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R admission into the program. Please review this document carefully. Applicants are notified by email upon acceptance into the nursing program. Name Home Phone Last First Middle Previous Name(s) Alternate Phone (Cell) Important if your records reflect a name different from above Mailing Address SS # G# (Required by the Board of Registered Nursing) Age City State Zip Birth Date (Confidential for records only) E-mail Address High School City/State Submit Official Copy of HS o.
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