PLEASE READ ALL OF THE ABOVE INFORMATION
|
|
- Samson Caldwell
- 8 years ago
- Views:
Transcription
1 INFORMATION FOR THE CLASS OF 2016 Huntsville Memorial Hospital's Joe G. Davis School of Vocational Nursing is approved by the Texas Board of Nursing and the Texas Education Agency The program is a twelve (12) month consecutive program. The program consists of classroom, laboratory, and clinical experiences. In addition to Huntsville Memorial Hospital, other health care facilities in the area are used for clinical rotations. A diploma is issued upon satisfactory completion of all program requirements. Graduates of the program are eligible to take the State Board Licensing Examination known as the NCLEX. More information concerning eligibility may be obtained at The graduate is not considered to be a Licensed Vocational Nurse (LVN) until successfully passing the State Board Licensing Examination. ALL STUDENTS MUST COMPLETE FBI FINGERPRINTING AND TEXAS BOARD OF NURSING BACKGROUNG CHECK CLEARANCE BEFORE ATTENDING SCHOOL * NO EXCEPTIONS* BEGINNING THE PROCESS Submit your fully completed/signed application with Official GED scores/high school/college transcripts/licenses to Joe G. Davis School by mail or in person. All applications must be in possession of the school no later than the last day of August, PRE-ENTRANCE EXAMINATION Test can be scheduled as soon as your fully completed/signed application and official transcripts/licenses are verified as received by the school. AT LEAST (10) DAYS BEFORE TESTING: Potential students must phone SHSU in advance to schedule time and pay a $50 nonrefundable deposit. They may pay this in person or via phone. Their appointment to test will not be set until payment is received. When they arrive for the test, they must pay the balance due of $ If they fail to arrive for the scheduled test, they will be required to pay an additional $ The total cost for the testing is $ This is an estimated cost only. Please call SHSU at to verify actual cost. After Submission: Test location Sam Houston State University testing center. Center is open Monday Friday testing times are 8am to 11am. If you choose to retake the test, the last test taken is the score that will be used by the school, but all scores must be submitted. All testers must bring a picture ID. All students must submit test scores to the school on the day you are tested. INTERVIEW REQUIREMENTS Official GED/high school transcript/ college transcripts/licensures. Good physical and mental health Picture ID (ex: Driver s License) Completed application and any additional requested paperwork at time of interview. Satisfactory score on the school s preentrance examination. At least four (4) personal references. No relatives or extended family members will be accepted. At least three (3) work references if you have ever been employed. (If you have less than 3, submit 2 additional personal references). Proof of starting the Hepatitis B Vaccine Series. A titer will be required for selected applicants prior to attending class. Proof of all vaccines (TB, MMR, TD, Flu, Chicken Pox and Hepatitis B series). TUITION AND FEES: The tuition is $ for the year and must be paid in full no later than (2) weeks before the first day of school. Estimated additional costs (Books, uniforms, etc.) could range up to $ depending on non-affiliated vendor cost. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. Mail completed applications to: Joe G. Davis School of Vocational Nursing P O Box 4001 Huntsville, Texas Telephone: Applications will be accepted for processing the month of May PLEASE READ ALL OF THE ABOVE INFORMATION Classroom facilities are located at: 521 I-45 South, Suite 8, Huntsville, TX. Application reviewed by the Advisory Committee
2 STUDENT APPLICATION FOR CLASS OF 2016 Joe G. Davis School of Vocational Nursing HUNTSVILLE MEMORIAL HOSPITAL P.O. Box 4001 Huntsville, Texas (936) SCHOOL USE ONLY Test: Test: Joe G. Davis School of Vocational Nursing is an equal opportunity institution and complies with all federal and Texas laws, regarding affirmative action requirements in all programs and policies. In compliance with Title VII of the Civil Rights Act of 1964, as amended by the Equal Opportunity Act of 1972, and Section 504 of the Rehabilitation Act of 1973, and the Older Americans Amendment of 1975, this institution does not discriminate on the basis of age, race, color, religion, sex, national origin, or disability in administration of its education policies, admissions policies, scholarship programs, and other school administered programs PLEASE PRINT ALL INFORMATION INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED Last Name First Name Middle Name Maiden Name Street Address (If different from ) City State Zip Code Home Phone Cell Phone Work Phone Address Social Security Number Date of Birth Texas Drivers License/ID Number Alternate Address PERSONAL INFORMATION Do you have any business, social/family obligations or medical conditions that would prevent you from attending school consistently if you are accepted? Yes No If Yes, please explain below. FOR SCHOOL USE ONLY Date Received: Are you either a U.S. Citizen or an alien who has the legal right to attend school in the U.S.A.? Yes No If no, are you considered a permanent resident? Yes No Card # Are you a former student of the Joe G. Davis School of Vocational Nursing? Yes No If "Yes", year enrolled Have you previously applied for enrollment in this school? Yes No Year:
