Practical Nursing Application

Practical Nursing Application
Name*

First NameLast Name
Email*
example@example.com
Which cohort are you applying for?*

Fall (August)Spring (January)
Which exam have you taken?*

PAX (Pre-Admission Exam)TEAS (Test of Essential Academic Skills)None
TEAS or PAX Results

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Professional Goal Statement*

Upload a Word or PDF document of your professional goals statement. The statement must be typed and between 150-200 words.
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Essay: "A Good Nurse..."*

Upload a Word or PDF document of your essay entitled "A Good Nurse Is." The essay must be typed and should be two pages in length.
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Are you certified in the following?*

Certified Nursing Assistant (CNA)Medical Assistant (MA)Emergency Medical Technician (EMT)PhlebotomistNone
Upload a Copy of Your Certifications

If you marked any of the certifications above, upload a copy of your certifications that include the date of expiration.
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Upload a Copy of Unofficial Transcripts

You may submit any unofficial transcripts here.
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Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Education*
List high schools and colleges/universities attended. Indicate the dates that you attended each institution and whether or not you received a degree from each. (Degrees must be from a regionally-accredited college or university to be considered for application points.)
Educational Honors
List any honors and special awards you have received throughout your education.
Healthcare Work or Healthcare Volunteer Experience*
Include the name of the agency, address, phone number, supervisor, the position and job description, and the dates that you worked there. List the most recent work or volunteer experience first. If none, indicate by N/A.
All prerequisite courses must be completed with a grade of "C" or better. Grades below "C" are unacceptable. Physiology and Physiology Lab must have been taken in the past 5 years before applying. Prerequisite courses may not be taken more than three times during the five years prior to application. Courses must be taken from a regionally-accredited college or university.
Prerequisite Courses*

I have read and understand the requirements above
Please indicate in the forms below the details for each prerequisite course. Be sure to enter the exact grade, with a plus or minus as applicable. Please be aware that all grades will be verified using official transcripts that you will be required to submit if accepted into the program.
Prerequisite Course: BIOL 2320 Human Anatomy*
Please indicate the school, year, semester, and grade.
Prerequisite Course: BIOL 2325 Human Anatomy Lab*
Please indicate the school, year, semester, and grade.
Prerequisite Course: BIOL 2420 Human Physiology*
Please indicate the school, year, semester, and grade.
Prerequisite Course: BIOL 2425 Human Physiology Lab*
Please indicate the school, year, semester, and grade.
Prerequisite Course: FLHD 1500 Human Development Across the Lifespan*
Please indicate the school, year, semester, and grade.
For your application to be accepted, we must receive reference evaluation forms from three (3) different professional people prior to the application deadline. Select your references and send them this link to submit: https://www.stech.edu/pn/evaluation
References*

I am responsible to have three reference evaluations submitted prior to the application deadline.
Verification*

I verify that all information is accurate to the best of my knowledge. I understand that providing false or misinformation, including grades I received in any of the prerequisite courses, may render my application void.
Please verify that you are human*
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