Nursing Application

APPLICATION PROCEDURES:

1. Please send official transcripts from all colleges/universities where coursework was attempted to: Ashland University Admissions, 401 College Avenue, Ashland, Ohio 44805.

2. Fill out the form below and click Submit to submit your application.

Personal Info

First Name: *

Middle:

Last Name: *

Maiden Name:

State Nurse Registration Number: *

Gender:

male

female

Birthdate:

Marital Status:

single

married

Military Veteran:

yes

Ethnic Origin:

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 this question.

Contact Info

Email: *

Home Phone: *

Business Phone:

Address: *

City: *

State: *

Zip: *

Ohio County:

Ohio Residents ONLY

Education History

Prelicensure Program in Nursing was: *

Diploma

Associate Degree

List in Chronological order the School of Nursing and/or all colleges attended:

Education

University/College Name: *

Start Date:

End Date:

Degree Earned: *

Area of Study:

Additional Education

University/College Name:

Start Date:

End Date:

Degree Earned:

Area of Study:

Additional Education

University/College Name:

Start Date:

End Date:

Degree Earned:

Area of Study:

Work Experience

Employer

Employer:

Location:

Job Title:

Employment Start:

Employment End:

Additional Employer

Employer:

Location:

Job Title:

Employment Start:

Employment End:

Additional Employer

Employer:

Location:

Job Title:

Employment Start:

Employment End:

Additional Employer

Employer:

Location:

Job Title:

Employment Start:

Employment End:

Additional Employment Information:

By submitting this form, 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.

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 419-520-2625 or contact us via e-mail at nursing@ashland.edu.

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