☏ Call Us: (801) 689-2160Enrollment Application - New Form APPLICANT INFORMATIONName of Admissions Advisor you have worked with:*Select an AdvisorAmariah GibbsAndrea BushBarbara GillespieBrandi MayberryDan PriceDarren YatesDonna MillerDusti HyerEmily BurtEmily SmithElizabeth GulzarEzra AndersonHannah FoxHeath SouthworthHeather CurtisJasmine LewisJared MitchellJared ThompsonJennifer CantwellJohn LittleJemima CastilloJennifer SumnerKatherine DialsLisa RasmussenMaddi RowleyMichelle StanleyMorgan RaceMelissa PaskettMcKenna ChristensenRussell WeaverRaymond AllenSamuel WhitneySarah NelsonSasha SouthardsScotty GillTara CoteValerie JacksonXaishia SuttonNOTE: If you have not worked with an Admissions Advisor, please call 801-689-2160 before applyingWhat start date are you applying for:January 3, 2022May 2, 2022August 29, 2022What SOFE Area are you applying for:Select OptionsAnchorage AKColorado Springs CODenver-Boulder COFort Collins COOrlando FLBoise IDCoeur d'Alene IDPocatello IDTwin Falls IDDes Moines IADodge City KSManhattan KSWichita KSColumbia MDReno NVLas Vegas NVCincinnati OHErie PALancaster PASioux Falls SDPittsburgh PAPenn Highlands (DuBois PA)Logan UTProvo UTSalt Lake City-Ogden UTSt. George UTCasper WYCheyenne WYEvanston WYOther (RN-to-BSN only, Licensed RNs only)Other (MSNED only, BSN required)Remote trackFirst Name* First Last Name* Last Middle Initial Middle Maiden Name (if applicable)Date of Birth* MM slash DD slash YYYY 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 SeparatedWidowedGenderMaleFemaleNon-binaryNot specifiedProgram Applying for*Please SelectPractical Nurse (PN) Diploma ProgramBachelor of Science in NursingRN- Bachelor of Science in NursingBMTC-Bachelor of Science in NursingMaster of Science in Nursing EducationNon-MatriculatingPlease list any and all states you may wish to test or become registered as a nurse in the future* This may affect your course schedule as some states have specific course requirementsPaid Application Fee?* Yes NoAre you a citizen of the United States?* Yes NoHave you ever served in the military?* Yes NoIf yes, select your military status. Veteran Spouse of Veteran Active Duty Servicemember Spouse of Active Duty ServicememberHave you applied to Nightingale previously? Yes NoIf so, when?Have you ever been convicted of a felony?* Yes NoIf yes, explainPREVIOUS EDUCATIONHighest level of EducationHigh School EquivalencyCertificateSome CollegeAS degreeBS degreeGrad degreeAre you an LPNNOYESHigh School NamePlease mark the diploma received. High School Diploma GED Secondary Leaving CertificateCollege Attended #1College Attended #2College Attended #3College Attended #4Did You Graduate College? Yes NoDegree(s) ObtainedSignature*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* MM slash DD slash YYYY In order to complete your application, please upload your proof of high school graduation and a picture ID or passport below: Drop files here or Select filesMax. file size: 20 MB, Max. files: 2. NOTE: The application fee is $150 and entrance exam fee is $20. You may cancel this application and receive a refund of the $170.00 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.