To complete registration, supply all the following information in full.
Attendance is optional for persons recertifying.


Terms and Conditions
  • The deadline to register is 7 days prior to the first session of the course.
  • Payment of $45 to the CRSN is required. This fee is for the license code to write the AlphaFIM test, not for the education session. The fee is normally collected by the CRSN directly from your department's manager.
  • If attending by videoconference, it is the responsibility of the participant to arrange a room and sign up for the OTN event at their facility (Event ID will be provided by CRSN). More information will be provided in a reminder email
To complete registration, fill in the information below in full. An asterisk (*) indicates a required field. Registrants have the choice of attending in person at
  • Parkdale Clinic, Room 50, Main Floor North
    Civic Campus, Ottawa Hospital, 1053 Carling Ave, Ottawa
  •             OR
  • by videoconference.
  • (Further details will be emailed after the registration has been accepted)

You must pick one of the listed options

Please be sure to CLICK on your selection. Registration will be void if this choice is not properly made.

Please supply Registrant's last name

Last (or family) name of person being registered

Please supply the registrant's first name

1st (or given) name of person being registered

Please supply your email address

Enter the work email of person being registered

Please supply your email address

Please enter the same email address again

Please supply your email address

Enter another email address

Please fill in area code and 7-digit phone number for your place of work. Please note, NUMBERS ONLY.
Any extension # goes in the next field

Numbers only please, no letters, spaces, dashes or symbols.
Usual daytime phone number. Please list extension in the next field.

Please fill in your phone number extension if any for your place of work

Numbers only please, no letters, spaces, dashes or symbols

Please select the name of your organization

Name of the organization, business, or hospital registrant works for. Please be sure to CLICK on your selection

It is *required* that you choose one item from each of the drop-down boxes below. All choices MUST be made in order for registration to be accepted.

Please make one choice from the list provided

Position within the Health Care System the registrant works for. Please be sure to CLICK on your selection

Invalid Input

Where on the continuum of care best describess where the person being registered usually works?
Please remember to CLICK on your selection.

Please choose from one of the values listed

Number of years the applicant has worked professionally in health care. Please be sure to CLICK on your selection

Please choose from one of the values listed

Number of years the applicant has worked professionally with stroke survivors. Please be sure to CLICK on your selection


Please supply the name of your Manager or Scheduler

Please provide the first name of Manager, Shift Scheduler, or Edu Coordinator

Please supply the name of your Manager or Scheduler

Please provide the last name of Manager, Shift Scheduler, or Edu Coordinator

Please supply your manager's email address or phone number

Email of Manager listed above



Important to Process Registration.
  • I acknowledge that the CRSN will arrange with the manager of my department to have the $45 licence fee paid to the CRSN prior to the completion of this training session.

Please Check to indicate that you acknowledge the terms of this agreement.


                            

Once registration is received at CRSN, the participant will receive an email confirming their registration. Participants will also receive reminder emails before each session.

                            

Contact us

Champlain Regional Stroke Network The Ottawa Hospital - Civic Campus Civic Parkdale Clinic, Main North 1053 Carling Avenue Ottawa, ON K1Y 4E9

Phone: 613-798-5555 x 16153
SPC Phone: 613-798-5555 x 16156