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StateRequired -- choose one -- ALABAMA ALASKA AMERICAN EMBASSY AMERICAN SAMOA ARIZONA ARKANSAS ARMED FORCES THE PACIFIC CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINA WISCONSIN WYOMING

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Degree ChoiceRequired -- choose one -- Associate Degree in Nursing Basic Nursing Assistant Program

Start Date OptionsRequired -- choose one -- ADN Spring 2025 BNAP Fall 2024 BNAP Spring 2025

Military StatusRequired -- choose one -- Active Duty Never Served Spouse of Active Duty Member Spouse of Veteran Veteran

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

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

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If you are registered for Selected Services, please provide your registration #:Required

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

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