Frontier Nursing University Courier Application
To be considered for the 2019 Courier Program, please complete the following application. It is suggested that you prepare your answers in a separate document beforehand, in case the form times out. Thank you for your interest in the Courier Program at Frontier Nursing University!
Email address *
Full Name: *
Permanent Address: *
School Name:
School Address:
Major: *
School Years Completed: *
Degree Status:
Email Address: *
Phone: *
Age, as of May 1, 2019: *
Race (select one or more boxes):
How did you hear about the Courier Program? If you heard about the program from a person, please include the individual's name, position, institution, and contact information. *
What do you hope to gain out of this experience? *
What is your personal definition of servant leadership? In what ways do you embody these qualities (please use specific examples)?:
What is your preferred method of supervision and why?
What motivates you to serve as a Courier? How does the Courier program and the mission of FNU relate to your personal or career goals?
Describe an encounter you've had with people different from yourself, and demonstrate how you successfully navigated the experience.
Participating in the Courier program may mean that you are placed at a remote, rural site, with limited social outlets and without other Couriers on site. What personal attributes or coping skills will you use to thrive in such a placement?
Briefly describe any volunteer and/or medical shadowing experience:
Do you have a vehicle available for use during the summer program?
Preferred clinical site
List your top three preferred sites and explain briefly why you prefer that site: Refer to the 2018 brief site descriptions link to read more about our sites at:
First choice:
Second choice:
Third choice:
How might you respond if you are not placed at one of your top three sites?
Is there anything else you would like to disclose, or that you feel is pertinent to your application?
The following files must be submitted prior to completing the form
Copy of Driver's License (Please title the file "last name_DL." Example: Smith_DL)
Copy of Unofficial Transcript (Please title the file "last name_Transcript." Example: Smith_Transcript)
Two letters of recommendation must be submitted by April 2, 2019 at 5 pm EST in order for the application to be considered complete. References should send letters by email to: Please include applicant name in the subject line, or by uploading with this application.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Frontier Nursing University. - Terms of Service