3 EDUCATION AND TRAINING The applicant is to furnish the School of Vocational Nursing original transcripts from each of the listed educational facilities. If applicable, a photocopy of the GED report showing test scores must be furnished to the School. LAST YEAR NAME OF INSTITUTION COURSE OF STUDY COMPLETED DID YOU GRADUATE? MONTH/YEAR GRADUATED (High School City/State) YES NO GED (State Obtained) (College) (Vocational/Tech School) YES NO YES NO Please answer the following questions: 1) No Yes For any criminal offense, including those pending appeal, have you: A) been convicted of a misdemeanor? B) been convicted of a felony? C) pled nolo contendere, no contest, or guilty? D) received deferred adjudication? E) been placed on community supervision or court-ordered probation, whether or not adjudicated guilty? F) been sentenced to serve jail or prison time? court-ordered confinement? G) been granted pre-trial diversion? H) been arrested or any pending criminal charges? I) been cited or charged with any violation of the law? J) been subject of a court-martial; Article 15 violation; or received any form of military judgment/punishment/action? (You may only exclude Class C misdemeanor traffic violations.) 2) No Yes Do you have any criminal charges pending, including unresolved arrests? 3) No Yes Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of, suspended, placed on probation, refused to renew a professional license or certificate held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you? 4) No Yes Within the past five (5) years have you been addicted to and/or treated for the use of alcohol or any other drug? 5) No Yes Within the past five (5) years have you been diagnosed with, treated, or hospitalized for schizophrenia and/or psychotic disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder? Yes No If YES, indicate the condition: schizophrenia and/or psychotic disorders, bipolar disorder, paranoid personality disorder, antisocial personality disorder, borderline personality disorder All students must have full clearance with the Texas Board of Nursing prior to attending nursing school. The questions above may determine your eligibility to attend nursing school and to become licensed. For more information on eligibility please contact the Texas Board of Nursing at (512)
4 EMPLOYMENT HISTORY Beginning with most recent employment, please provide COMPLETE CURRENT MAILING ADDRESSES FOR EACH PLACE OF EMPLOYMENT LISTED INCLUDING ZIP CODES and CORRECT employment dates. Do not list self-employment or those that no longer are in business. List only employments that can be verified. Incorrect information/omitted information may delay or cause your application not to be processed for final review. Incomplete information may result in applicant not being able to register to test or attend school. PLEASE NOTE: IF LESS THAN THREE (3) WORK REFERENCES PLEASE PROVIDE TWO (2) ADDITIONAL PERSONAL REFERENCES PLEASE PRINT LEGIBLY COMPLETE MAILING ADDRESSES on your work and personal references are required. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
5 Personal references - do not list relatives or employers. Use counselors, teachers, coworkers, church members, etc. Do Not list as personal references the same persons listed as supervisors in your employment history. Incorrect/omitted information may delay or cause your application not to be processed for final review. PLEASE PRINT LEGIBLY PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION FORM: I certify that all statements made on this application are true and correct. I authorize former employers to release any information they may have regarding employment. I release from liability any person giving or receiving information pertinent to the investigation or verification of data provided in this application. If anything contained in this application and/or resumé is found to be untrue, I understand that I will be subject to dismissal or rejection. I understand that I will be subject to a personal interview and a photograph will be taken of me prior to the interview and attached to my application. I understand if I am accepted into the school, I will be required to have a physical examination and based on the information received from this exam, more information may be requested. I further understand that I will be required to be immunized for various diseases as recommended by the Texas Department of Health. I consent to random drug testing by urinalysis or blood tests to determine substance use and/or abuse at any time during the application process and/or school year. I understand a criminal background/history check will be made by Huntsville Memorial Hospital in the application process and the Texas Board of Nursing in order to attend school. The BON background check may result in my failure to be eligible to attend the Joe G. Davis Vocational School of Nursing or for taking the state board exam and licensure as a Vocational Nurse in the State of Texas. Printed Name Signature Date OFFICIAL HIGH SCHOOL/GED/COLLEGE TRANSCRIPTS MUST BE SUBMITTED WITH THIS FULLY COMPLETED AND SIGNED APPLICATION.
