PLEASE READ ALL OF THE ABOVE INFORMATION

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "PLEASE READ ALL OF THE ABOVE INFORMATION"

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

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 information

HEALTH 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 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 information

UPWARD MOBILITY NURSING PROGRAM APPLICANT CHECKLIST. Applicant Name:

UPWARD 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 information

Texas Board of Nursing 333 Guadalupe, Ste 3-460, Austin, TX 78701 Phone: 512-305-7400

Texas 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 information

Eligibility Requirements for RN Licensure in the State of Texas

Eligibility 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 information

DEPARTMENT OF NURSING BOX T-0500, STEPHENVILLE, TEXAS 76402 APPLICATION FORM Instructions

DEPARTMENT 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 information

VOCATIONAL NURSING APPLICATION PROCEDURES

VOCATIONAL 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 information

Department of Nursing. Box T- 0500, Stephenville, Texas 76402 APPLICATION FORM. Instructions

Department 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 information

The University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria

The 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 information

Incomplete application packets will not be processed.

Incomplete 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 information

SAN JACINTO COLLEGE VOCATIONAL NURSING PROGRAM INFORMATION

SAN 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 information

Central Campus: Application for ADN-RN Program

Central 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 information

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

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 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 information

Program Fact Sheet. Contact Odessa College School of Vocational Nursing- Monahans Center for application deadline.

Program 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 information

Application for ADN-RN Program

Application 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 information

At the time you apply the following pre-requisite courses must be complete or you must be enrolled in for Spring 2016:

At 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 information

Valley Baptist Medical Center Vocational Nursing Program

Valley 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 information

LVN PROGRAM APPLICANT CHECK LIST

LVN 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 information

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

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 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 information

Frank 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. 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 information

Valley Baptist Medical Center Vocational Nursing Program

Valley 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 information

TEXAS 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 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 information

Associate Degree Nursing/Tech Prep Plan (Generic Student Curriculum)

Associate 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 information

Students applying for admission to the Associate Degree Nursing program must complete the following steps:

Students 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 information

INSTRUCTIONS FOR COMPLETING THE PETITION FOR REINSTATEMENT OF LICENSE

INSTRUCTIONS 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 information

TEXAS SOUTHMOST COLLEGE VOCATIONAL NURSING PROGRAM. Full Time Track. Information Pack

TEXAS 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 information

LVN to ADN Transition Program

LVN 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 information

DEMOGRAPHIC INFORMATION

DEMOGRAPHIC 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 information

Licensed Practical Nursing Applications For the Fall 2016 Class

Licensed 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 information

Lee 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 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 information

3. All applicants must meet the following requirements prior to admission into the nursing program:

3. 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 information

Texas Board of Nursing 333 Guadalupe, Ste. 3-460, Austin, TX 78701-3944 Phone: 512-305-7400 -- Web Site: www.bon.texas.gov

Texas 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 information

LVN to ADN Transition Program

LVN 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 information

VOCATIONAL NURSING PROGRAM

VOCATIONAL 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 information

Application for Admission

Application 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 information

Thank 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. 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 information

APPLICANT INSTRUCTIONS

APPLICANT 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 information

Date of Application: Social Security Number: - -

Date 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 information

PLEASE REMOVE THIS PAGE BEFORE SUBMITTING APPLICATION.

PLEASE 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 information

May 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: 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 information

August 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: 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 information

Vocational Nursing Program Wharton

Vocational 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 information

Certified Registered Nurse Anesthetist General Instructions for Licensure Application

Certified 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

Retain this page for reference purposes

Retain 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 information

Application for New Louisiana Pharmacy Technician Candidate Registration

Application 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 information

Pierpont Community & Technical College School of Health Careers Practical Nursing Program

Pierpont 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 information

Mid-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 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 information

**Make check or money order payable to the Montana Board of Barbers and Cosmetologists**

**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 information

Licensure by Examination Information For Graduates from Nursing programs within the United States

Licensure 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 information

A $100.00 application fee in the form of a money order made payable to LSBN must accompany this form

A $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 information

EMPLOYMENT 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. (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 information

Texas Board of Nursing 333 Guadalupe, Ste. 3-460, Austin, TX 78701-3944 Phone: 512-305-7400 -- Web Site: www.bon.state.tx.us

Texas 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 information

Personal Information

Personal 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 information

DIVISION 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 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 information

STATE 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 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 information

TECHNICIAN-IN-TRAING IS NOT PERMITTED TO PRACTICE IN MONTANA IN ANY MANNER WITHOUT AN ACTIVE MONTANA REGISTRATION

TECHNICIAN-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 information

Name: (Last) (First) (Middle) Address: (Street) (City) (State) (Zip Code) Home Phone: ( ) Work Phone: ( ) Ext. Cell Phone: ( ) Alt Phone:

Name: (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 information

NURSING. 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 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 information

GLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER

GLYNN 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 information

Thank 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. 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 information

Vocational Nursing Admission Procedures January 2015- May 2016

Vocational 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 information

II. POLICY AND PROCEDURE FOR GENERAL ADMISSION INTO THE NURSING PROGRAM

II. 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 information

Board of Speech-Language Pathology and Audiology

Board 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 information

UPMC SCHOOLS OF NURSING POLICY AND PROCEDURE

UPMC 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 information

TEXAS 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 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 information

