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Personal Information

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Email Address *

Phone Number *

Residence Status *Select your statusUS CitizenResidentNon-Resident

Employer *

Position *

Schedule *Select your schedulePart TimeFull Time

Prior Education

Secondary EducationHigh School GraduateG.E.D.

Name of High School you graduated from

Date

I'm interested in applying for *Nursing (BSN)Nursing (RN to BSN)Nursing (ADN)Nursing (PN)

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