Follow the steps to complete your application online.

1. Click the ‘Get Form’ button to download the application and open it in the online editor of your choice.
2. Fill in your student name in the specified field. Ensure that your name matches any identification documents you may have.
3. Enter your current address, providing the necessary details such as street, city, state, and zip code.
4. Provide your home phone number and, if applicable, a cell phone number in the designated fields.
5. Indicate your availability for clinical training by selecting your preferred shifts and days of the week. Remember that attendance is mandatory for all classroom hours.
6. Input the date you are submitting the application. Be mindful that this date should reflect the day you fill out the form.
7. Confirm your age by answering whether you are at least 18 years of age. Choose the appropriate option.
8. Enter emergency contact information. Include both a primary and a secondary contact with their names and phone numbers.
9. Answer questions regarding any disciplinary actions taken against you concerning health licenses or permits. If applicable, provide explanations.
10. Respond to inquiries about whether you have ever been denied a license or faced charges related to health occupations. Include explanations if needed.
11. Carefully review the section regarding criminal history. Answer the questions accurately regarding felony or misdemeanor convictions, unresolved charges, and provide required details.
12. Affirm the accuracy of the information provided by signing and dating the application in the designated section.
13. Once you have filled out all sections, save your changes. You can then download, print, or share the completed application.

Complete your application today to take the first step towards your career in nursing.