DEADLINE DATES SUBMITTING YOUR APPLICATION DISCLAIMER FRANKFORD HOSPITAL SCHOOL OF NURSING APPLICATION FOR ADMISSION

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1 FRANKFORD HOSPITAL SCHOOL OF NURSING APPLICATION FOR ADMISSION 4918 Penn Street Philadelphia, PA Phone (215) x124 Fax (215) INSTRUCTIONS Please read all instructions and information before completing your application. The information you provide will help us to serve you better. SUBMITTING YOUR APPLICATION DEADLINE DATES 1. Complete and submit the application with a $50 nonrefundable check or money order payable to the Frankford Hospital School of Nursing. 2. Read the enclosed information regarding entrance testing. Please indicate your top three choices on the area provided on the application. You will be contacted by phone after your application is received to confirm your testing date. The Admissions Office will make every effort possible to accommodate your first choice. 3. Type on a separate sheet of paper an essay of no less than 300 words on the following topic: What does nursing mean to you and why are you choosing it as your profession? 4. Send all official transcripts from high schools, college(s), including nursing schools, directly to the Frankford Hospital School of Nursing to the attention of the Admissions Office. 5. Forward two (2) recently dated recommendations to the Frankford Hospital School of Nursing. These must be on letterhead and mailed directly to the Admissions Office from the person making the recommendation. Recommendations from friends, neighbors and relatives will not be accepted. 6. Optional interviews are available. Please contact the Admissions Office after Frankford Hospital School of Nursing receives your transcripts if you would like to schedule an interview. Applications are due one month before all paperwork is due. This will allow applicants and the admissions office to have ample time to schedule and complete all entrance testing and paperwork. The last entrance exam is offered approximately 2 weeks prior to the paperwork deadline. Depending on the class for which a student is applying, application and paperwork deadlines are as follows: Application Paperwork Deadline Deadline** September February 1 March 1 Admissions January August 15 September 15 Admissions **It is the applicant s responsibility to have all required paperwork forwarded to Frankford Hospital School of Nursing, as there will be no exceptions to these deadlines. DISCLAIMER The Frankford Hospital School of Nursing does not discriminate in its selection of students because of race, creed, color, national origin, religion, age, sex, marital status, or physical handicap as required by federal law. All documents submitted become property of The Frankford Hospital School of Nursing and cannot be returned or transfered AEL 8/2006

2 BIOGRAPHIC INFORMATION Please print or type Today s Date Social Security Number Name Last First Middle Home Address Number and Street City or Town State Zip Code Gender: Male Female Date of Birth (Optional) Home Telephone ( ) Work Telephone ( ) Active Address: Cell Phone U.S. Citizen: Yes No Permanent Resident: Yes No Veteran: Yes No If you are not a U.S. Citizen, please call the admissions office for an appointment to present your residency/green card. Ethnicity (Optional): Caucasian African American/Black Hispanic/Latino/Spanish Asian or Pacific Islander American Indian or Alaskan Native Other (specify) Marital Status (Optional): Single Married Separated Divorced Would your records be listed under any name other than your present last name? Yes No If yes, please indicate Are you: First Time Freshman Transfer Student Seeking Readmission Date of Withdrawal Have you previously applied to Frankford? Yes No Date of Application What entry date are you applying for? (Specify year) September January How did you hear about Frankford Hospital School of Nursing? ENTRANCE TESTING Please select your top three choices for a testing date. You will be contacted by phone, after your application is received, to schedule your test. Choice: (1) (2) (3)

3 PREVIOUS EDUCATION High School Address Date of Graduation Do you have a G.E.D.? Yes No Date Received State Awarded College or University Enrollment Record (including Nursing Programs). Please include a copy of any licensure you have acquired, i.e. LPN, CNA. School Address Dates Attended Degree Credits School Address Dates Attended Degree Credits School Address Dates Attended Degree Credits School Address Dates Attended Degree Credits EMPLOYMENT INFORMATION Please list all work experiences, including military service, beginning with the most recent. From To Title or Position Employer (include address and phone number) Application Affidavit: To the best of my knowledge and belief this application contains no misrepresentation or falsification and information given by me is true and complete. Any misrepresentation or falsification will be grounds to deny admission or administrative dismissal from the school. Applicant s Full Signature Date