APPLICATION CHECKLIST
HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE - NURSING APPLICATION CHECKLIST A. Submit an application to the Texas Southmost College, MEET REQUIREMENTS FOR ADMISSION,
More informationHEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE NURSING Associate Degree Nursing Program
HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE NURSING APPLICATION CHECKLIST A. Submit an application to the Texas Southmost College, MEET REQUIREMENTS FOR ADMISSION,
More informationUPWARD MOBILITY NURSING PROGRAM APPLICANT CHECKLIST. Applicant Name:
Applicant Name: UPWARD MOBILITY NURSING PROGRAM APPLICANT CHECKLIST Please complete the following checklist to ensure all of the required items are submitted with your application. Incomplete applications
More informationTexas Board of Nursing 333 Guadalupe, Ste 3-460, Austin, TX 78701 Phone: 512-305-7400
For Office Use Only Date: Amount: Texas Board of Nursing 333 Guadalupe, Ste 3-460, Austin, TX 78701 Phone: 512-305-7400 PETITION FOR DECLARATORY ORDER Audit #: FBI HX: YES NO Complete this application
More informationEligibility Requirements for RN Licensure in the State of Texas
February 2015 1 Eligibility Requirements for RN Licensure in the State of Texas These requirements listed here are not exclusive. It is the student s responsibility to update themselves with all requirements
More informationDEPARTMENT OF NURSING BOX T-0500, STEPHENVILLE, TEXAS 76402 APPLICATION FORM Instructions
DEPARTMENT OF NURSING BOX T-0500, STEPHENVILLE, TEXAS 76402 APPLICATION FORM Instructions A point system is used to select students for admission to the Nursing Program at Tarleton State University (TSU).
More informationDepartment of Nursing. Box T- 0500, Stephenville, Texas 76402 APPLICATION FORM. Instructions
Department of Nursing Box T- 0500, Stephenville, Texas 76402 APPLICATION FORM Instructions A point system is used to select students for admission to the Nursing Program at Tarleton State University (TSU).
More informationThe University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria
1 The University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria 1. All students interested in applying for the Nursing Program must be admitted to the University
More informationVOCATIONAL NURSING APPLICATION PROCEDURES
VOCATIONAL NURSING APPLICATION PROCEDURES 1. Summit you VN application to the VN office at ITECC G 114. 2. Apply for college enrollment and financial aid at Oliveira Student Center as early as March for
More informationIncomplete application packets will not be processed.
BRIDGING APPLICATION FOR CONSIDERATION FOR SUMMER 2016 Print out this entire document. All pre requisites must be completed prior to applying. Sciences must be less than 10 years old at the time you apply.
More informationSAN JACINTO COLLEGE VOCATIONAL NURSING PROGRAM INFORMATION
North Campus South Campus 5800 Uvalde 13735 Beamer Rd. Allied Health Bldg., Room N-17.2112i Houston, Texas 77089 Houston, Texas 77049 281-484-1900 ext. 3504 or 3405 281-459-7114 Vocational.Nursing@sjcd.edu
More informationCentral Campus: Application for ADN-RN Program
Central Campus Application for ADN-RN Program This application and this checklist must be filled out completely and submitted to the Associate Degree Nursing Department you have selected during the application
More informationProgram Fact Sheet. Contact Odessa College School of Vocational Nursing- Monahans Center for application deadline.
Department Faculty and Staff: Monahans Extension Odessa College School of Vocational Nursing Monahans Center Program Fact Sheet Nancy Kilgore, R.N. Director of Nursing Ann McCalister, R.N., Instructor
More informationPUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made
PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made available to any person upon request. This application
More informationApplication for ADN-RN Program
Application for ADN-RN Program This application and this checklist must be filled out completely and submitted to the Associate Degree Nursing Department you have selected during the application period
More informationAt the time you apply the following pre-requisite courses must be complete or you must be enrolled in for Spring 2016:
ADN APPLICATION FOR CONSIDERATION FOR FALL 2016 Print out this entire document. At the time you apply the following pre-requisite courses must be complete or you must be enrolled in for Spring 2016: BIOL
More informationValley Baptist Medical Center Vocational Nursing Program
Valley Baptist Medical Center Vocational Nursing Program PRE-ENTRANCE PACKET Class of 2016 Dear Prospective Student, You must read all the information in this packet and on the school website before you
More informationPUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made
PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made available to any person upon request. This application
More informationLVN PROGRAM APPLICANT CHECK LIST
LVN PROGRAM APPLICANT CHECK LIST Download Information Packet and read thoroughly Application packet Completed all college admission requirements (see catalogue) Register for TEAS in the Testing Center
More informationTEXAS BOARD OF NURSING 333 Guadalupe #3-460, Austin, Texas 78701 (512) 305-7400
TEXAS BOARD OF NURSING 333 Guadalupe #3-460, Austin, Texas 78701 (512) 305-7400 APPLICATION FOR SIX MONTH TEMPORARY PERMIT TO COMPLETE REFRESHER COURSE, EXTENSIVE ORIENTATION, OR NURSING PROGRAM OF STUDY
More informationAssociate Degree Nursing/Tech Prep Plan (Generic Student Curriculum)
Associate Degree Nursing/Tech Prep Plan (Generic Student Curriculum) Dear Associate Degree Nursing Applicant, Victoria College offers a two-year Associate of Applied Science degree in nursing. Upon successful
More informationFrank Phillips College Vocational Nursing Department 1301 W. Roosevelt P.O. Box 5118 Borger, TX 79008 806-457-4200 ext. 746 www.fpctx.
