Trainee Intake Form

Due to the nature of our funding, we are required to collect various demographic information about grant participants. We use this form to collect that data, as well as to gain an understanding of your level of SANE experience. We then use this information to connect you with trainings that meet your specific education needs.


If you have any additional questions, please email Stephanie Dutenhafer, Project Coordinator, at stephanie.dutenhafer@hcmed.org.


Contact Information

Please provide a personal email address.

Phone
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Mailing Address

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Demographic Information

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Examples:

She, her, hers

He, him, his

They, them, theirs

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You may use your best judgement to determine this

or reference the HRSA definition here: https://bhw.hrsa.gov/grants/resourcecenter/glossary#D.

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Please reference this document for definitions of medically underserved community, preceptor, primary care setting, and rural:

https://3b2c60ed-0878-46de-ad74-9178cb86a181.usrfiles.com/ugd/3b2c60_8f17848e773a4b9bb1fb0c1b3e0c847d.pdf.

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SANE Training and Employment

A didactic course is where you learn by listening to an instructor teach (vs. a hands-on course where you learn by practicing a skill after seeing an instructor demonstrate it). A didactic SANE course is usually offered as a multi-day, in-person training or an online, module-based training focused. The focus of the adult/adolescent course is on providing trauma-informed medical-forensic care to victims of sexual assault who are age 13 and up.

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See definition of a didactic SANE course above. The focus of the pediatric didactic course is on providing trauma-informed medical-forensic care to victims of sexual assault who of sexual assault who are age 12 and under.

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Reference this page for more information: https://www.forensicnurses.org/page/IPVNE.

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A Sexual Assault Nurse Examiner clinical skills lab is a training, usually spanning multiple days, where you have the opportunity to practice SANE skills using standardized patients, simulation, or other hands-on methods.

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Are you currently employed at any level (casual, part-time, full-time, per-diem, etc.) as a nurse whose main purpose while in that role is to perform medical-forensic exams for patients who have been sexually assaulted, assaulted by their intimate partner, human trafficked, or otherwise assaulted? A medical-forensic exam is an exam during which includes injury treatment and documentation, provision of medications to prevent sexually transmitted infections and pregnancy, and evidence collection, among other things). This type of exam is generally performed by Sexual Assault Nurse Examiners (SANEs)/Forensic Nurse Examiners (FNEs).

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After completing your initial SANE training and working as a SANE for at least a year, you may be eligible to sit for either the SANE-A (Sexual Assault Nurse Examiner – Adult/Adolescent) or the SANE-P (Sexual Assault Nurse Examiner – Pediatric) Exam. These certifications demonstrate excellence, validate your knowledge, provide credibility, and can enable a SANE to earn higher wages. Our grant offers a scholarship for the cost of the exam and exam prep book, as well as a facilitated peer study group to prepare test takers for success.


Refer to this page for more information: https://www.forensicnurses.org/page/Certification.

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Your plans for working as a SANE; whether you pass or fail the SANE-A/SANE-P exam; and if you choose to leave the program, your reason for leaving.

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