Nursing at Ashland University | Application for Admission

Application for Admission

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

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:
Social Security 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:

Race:
American Indian/Alaska Native
Asian
Black/African American

Hawaiian/Pacific Islander

White
Other

Ethnicity:

Hispanic or Latino
Not Hispanic or Latino

Military Veteran: YES NO

EDUCATION
Prelicensure Program in Nursing was: Diploma Associate Degree

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:

If additional space is needed for education, please list here

WORK EXPERIENCE

List in chronological order from most recent backwards.

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 .