Enrollment Application APPLICANT INFORMATIONFirst Name* Middle Initial Last Name* Date of Birth* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Check the box to receive official College documents via text message Opt In to Receive Text MessagesE-Mail Address* Social Security No.*Race*Please SelectAmerican Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOtherEthnicity*Please SelectHispanic or LatinoNot Hispanic or LatinoMarital Status*Please SelectSingle (Never Married)Married or in a Domestic PartnershipDivorced or SeparatedWidowedProgram Applying for*Please SelectGeneral Education (GE) CoursesASN/RNLPN-RNBDN/RNRN-to-BSNBMTC-to-RNNon-MatriculatingPaid Application Fee?*YesNoAre you a citizen of the United States?*YesNoHave you ever served in the military?*YesNoIf yes, select your military status.VeteranSpouse of VeteranActive Duty ServicememberSpouse of Active Duty ServicememberHave you applied to Nightingale previously?YesNoIf so, when?Have you ever been convicted of a felony?*YesNoIf yes, explainPREVIOUS EDUCATIONHigh School NameHigh School YearsPlease mark the diploma received.High School DiplomaGEDCollegeCollege YearsDid You Graduate College?YesNoOther EducationOther Eduaction YearsDid You Graduate?YesNoGENERAL EDUCATION COMPLETEDAnatomyYesNoIf yes, course titleIf yes, college nameIf yes, how many creditsPhysiologyYesNoIf yes, course titleIf yes, college nameIf yes, how many creditsPathophysiologyYesNoIf yes, course titleIf yes, college nameIf yes, how many creditsMicrobiologyYesNoIf yes, course titleIf yes, college nameIf yes, how many creditsGeneral Psychology or Human Growth and DevelopmentYesNoIf yes, course titleIf yes, college nameIf yes, how many creditsChemistryYesNoIf yes, course titleIf yes, college nameIf yes, how many creditsEnglishYesNoIf yes, course titleIf yes, college nameIf yes, how many creditsMathYesNoIf yes, course titleIf yes, college nameIf yes, how many creditsSignature*By placing your name in this box you agree to submit this information to Nightingale College and are permitting the College to contact you via your primary contact information (If you are providing a cell phone, you are consenting to being contacted through text messages).Date* NOTE: The application fee is $100.00. You may cancel this application and receive a refund of the $100.00 application fee within Three (3) business days of submitting the application, unless you have undergone admissions testing within the three (3) business days. After three (3) business days, the application fee becomes non-refundable.