4 FRANKFORD HOSPITAL SCHOOL OF NURSING 4918 Penn Street * Philadelphia, PA * Accredited by: The National League for Nursing Accrediting Commission Approved by: Pennsylvania State Board of Nursing Dear Applicant: Frankford Hospital School of Nursing will now require applicants to take an entrance examination as part of the admission process. The results of this entrance examination will be used in conjunction with other required academic information, reference letters and essay when considering admission to the Frankford Hospital School of Nursing. The test you will be taking is called The Test of Essential Academic Skills (TEAS). The TEAS is designed to predict the academic readiness of applicants prior to admission into a program of study in nursing. The four subtests are Math, Science, English, and Reading. The Admissions Committee at Frankford Hospital School of Nursing has determined that candidates should have an Adjusted Composite Score score of 70% or higher, when being considered for admission. As stated above, this score is just one component in our decision making process. I highly recommend that you read more about this test by accessing the website at where you can find information on how to obtain a study guide as well. Testing dates are on the reverse side of this letter, as well as on the Frankford Hospital School of Nursing website: On your application, at the bottom of page 2, please select your first, second and third choice of testing dates, then return your completed application, along with your essay and application fee, to our Admission Coordinator, Aimee DiLacqua. You will then be contacted by phone to confirm a testing date. All tests are computerized and administered at the Frankford Hospital School of Nursing. I will make every effort to give you your first choice; however this is dependent on the number of candidates and availability of computer space. Please note: All testing must be completed by two (2) weeks prior to the paperwork deadline. No testing will be done after this date. Should you have any questions regarding this entrance examination or testing dates, you may contact me by phone at at ext. 121 or Aimee DiLacqua, Director of Admissions, at ext.124. Sincerely, Brian Greiman Computer Technologist BGreiman@fhcs.org

5 Testing Dates for September 2008 Admittance Testing Dates for January 2009 Admittance Testing Dates for September 2009 Admittance December, 2007 June, 2008 December, 2008 Monday 17th 9AM to 1PM Thursdays 5th 12NN to 4PM Mondays 15th 9AM to 1PM Tuesday 18th 9AM to 1PM 12th 12NN to 4PM 22nd 9AM to 1PM Wednesday 19th 9AM to 1PM 19th 12NN to 4PM Tuesdays 16th 9AM to 1PM Thursdays 6th 12NN to 4PM 26th 12NN to 4PM 23rd 9AM to 1PM 20th 12NN to 4PM Fridays 6th 9AM to 1PM Wednesday 17th 9AM to 1PM Fridays 7th 9AM to 1PM 13th 9AM to 1PM Thursdays 4th 12NN to 4PM 21st 9AM to 1PM 20th 9AM to 1PM 18th 12NN to 4PM January, th 9AM to 1PM Fridays 5th 9AM to 1PM Thursdays 3rd 12NN to 4PM July, th 9AM to 1PM 10th 12NN to 4PM Thursdays 10th 12NN to 4PM January, th 12NN to 4PM 17th 12NN to 4PM Thursdays 8th 12NN to 4PM 24th 12NN to 4PM 24th 12NN to 4PM 15th 12NN to 4PM 31st 12NN to 4PM 31st 12NN to 4PM 22nd 12NN to 4PM Fridays 4th 9AM to 1PM Fridays 11th 9AM to 1PM 29th 12NN to 4PM 11th 9AM to 1PM 18th 9AM to 1PM Fridays 9th 9AM to 1PM 18th 9AM to 1PM 25th 9AM to 1PM 16th 9AM to 1PM 25th 9AM to 1PM August, rd 9AM to 1PM Saturday 26th 9AM to 1PM Mondays 11th 9AM to 1PM 30th 9AM to 1PM February, th 9AM to 1PM Saturday 17th 9AM to 1PM Tuesdays 5th 9AM to 1PM 25th 9AM to 1PM February, th 9AM to 1PM Tuesdays 12th 9AM to 1PM Tuesdays 3rd 9AM to 1PM 19th 9AM to 1PM 19th 9AM to 1PM 10th 9AM to 1PM Wednesdays 6th 9AM to 1PM 26th 9AM to 1PM 17th 9AM to 1PM 13th 9AM to 1PM Wednesdays 13th 9AM to 1PM Wednesdays 4th 9AM to 1PM 20th 9AM to 1PM 20th 9AM to 1PM 11th 9AM to 1PM Thursdays 7th 12NN to 4PM 27th 9AM to 1PM 18th 9AM to 1PM 14th 12NN to 4PM Thursdays 14th 12NN to 4PM Thursdays 5th 12NN to 4PM 21st 12NN to 4PM 21st 12NN to 4PM 12th 12NN to 4PM Fridays 1st 9AM to 1PM 28th 12NN to 4PM 19th 12NN to 4PM 8th 9AM to 1PM Fridays 1st 9AM to 1PM Fridays 6th 9AM to 1PM 15th 9AM to 1PM 15th 9AM to 1PM 13th 9AM to 1PM 22nd 9AM to 1PM 22nd 9AM to 1PM 20th 9AM to 1PM Saturday 9th 9AM to 1PM Saturday 7th 9AM to 1PM 9/24/2007

