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School History:
| High School or Equivalent: | City/Town/State: |
|
| _____________________________________ | ______________________________ |
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| _____________________________________ | ______________________________ |
| College(s): | Year of Graduation: | City/Town/State: |
|
| _____________________________________ | __________ | _________________________ |
|
| _____________________________________ | __________ | _________________________ |
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| _____________________________________ | __________ | _________________________ |
Employment/Military History:
| Occupation/Job Title: | Employer/Branch of Service: | Start/End Dates: |
| ________________________ | ________________________ | ____/___To____/___
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| ________________________ | ________________________ | ____/___To____/___
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| ________________________ | ________________________ | ____/___To____/___
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List special recognition(s) given for academic achievements/awards:
| __________________________________________________________________________ |
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| __________________________________________________________________________ | |
| Have two (2) letters of reference sent directly to Our Lady of Lourdes School of Nursing. References must be
from educators or employers. If you have attended another Nursing program, at least one (1) letter must be from
a former instructor of that program. |
| On a separate sheet of paper, submit an essay explaining why you wish to enter the Nursing profession.
Describe some of the experiences that influenced your decision. Your essay should be a minimum of 100 words. |
| Our Lady of Lourdes School of Nursing is committed to comply with all state and federal laws
prohibiting discrimination. Applicants to the School of Nursing must have the ability to satisfactorily meet the
cognitive, physical, and emotional requirements of the Nursing curriculum. (See attached, Abilities Considered Essential
for Nursing Practice, sign and submit with application.) |
| I hereby certify that the information on this application is complete and accurate in every respect. I realize
that failure to provide accurate and/or complete information can result in cancellation of the application
and/or revocation of admission. |
| PLEASE INCLUDE A $30.00 NON-REFUNDABLE FEE WHEN RETURNING THIS
FORM. YOUR APPLICATION CANNOT BE PROCESSED WITHOUT THIS FEE. |
| SIGNATURE________________________________________ | DATE ________________ |
| Parent's signature (if under 18 years of age) | _______________________________________ |
| | OFFICE USE ONLY: |
| | Fee Received: YES______ NO ______ |
| | Initials |
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