Frank Phillips College Vocational Nursing Department 1301 W. Roosevelt P.O. Box 5118 Borger, TX 79008 806-457-4200 ext. 746 www.fpctx.edu KEEP THIS INFORMATION TO REMIND YOU OF NEEDED REQUIREMENTS. THE
More informationStudents applying for admission to the Associate Degree Nursing program must complete the following steps:
Central Campus Application for ADN-RN Program: This application and this checklist must be filled out completely and submitted to the Associate Degree Nursing Department you have selected during the application
More informationValley Baptist Medical Center Vocational Nursing Program
Valley Baptist Medical Center Vocational Nursing Program PRE-ENTRANCE PACKET Class of 2014 Dear Prospective Student, You must read all the information in this packet and on the school website before you
More informationINSTRUCTIONS FOR COMPLETING THE PETITION FOR REINSTATEMENT OF LICENSE
INSTRUCTIONS FOR COMPLETING THE PETITION FOR REINSTATEMENT OF LICENSE PLEASE PROVIDE ALL THE INFORMATION REQUESTED ON THE PETITION. WE ASK THAT THE PETITION BY TYPEWRITTEN OR LEGIBLY PRINTED IN BLUE OR
More informationLVN to ADN Transition Program
LVN to ADN Transition Program The LVN to ADN Program, at Texas State Technical College (TSTC), is a fast- paced associate degree nursing program that serves a 26 county rural area of West Texas. TSTC works
More informationTEXAS SOUTHMOST COLLEGE VOCATIONAL NURSING PROGRAM. Full Time Track. Information Pack
TEXAS SOUTHMOST COLLEGE VOCATIONAL NURSING PROGRAM Full Time Track Information Pack Application Deadline: For Fall- June 1 st For Spring- November 1 st VOCATIONAL NURSING APPLICATION PROCEDURES 1. Complete
More informationDEMOGRAPHIC INFORMATION
AKRON SCHOOL OF PRACTICAL NURSING STUDENT APPLICATION APPLICATION FOR FULL-TIME PROGRAMS PROGRAM OF INTEREST FULL TIME DAY LPN PROGRAM August 2013 June 2014 January 2014 January 2015 August 2014 June 2015
More informationLicensed Practical Nursing Applications For the Fall 2016 Class
Licensed Practical Nursing Applications For the Fall 2016 Class 1 Application for the Fall 2016 class should be completed and returned to Giles County Technology Center to be notified of the testing session
More informationTexas Board of Nursing 333 Guadalupe, Ste. 3-460, Austin, TX 78701-3944 Phone: 512-305-7400 -- Web Site: www.bon.texas.gov
For Office Use Only: RN / LVN Amount Date Rec d Date App Expires Texas Board of Nursing 333 Guadalupe, Ste. 3-460, Austin, TX 78701-3944 Phone: 512-305-7400 -- Web Site: www.bon.texas.gov PETITION FOR
More informationLee College Student Application for Admission For Vocational Nursing (L.V.N.) Program
Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program Type of complete in ink. (Immunizations must be submitted with application.) Desired DATE OF ENTRY into program: Semester
More information3. All applicants must meet the following requirements prior to admission into the nursing program:
LAMAR UNIVERSITY COLLEGE OF ARTS AND SCIENCES JOANNE GAY DISHMAN DEPARTMENT OF NURSING Application for Spring 2016 BACCALAUREATE DEGREE NURSING PROGRAM Read carefully and follow all instructions: 1 If
More informationVOCATIONAL NURSING PROGRAM
VOCATIONAL NURSING PROGRAM Dear Prospective Student: Thank you for your interest in the Vocational Nursing Program at Texas State Technical College Harlingen. The Vocational Nursing Program is located
More informationDate of Application: Social Security Number: - -
La Feria Independent School District P.O. Box 1159 203 E. Oleander La Feria, Texas 78559 (956) 797-2612 FAX (956) 797-3737 Raymundo P. Villarreal Jr., Superintendent Employment Application for Service
More informationThank you for your interest in the Alvin Community College Associate Degree Nursing 1-year Transition program.
Thank you for your interest in the Alvin Community College Associate Degree Nursing 1-year Transition program. The next Transition program you can apply to starts May 2014. The application period for that
More informationMid-America Technology Center Division of Practical Nursing P. O. Box H, 27438 State Highway 59 Wayne, OK 73095 405.449.3391
Mid-America Technology Center Division of Practical Nursing P. O. Box H, 27438 State Highway 59 Wayne, OK 73095 405.449.3391 Application Information Application Period: February 1, 2012 through April 27,
More informationApplication for Admission
Application Page 1 Application for Admission http://www.ariahealth.org/nursing Admissions Office, Suite 203 Three Neshaminy Interplex Trevose, PA 19053 Phone (215) 710-3531 Instructions Failure to completely
More informationLVN to ADN Transition Program
LVN to ADN Transition Program The LVN to ADN Program, at Texas State Technical College (TSTC), is a fast- paced associate degree nursing program that serves a 26 county rural area of West Texas. TSTC works
More informationPLEASE REMOVE THIS PAGE BEFORE SUBMITTING APPLICATION.
