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Membership Type
Application Type
Member Type

I, the undersigned, hereby apply for admission as a:    (select one)

Personal Information
Name
Title
Home Address
Employer
Telephone
Email
Preferred Contact
How would you prefer CINA to contact you?
Education
Highest Education
Highest level of education achieved:
Highest Education
School of highest education
Program of highest education
Areas of Expertise
Select all that apply and indicate length of expertise (in years):
Area : Length (in years)
Acute Care :
Addictions/Mental Wellness :
Child/Youth Health :
Community Health/Development :
Education :
Environmental Health :
Health Promotion/Prevention :
Home Care :
Indigenous Knowledge :
Infectious Diseases :
Long-term Care :
Medical Nursing :
Policy & Leadership :
Population Health :
Public Health :
Surgical Nursing :
Traditional Healing :
Other :
Please specify
Credentials

Complete the section that pertains to the Membership Type for which you are applying.

Regular Member
Regular Member

I am a ________ who is in good standing with my Regulatory Body. (Select one)

Provide your registration number(s) and the province(s) in which you are registered.
Supporting Member
Profession
I am a ________ who is in good standing with my Regulatory Body. (Select one)
Profession
Provide your registration number(s) and the province(s) in which you are registered, if applicable.
Retired Member
Retired Member
Undergraduate Student or Graduate Nurse Member
Undergraduate Student or Graduate Nurse Member
If applying as an Undergraduate Student Member, attach your current valid sutdent ID card.
If appliying as a Graduate Nurse Member, attach your Graduate Nurse certificate.
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Indigenous Ancestry

Why Self-Identify?

The Canadian Indigenous Nurses Association (CINA) is committed to the retention and recruitment of Indigenous Peoples, with the aim of achieving equity in both the workforce and in educational institutions. To increase the representation of Indigenous Nurses it is important to known how many Nurses there are in Canada to ensure policies aimed at increasing accessibility and equity. For this purpose, according to our bylaws and in order to improve the assessment of our practice environments and achievement of Indigenous nurses, you are required to self-identify if you are of First Nations, Inuit or Métis ancestry within the meaning of the Canadian Constitutional Act of 1982.

Definition of Aboriginal People:

In accordance with the Constitution Act, 1982, Part II, Section 35(2), an Aboriginal applicant is a First Nations, Inuit, or Métis person of Canada. 

By Self-Identifying as an Indigenous Nurse, you help CINA to:

  • Contribute to provision of high-quality learning opportunities, programs and incentives that are responsive to the needs of Indigenous Nurses. 

  • Contribute to strategic goals and policies set by the CINA, and external partners/stakeholders of CINA. 

  • Track the number of Indigenous Nurses in Canada.

  • Promote effective, respectful working relationships and partnerships with Indigenous nurses and the Indigenous community in the delivery of nursing services.

Indigenous Declaration

I am: (select at least one)

Indigenous Documentation
For the purposes of demonstrating Indigenous ancestry, I am including a copy of the following valid supporting document(s) with this Membership Application:   (select at least one)
Indigenous Documentation
Upload the copy of the supporting document(s) you indicated above.
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Certification

I, the undersigned:

  • am interested in furthering CINA’s purposes; 

  • confirm that all information I have given herein is true and complete and may be verified;

  • agree that admission as a Member of CINA is at the sole discretion of the Board of Directors of CINA, and that the Board may request additional supporting documentation of my qualifications for membership;

  • acknowledge and understand that membership in CINA is on an annual basis commencing on April 1st and expiring on March 31st of the following year until renewed, and that membership fees are not pro-rated;

  • consent to the participation in a meeting of CINA Members by means of a conference call or other communications equipment (e.g., Skype); and

  • understand that if it is determined that any declaration made above is false, such false declaration shall constitute just cause for termination of membership.

Sign above