6 8/19/05 Para informacion en espanol, visite o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment or to take another adverse action against you must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your file disclosure ). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identify theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. PHL: /

7 In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information. You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to You may limit prescreened offers of credit and insurance you get based on information in your credit report. Unsolicited prescreened offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at OPTOUT ( ). You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. PHL: /

8 Identity theft victims and active duty military personnel have additional rights. For more information, visit States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are: TYPE OF BUSINESS: Consumer reporting agencies, creditors and others not listed below National banks, federal branches/agencies of foreign banks (word National or initials N.A. appear in or after bank s name) Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Savings associations and federally chartered savings banks (word Federal or initials F.S.B. appear in federal institution s name) Federal credit unions (words Federal Credit Union appear in institution s name) State-chartered banks that are not members of the Federal Reserve System Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act, 1921 CONTACT: Federal Trade Commission: Consumer Response Center - FCRA Washington, DC Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC Federal Reserve Board Division of Consumer & Community Affairs Washington, DC Office of Thrift Supervision Consumer Complaints Washington, DC National Credit Union Administration 1775 Duke Street Alexandria, VA Federal Deposit Insurance Corporation Consumer Response Center, 2345 Grand Avenue, Suite 100 Kansas City, Missouri Department of Transportation, Office of Financial Management Washington, DC Department of Agriculture Office of Deputy Administrator - GIPSA Washington, DC PHL: /

9 DISCLOSURE STATEMENT AND AUTHORIZATION FOR PROCUREMENT OF CONSUMER REPORT FOR ADMISSIONS PURPOSES This Disclosure Statement is to inform you that, as part of your application for admission to the Frankford Hospital School of Nursing ( School of Nursing ), a consumer report will be requested from a Consumer Reporting Agency providing the following information to the School of Nursing: your criminal record, if any, including, but not limited to, all felony and misdemeanor convictions. You will be ineligible for admission if you have a conviction which the School of Nursing determines relates to your qualifications for admission to the Nursing program. Enclosed is a summary of your rights under the Fair Credit Reporting Act. If you have any questions about the nature or scope of our investigation, please contact Aimee DiLacqua at x124. I hereby authorize the School of Nursing to request a consumer report about me as described above from a Consumer Reporting Agency and for the Consumer Reporting Agency to provide the School of Nursing with the information requested. I further agree that a photocopy of this authorization may serve as an original. Signature Date PHL: /FRA