August 18, 2014 Admission to Nursing Program, GENERIC OPTION January 2015 Dear Potential Applicant: This letter contains vital information and instructions that you must implement completely in order to
More informationTexas Board of Nursing 333 Guadalupe, Ste. 3-460, Austin, TX 78701-3944 Phone: 512-305-7400 -- Web Site: www.bon.state.tx.us
For Office Use Only: Amount Date Recd Texas Board of Nursing 333 Guadalupe, Ste. 3-460, Austin, TX 78701-3944 Phone: 512-305-7400 -- Web Site: www.bon.state.tx.us Application by NCLEX-RN Examination for
More informationAPPLICANT INSTRUCTIONS
APPLICANT INSTRUCTIONS Thank you for your interest in employment with our Company. We appreciate your application, and look forward to the possibility of you joining our team. This sheet is for your information.
More informationApplication for New Louisiana Pharmacy Technician Candidate Registration
Louisiana Board of Pharmacy 3388 Brentwood Drive Baton Rouge, Louisiana 70809-1700 Telephone 225.925.6496 ~ Facsimile 225.925.6499 www.pharmacy.la.gov ~ E-mail: info@pharmacy.la.gov Application for New
More informationMay 6, 2015. Admission to Nursing Program, GENERIC OPTION August 2015. Dear Potential Applicant:
May 6, 2015 Admission to Nursing Program, GENERIC OPTION August 2015 Dear Potential Applicant: Thank you for your interest in the nursing program at Polk State College. This packet contains vital information
More informationCertified Registered Nurse Anesthetist General Instructions for Licensure Application
4305 S. LOUISE AVENUE SUITE 201 SIOUX FALLS, SD 57106-3115 (605) 362-2760 Fax: 362-2768 doh.sd.gov/boards/nursing General Instructions for Licensure Application Please follow instructions carefully to
More information**Make check or money order payable to the Montana Board of Barbers and Cosmetologists**
Page 1 of 5 MONTANA BOARD OF BARBERS AND COSMETOLOGISTS P. O. Box 200513 301 S PARK, 4 TH FLOOR (Delivery) Helena, Montana 59620-0513 (406) 841-2202 FAX (406) 841-2309 E-MAIL: dlibsdcos@mt.gov WEBSITE:
More informationName: (Last) (First) (Middle) Address: (Street) (City) (State) (Zip Code) Home Phone: ( ) Work Phone: ( ) Ext. Cell Phone: ( ) Alt Phone:
Lee College Associate Degree Nursing Application AD2 Generic TN2 Transitional VN License # AD2 Transfer TN2 Transfer VN expiration / / Desired DATE OF ENTRY into program: Semester Year Social Security
More informationPierpont Community & Technical College School of Health Careers Practical Nursing Program
Pierpont Community & Technical College School of Health Careers Practical Nursing Program ADMISSION PROCESS 1. Complete and submit Pierpont Community & Technical College application including: a. Submit
More informationRetain this page for reference purposes
To: All New Applicants Friendswood Independent School District 302 Laurel Drive Friendswood, TX 77546 SS UU BB SS TT II ITT UU TT EE AA PP PP LL II ICC AA TT II IOO NN GG EE NN EE RR AA LL II INN FF OO
More informationAugust 18, 2015. Admission to Nursing Program, GENERIC OPTION January 2016. Dear Potential Applicant:
August 18, 2015 Admission to Nursing Program, GENERIC OPTION January 2016 Dear Potential Applicant: Thank you for your interest in the nursing program at Polk State College. This packet contains vital
More informationVocational Nursing Program Wharton
Vocational Nursing Program Wharton APPLICATION DEADLINE Last Thursday of March PLEASE READ ALL SECTIONS OF THE APPLICATION PACKET TO ENSURE ELIGIBILITY BEFORE SUBMITTING AN APPLICATION Program Information
More informationThank you for your interest in the Alvin Community College Associate Degree Nursing LVN-to-ADN Transition program.
Thank you for your interest in the Alvin Community College Associate Degree Nursing LVN-to-ADN Transition program. We are no longer taking applications for the Transition program that starts May 2015.
More informationII. POLICY AND PROCEDURE FOR GENERAL ADMISSION INTO THE NURSING PROGRAM
Del Mar College Department of Nurse Education Admission Guidelines I. DATE FOR ONLINE APPLICATION SUBMISSION The Department of Nurse Education will accept applications for all on campus Tracks between
More informationLicensure by Examination Information For Graduates from Nursing programs within the United States
17938 SW Upper Boones Ferry Road Portland, Oregon 97224-7012 Licensure by Examination Information For Graduates from Nursing programs within the United States Non-United States Graduate: If you studied
More informationThank you for your interest in the Alvin Community College Associate Degree Nursing 2-year program.