CAMERON 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 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 information

PLEASE READ BEFORE COMPLETING APPLICATION

PLEASE 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 information

Thank 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. 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 information

Clinical Nurse Specialist General Instructions for Licensure Application

Clinical 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 information

This is a Legal Document. By completing and signing, this you certify under

This 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 information

Diman Regional Technical Institute. Practical Nursing Program Admission Policy

Diman 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 information

MARTIN S MILL INDEPENDENT SCHOOL DISTRICT 301 FM 1861 ~BEN WHEELER, TX 75754

MARTIN 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 information

LVN-ADN TRANSITION NURSING PROGRAM WHARTON CAMPUS ONLY

LVN-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 information

Bell Tech Career Institute Vocational Nursing

Bell 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 information

Michael Gayoso, Jr. Office of the County Attorney TH

Michael 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 information

Lee College Student Application for Admission Transitional (VN-RN)

Lee 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 information

VOCATIONAL NURSING PROGRAM

VOCATIONAL 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 information

ASSOCIATE DEGREE NURSING PROGRAM APPLICATION PERIOD: DEADLINES:

ASSOCIATE 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 information

EMPLOYMENT APPLICATION FORM

EMPLOYMENT APPLICATION FORM Elite Medical Transport, LLC - Deming 1100 S. Diamond Street - Deming PO Box 929 Santa Teresa, NM 88008 Main Telephone: (915) 542-1194~~Fax: 915-613-1693 EMPLOYMENT APPLICATION FORM Elite Medical Transport

More information

DSHS Publication #64-10701 MASSAGE THERAPY LICENSE APPLICATION

DSHS 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 information

Eligibility Questions (if you answer YES to Eligibility Questions, instructions are located on Page 3)

Eligibility 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 information

Michigan 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) 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 information

The Radiologic Science Program at the College of Coastal Georgia

The 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 information

THE APPLICANT IS RESPONSIBLE FOR KNOWING WHETHER THEY ARE ELIGIBLE FOR LICENSURE BASED ON NEW MEXICO RULES.

THE 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 information

Application to the Basics in Addiction Counseling (BAC) Program. Section I. Application Requirements & Procedures

Application 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 information

Dear School Psychologist:

Dear School Psychologist: 125 W. Market Street Suite 300 Indianapolis, IN 46204 (866) 518-4472 or (317) 472-6955 www.iasponline.org Dear School Psychologist: Enclosed is information regarding the application process for an independent

More information

WYOMING RENTS, LLC APPLICATION FOR EMPLOYMENT DRUG AND ALCOHOL-FREE WORK PLACE

WYOMING RENTS, LLC APPLICATION FOR EMPLOYMENT DRUG AND ALCOHOL-FREE WORK PLACE WYOMING RENTS, LLC APPLICATION FOR EMPLOYMENT DRUG AND ALCOHOL-FREE WORK PLACE People at this company want a safe and healthy place to work. Illegal drugs are wrong! There is no place here for them or

More information

Eastern Shore Community College Practical Nursing Program Application Packet 2015

Eastern Shore Community College Practical Nursing Program Application Packet 2015 Eastern Shore Community College Practical Nursing Program Application Packet 2015 The Eastern Shore Community College School of Practical Nursing was originally Northampton- Accomack Memorial Hospital

More information

Athletic Trainer License Application Methods

Athletic Trainer License Application Methods Athletic Trainer License Application Methods Please read carefully to determine the application method for which you are qualified Indicate the appropriate method on the application and submit the required

More information

Vocational Nursing Program

Vocational 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 information

VOCATIONAL REHABILITATION COUNSELOR

VOCATIONAL 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 information

Dear Applicant for Nursing Licensure in New Mexico,

Dear Applicant for Nursing Licensure in New Mexico, Dear Applicant for Nursing Licensure in New Mexico, Thank you for applying for licensure as a nurse in New Mexico. The information in this packet is designed to provide you with the necessary information

More information

Uniform Employment Application for Nurse Aide Staff

Uniform Employment Application for Nurse Aide Staff Uniform Employment Application for Nurse Aide Staff This application form is required by Title 63 O.S. Section 1-1950.4 of state law and by the Oklahoma State Board of Health Rules OAC 310-2-15-3. This

More information

Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing

Department 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 information

INFORMATION/INSTRUCTION SHEET CERTIFIED PODIATRIC X-RAY ASSISTANT

INFORMATION/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 information

APPLICATION FOR LICENSURE LICENSED SUBSTANCE ABUSE COUNSELOR CERTIFIED SUBSTANCE ABUSE COUNSELOR CERTIFIED SUBSTANCE ABUSE COUNSELOR INTERN

APPLICATION 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 information

APPLICATION 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 information

UNDERGRADUATE STUDIES

UNDERGRADUATE 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 information

Name: Last First Middle. Mailing Address: Street City/State Zip Street Address: Street City/State Zip Telephone: ( ) Social Security Number:

Name: Last First Middle. Mailing Address: Street City/State Zip Street Address: Street City/State Zip Telephone: ( ) Social Security Number: School Nurse Application for Employment TANQUE VERDE UNIFIED SCHOOL DISTRICT, NO. 13 11150 E. Tanque Verde Road Tucson, AZ 85749 520-749-5751 / fax 520-749-5400 All positions require an Arizona Registered

More information