* = Required Information

General Nursing Council, Guyana

Application Form

Temporary registration as a Nurse/Midwife/Nursing Assitant

Surname *

First Name *

Middle Name

Date of Birth *

Home Address

Temporary Address (in Guyana)

State whether Single or Married

Maiden Name

Project/Company or Hospital of Attachment

Telephone Number *

Seeking Registration as

Nurse

Midwife

Nursing Assistant

Period of Stay in Guyana

From

You are required to produce an Original or a Cerified Copy of Current Registration BEFORE Temporary Registration is granted. Registration will be valid for a period of six months (6) only after which is MUST be renewed.

Fee

Dated

Full Name of Applicant *

Please attach copy of certification

Full Name of Witness *

Address of Witness *