Thank you for your interest in the Alvin Community College Associate Degree Nursing 2-year program. We are no longer taking applications for the 2-year program that starts January 2016. The next 2-year
More informationDIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292
DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292 PHARMACY TECHNICIAN REGISTRATION APPLICATION AND INSTRUCTIONS October
More informationTECHNICIAN-IN-TRAING IS NOT PERMITTED TO PRACTICE IN MONTANA IN ANY MANNER WITHOUT AN ACTIVE MONTANA REGISTRATION
Page 1 of 8 MONTANA BOARD OF PHARMACY (301 S PARK, 4 TH FLOOR, HELENA, MT 59601 - Delivery) P. O. Box 200513 Helena, Montana 59620-0513 PHONE (406) 841-2300 FAX (406) 841-2344 E-MAIL: dlibsdpha@mt.gov
More informationA $100.00 application fee in the form of a money order made payable to LSBN must accompany this form
OFFICE USE ONLY: APPROVED BY (initial) DATE PERMIT ISSUED RN LICENSE NUMBER DATE RN LICENSE ISSUED ATTACH PHOTO With tape only - Attach a 2 x 2 inch passport type, fade-proof photo taken in the last six
More informationSTATE OF FLORIDA BOARD OF MASSAGE THERAPY APPLICATION FOR COLON HYDROTHERAPY UPGRADE TO MASSAGE THERAPIST LICENSE WITH INSTRUCTIONS
STATE OF FLORIDA BOARD OF MASSAGE THERAPY APPLICATION FOR COLON HYDROTHERAPY UPGRADE TO MASSAGE THERAPIST LICENSE WITH INSTRUCTIONS Board of Massage Therapy 4052 Bald Cypress Way, Bin # C-06 Tallahassee,
More informationEMPLOYMENT APPLICATION Human Resources Office City of Clayton * 10 N. Bemiston * Clayton, Missouri 63105. (City, State & Zip)
EMPLOYMENT APPLICATION Human Resources Office City of Clayton * 10 N. Bemiston * Clayton, Missouri 63105 SECTION 1: GENERAL INFORMATION [ Please print or type ] Position(s) of Interest: Name: Social Security
More informationBoard of Speech-Language Pathology and Audiology
Board of Speech-Language Pathology and Audiology Application for Speech-Language Pathology or Audiology Provisional Licensure With Instructions Attached Board of Speech-Language Pathology and Audiology
More informationTEXAS DEPARTMENT OF STATE HEALTH SERVICES RESPIRATORY CARE PRACTITIONERS CERTIFICATION PROGRAM (512) 834-6632 APPLICATION INFORMATION
TEXAS DEPARTMENT OF STATE HEALTH SERVICES RESPIRATORY CARE PRACTITIONERS CERTIFICATION PROGRAM (512) 834-6632 APPLICATION INFORMATION An incomplete application will not be processed until all required
More informationPLEASE READ BEFORE COMPLETING APPLICATION
PLEASE READ BEFORE COMPLETING APPLICATION Information for Licensure: SOCIAL WORKER (LSW) Each item on the enclosed application must be completed. Allow 30 days for processing of the application. Failure
More informationThis is a Legal Document. By completing and signing, this you certify under
APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) BY ENDORSEMENT, or DEEMING *All certificates expire December 31 of every EVEN year* This is a Legal Document. By completing and signing, this
More informationCAMERON FOUNDATION CHEMICAL DEPENDENCY FELLOWSHIP PROGRAM. Counselor Intern Training Program. Information For Applicants
CAMERON FOUNDATION CHEMICAL DEPENDENCY FELLOWSHIP PROGRAM Counselor Intern Training Program Information For Applicants Memorial Hermann Prevention and Recovery Center 3043 Gessner Houston, Texas 77080
More informationUPMC SCHOOLS OF NURSING POLICY AND PROCEDURE
Page 1 of 5 Schools of Nursing UPMC SCHOOLS OF NURSING POLICY AND PROCEDURE SUBJECT: RN Program Admissions Policy DATE: September 19, 2014 INDEX TITLE: Administrative Policies I. POLICY: It is the policy
More informationNURSING. East Mississippi Community College P.O. Box 100 Mayhew, MS 39753 (662) 243-1910 2012-2013 PRACTICAL NURSING ADMISSION REQUIREMENTS
NURSING East Mississippi Community College P.O. Box 100 Mayhew, MS 39753 (662) 243-1910 2012-2013 PRACTICAL NURSING ADMISSION REQUIREMENTS Disclaimer The content and requirements of this admission packet
More informationPersonal Information
Forsyth R-III School District P.O. Box 187 Forsyth, MO 65653 Phone: 417-546-6384 Fax: 417-546-2204 Certified Personnel Employment Application Personal Information Last Name First Middle Date Street City,
More informationGLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER
P.O. Box 793 100 Sulphur Springs Road Brunswick, GA 31520 Telephone: (912) 554-7600 * Fax: (912) 554-7681 Web Page Address: www.glynncountysheriff.org INSTRUCTIONS AND INFORMATION PLEASE READ CAREFULLY
More informationEligibility Questions (if you answer YES to Eligibility Questions, instructions are located on Page 3)
TEXAS BOARD OF NURSING 333 Guadalupe #3-460, Austin, Texas 78701 (512) 305-7400 For Office Use Only Approved by: Permit #: Issuance Date: Exp. Date: APPLICATION FOR SIX-MONTH TEMPORARY PERMIT TO COMPLETE
More informationClinical Nurse Specialist General Instructions for Licensure Application
4305 S. LOUISE AVENUE SUITE 201 SIOUX FALLS, SD 57106-3115 (605) 362-2760 Fax: 362-2768 doh.sd.gov/boards/nursing General Instructions for Licensure Application Please follow instructions carefully to
More informationUNDERGRADUATE STUDIES
UNDERGRADUATE STUDIES Purpose The purpose of undergraduate studies is to prepare generalist nurses who will develop into leaders for the future as they provide competent, compassionate patient care in
More informationLVN-ADN TRANSITION NURSING PROGRAM WHARTON CAMPUS ONLY
Dear Applicant, LVN-ADN TRANSITION NURSING PROGRAM WHARTON CAMPUS ONLY PLEASE READ THE FOLLOWING INFORMATION CAREFULLY APPLICATION PERIOD: SEPTEMBER THROUGH JANUARY DEADLINE: THIRD WEDNESDAY OF JANUARY
More informationDiman Regional Technical Institute. Practical Nursing Program Admission Policy
Section I. Introduction Diman Regional Technical Institute Practical Nursing Program Admission Policy The Practical Nursing Program offers a full-time day, part-time day, and part-time evening program.
More informationApplication to the Basics in Addiction Counseling (BAC) Program. Section I. Application Requirements & Procedures
Requirements: Application to the Program Section I. Application Requirements & Procedures All applicants are required to be Psychology Majors and have: Procedures: Enrolled in the equivalent of the 4 th
More informationTHE APPLICANT IS RESPONSIBLE FOR KNOWING WHETHER THEY ARE ELIGIBLE FOR LICENSURE BASED ON NEW MEXICO RULES.
ONLY COMPLETE APPLICATION PACKETS ARE ACCEPTED. PLEASE BE SURE TO READ THE NEXT PAGE OF THIS APPLICATION. THE APPLICANT IS RESPONSIBLE FOR KNOWING WHETHER THEY ARE ELIGIBLE FOR LICENSURE BASED ON NEW MEXICO
More informationVOCATIONAL NURSING PROGRAM
2013-2014 Application for admission to: VOCATIONAL NURSING PROGRAM PLEASE SPECIFY WHICH CAMPUS SITE(S) YOU WISH TO APPLY BY RANKING EACH IN ORDER OF PREFERENCE: Cuero Gonzales Hallettsville Victoria PLEASE
More informationVocational Nursing Admission Procedures January 2015- May 2016
Career & Technical Education Vocational Nursing Program (530) 841-5929 Fax (530) 841-5214 Vocational Nursing Admission Procedures January 2015- May 2016 The application period will begin August 11, 2014
More informationASSOCIATE DEGREE NURSING PROGRAM APPLICATION PERIOD: DEADLINES:
Dear Applicant, ASSOCIATE DEGREE NURSING PROGRAM PLEASE READ APPLICATION CAREFULLY AND FOLLOW ALL DIRECTIONS APPLICATION PERIOD: WHARTON-FALL-November through March SUGAR LAND-SPRING-April through August
More informationVocational Nursing Program
1 Vocational Nursing Program San Antonio Campus: New Braunfels Campus: 1801 Martin Luther King Drive 2189 FM 758 San Antonio, Texas 78203 New Braunfels, Texas 78130 (210) 486-2055 (210) 486-7402 or (830)
More informationMichael Gayoso, Jr. Office of the County Attorney TH
Michael Gayoso, Jr. Office of the County Attorney TH 11 Judicial District/Crawford County, Kansas DIVERSION PROGRAM -- DRIVING UNDER THE INFLUENCE Pursuant to K.S.A. 22-2906 et seq. the Crawford County
More informationPHYSICAL THERAPIST AND PHYSICAL THERAPY ASSISTANT LICENSE APPLICATION PACKET
THE STATE of ALASKA Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing Board of Physical Therapy and Occupational Therapy State Office
More informationDSHS Publication #64-10701 MASSAGE THERAPY LICENSE APPLICATION
DSHS Publication #64-10701 MASSAGE THERAPY LICENSE APPLICATION BUDGET ZZ121 FUND 105 PRINT or TYPE all information on the application. Please answer all questions completely, do not leave any blank. The
More informationMARTIN S MILL INDEPENDENT SCHOOL DISTRICT 301 FM 1861 ~BEN WHEELER, TX 75754
Education/Training Position Data Personal Data MARTIN S MILL INDEPENDENT SCHOOL DISTRICT SERVICE AND SUPPORT PERSONNEL EMPLOYMENT APPLICATION We consider applicants for all positions without regard to
