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UNITED STATES
CANADA
AFGHANISTAN
ALBANIA 999
ALGERIA
ANDORRA
ANGOLA
ANTIGUA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA
BOTSWANA
BRAZIL
BRUNEI
BULGARIA
BURKINA FASO
BURMA
BURUNDI
CAMBODIA 555
CAMEROON
CAPE VERDE
CENTRAL AFRICAN REPUBLIC
CEYLON
CHAD
CHILE
CHINA
COLOMBIA
COMOROS
CONGO
COSTA RICA
COTE D"LVOIRE
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
ENGLAND
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FIJI
FINLAND
FRANCE
FRENCH ANTILLES
FRENCH GUIANA
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GREECE
GRENADA
GUADELOUPE
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HOLY SEE
HONDURAS
HONG KONG
HONG KONG
HUNGARY
ICELAND
II
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISRAEL
ITALY
IVORY COAST
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA
KUWAIT
KYRGSTAN
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MEXICO
MICRONESIA
MOLDOVA
MONACO
MONGOLIA
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NORTH KOREA
NORTHERN IRELAND
NORWAY
OMAN
PAKISTAN
PALAU
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
POLAND
PORTUGAL
PRINCIPE
QATAR
REPUBLIC OF CHINA
ROMANIA
RUSSIA
RWANDA
SAN MARINO
SAO TOME
SAUDI ARABIA
SCOTLAND
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEON
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH KOREA
SOUTH-WEST AFRICA
SPAIN
SRI LANKA
ST. KITTS
ST. LUCIA
ST. NEVIS
ST. VINCENT
SUDAN
SURINAME
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKSTAN
TANZANIA
Test
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THAILAND
THE GRENADINES
TOBAGO
TOGO
TONGA
TRINIDAD
TUNISIA
TURKEY
TURKMENISTAN
TUVALU
UAE
UGANDA
UKRAINE
UNITED KINGDOM
UPPER VOLTA
URUGUAY
USA, ISRAEL
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VANUATU
VATICAN CITY
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WEST AFRICA
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AMERICAN EMBASSY
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ARMED FORCES THE PACIFIC
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DELAWARE
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Name
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TEAS Test
Program & Start Options
*NOTE:Â If you currently do not have medical insurance coverage, please check the box below. An admissions counselor will contact you to discuss your individual case and help you identify insurance options that may be available for you.Â
is Required
High School/ GED Center
Required
Post-Secondary Institution
Required
Applicants should be aware that certain felony convictions will make them ineligible for license prior to entry or during the course of the educational program. Therefore they may be unable to work as a registered nurse. Please direct any concerns to the Nursing Coordinator at IDFPR/Division of Professional Regulation: Michele.Bromberg@Illinois.gov .
Degree Choice
Required
-- choose one --
Associate Degree in Nursing
Basic Nursing Assistant Program
Start Date Options
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-- choose one --
ADN Spring 2025
BNAP Summer 2024
Military Status
Required
-- choose one --
Active Duty
Never Served
Spouse of Active Duty Member
Spouse of Veteran
Veteran
is Required
If you have an outstanding balance or academic hold at another institution, please list the amount and reason: (Associates Candidates Only)
Required
If you have an active Certified Nurse Assistant Certification, please indicate the date obtained: (Associates Candidates Only)
Required
Please check the boxes of any courses completed with a passing grade. These will be verified with official transcripts.
Required
Biology 120
Biology 200
Biology 210
Chemistry 100
English 110
Math 110
Microbiology 200
None
If you have ever faced disciplinary action at a former school, please name the school and describe the circumstances. (Associates Candidates Only)
Required
Please list an Emergency Contact #2 (include name, phone #, address, & relationship)
Required
Please list an Emergency Contact #1 (include name, phone #, address, & relationship)
Required
Please explain what motivates you to beome a nurse.
Required
Please list all the languages you can read
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Please list all languages you can speak
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Please list all the languages you can write
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If you are registered for Selected Services, please provide your registration #:
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If you have taken the TEAS test, please list the date taken, name of institution where taken, overall TEAS score, and the Reading score. Your official TEAS scores will be requested for admission.
Required
If currently unemployed, please indicate the reason(s) for unemployment:
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Criminal Convictions:
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Convicted of Misdemeanor(s)
Convicted of Felony (ies)
No Convictions
Scholarship Application (Associates Candidates Only)
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Please check box if you are interested in applying for a scholarship.
Please list School Name and Degree(s) or Certificate(s) completed:
Required
Salary
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Health Insurance
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I have private health insurance coverage.
I have government health insurance coverage.
I have no insurance at all.
E-Signature (Please type in your full name & today's date):
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2520 S. Western Ave. | Chicago, IL 60608 | Phone: (773) 890-0055