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School Nurse Licensure Program Admission | School Nurse Licensure Program Admission

School Nurse Licensure Program Admission

APPLICATION PROCEDURES:
Please have the following sent to the Department of Nursing, Ashland University, 401 College Ave., Ashland, OH 44805:

 

  1. Official transcripts from a previous undergraduate college(s) and your school of nursing.

Fill out the form below and press the SUBMIT button to send your application.




PERSONAL INFORMATION
First Name:
Middle:
Last Name:
Maiden Name:

Ohio Nurse
Registration Number:
Gender: Male Female
Marital Status: Single Married

Address:
City:
State:
Zip:
Ohio County:

Email Address:
Home Phone:
Business Phone:
Birthdate:

Ashland University admits students with handicaps and those of any sex, race, age, religion, color and national or ethnic origin. In order for the University to respond to required state and federal questionnaires, you are asked to assist us, on a voluntary basis, by responding to the following:

U.S. Citizen?   YES   NO - If not, what is your present visa status?

Ethnicity:
Hispanic/Latino     OR     Non Hispanic/Latino (select at least 1 race option below)
       (click to reset)

      Race: (select all that apply)
         American/Alaska Native
         Asian
         Black or African American
         Hawaiian/Pacific Islander
         White

Military Veteran:    YES   NO



Education

Highest Nursing Degree Earned:: Diploma Associate Degree Bachelor of Science
                                                      Master of Science Nursing or higher

 

List in Chronological order the School of Nursing and/or all colleges attended:
Name of College/University:
Dates Enrolled: to
Degree Earned:
Area of Study/Major:

Name of College/University:
Dates Enrolled: to
Degree Earned:
Area of Study/Major:

Name of College/University:
Dates Enrolled: to
Degree Earned:
Area of Study/Major:

If additional space is needed for education, please list here




Employment Record

List in chronological order starting with most recent.

Job Title:
Dates: to
Employer:
Location:

Job Title:
Dates: to
Employer:
Location:

Job Title:
Dates: to
Employer:
Location:

Job Title:
Dates: to
Employer:
Location:

If additional space is needed for employment, please list here


By submitting this application, I hereby certify that the above information is accurate and complete. I understand that any misrepresentation of facts on this application could be cause for suspension from the university. Additionally, I agree to adhere to the conduct norms of the campus community and all policies/regulations of Ashland University.

TO GUARD AGAINST TECHNICAL DIFFICULTIES, PLEASE PRINT AND SAVE A COPY OF THIS APPLICATION FOR YOUR FILES.

Note: Ashland's policy is to release your name, address and basic attendance information to persons who inquire from outside the university. If you do not wish us to release any information you must notify the Registrar's Office and the Department of Nursing in writing.

Questions may be directed to the Nursing Department at 1-800-882-1548 or(419) 289-5242 or contact us via e-mail at nursing@ashland.edu .



401 College Avenue
Ashland, OH 44805
419.289.4142    800.882.1548

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