More informationMichigan Department of Licensing and Regulatory Affairs Bureau of Professional Licensing Board of Pharmacy PO Box 30670 Lansing, MI 48909 (517)
Michigan Department of Licensing and Regulatory Affairs Bureau of Professional Licensing Board of Pharmacy PO Box 30670 Lansing, MI 48909 (517) 373-8068 www.michigan.gov/bpl 1 PHARMACY TECHNICIAN LICENSE
More informationBell Tech Career Institute Vocational Nursing
Bell Tech Career Institute Vocational Nursing Title: Admissions Process Approved: Admission to Bell Tech Career Institute General Enrollment is open to men and women who are 18 years of age or older. The
More informationThe Radiologic Science Program at the College of Coastal Georgia
The Radiologic Science Program at the College of Coastal Georgia Page 1 of 7 Instructions 1. Complete a College of Coastal Georgia Application. (May be obtained from the Registrar s Office) Return the
More informationINFORMATION/INSTRUCTION SHEET CERTIFIED PODIATRIC X-RAY ASSISTANT
Chapter 461, Florida Statutes Rule Chapter 64B18-24, Florida Administrative Code INFORMATION/INSTRUCTION SHEET CERTIFIED PODIATRIC X-RAY ASSISTANT Any Certified Podiatric X-ray Assistant may perform services
More informationVOCATIONAL REHABILITATION COUNSELOR
STATE OF UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING APPLICATION FOR LICENSURE VOCATIONAL REHABILITATION COUNSELOR APPLICATION INSTRUCTIONS AND INFORMATION General Statement: The Utah Division
More informationDIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292
DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292 PHARMACIST EXAMINATION APPLICATION FOR U.S. AND PUERTO RICO GRADUATES
More informationAUXILIARY APPLICATION
PLEASE PRINT GREGORY-PORTLAND INDEPENDENT SCHOOL DISTRICT Office Use ONLY HUMAN RESOURCES Date Received: 608 COLLEGE STREET PORTLAND, TX 78374 (361) 777-1091, Ext. 1020 Date Approved: AUXILIARY APPLICATION
More informationAPPLICATION FOR LICENSURE LICENSED SUBSTANCE ABUSE COUNSELOR CERTIFIED SUBSTANCE ABUSE COUNSELOR CERTIFIED SUBSTANCE ABUSE COUNSELOR INTERN
STATE OF UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING APPLICATION FOR LICENSURE LICENSED SUBSTANCE ABUSE COUNSELOR CERTIFIED SUBSTANCE ABUSE COUNSELOR CERTIFIED SUBSTANCE ABUSE COUNSELOR INTERN
More informationDIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292
DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292 PHARMACIST EXAMINATION APPLICATION FOR U.S. AND PUERTO RICO GRADUATES
More informationAPPLICATION FOR ACCREDITATION AS A CLAIMS AGENT OR ATTORNEY
Form Approved, OMB No. 2900-0605 Respondent Burden: 45 minutes APPLICATION FOR ACCREDITATION AS A CLAIMS AGENT OR ATTORNEY INSTRUCTIONS: Please provide the applicable personal and employment data, then
More informationMASTER OF ARTS IN COUNSELING
ADMISSIONS REQUIREMENTS / CHECKLIST All applicants to the M.A. in Counseling must: 1. Hold a Bachelor s degree from a recognized institution; 2. Have achieved a minimum 2.75 GPA in undergraduate course
More informationDepartment of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing
MED THE STATE of ALASKA Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing State Medical Board PO Box 110806, Juneau, AK 99811-0806
More informationLee College Student Application for Admission Transitional (VN-RN)
Type or complete in ink. Lee College Student Application for Admission Transitional (VN-RN) Desire DATE OF ENTRY into program: Semester Year Social Security Number: - - (Optional) Lee College I. D. #:
More informationDeSoto County School of Practical Nursing
DeSoto County School of Practical Nursing 310 West Whidden Street Arcadia, Florida 34266 (863) 993-1333 (863) 993-9181 FAX Re: Practical Nursing Program 2015/2016 Dear Applicant, Thank you for your interest
More informationAPPLICATION FOR LICENSURE AS A CLINICAL SOCIAL WORKER (LCSW) State Form 50325 (R2 / 2-06) Approved by State Board of Accounts, 2006 SOCIAL WORKER, MARRIAGE AND FAMILY THERAPIST AND MENTAL HEALTH COUNSELOR
More informationSCHOOL OF REGISTERED NURSING
SCHOOL OF REGISTERED NURSING Purpose This program is designed to provide: dynamic, interactive classroom information; simulation experiences to enhance clinical capabilities; simulation scenarios to test
More information