New VN basic pre-enrollment

First Name

Last Name

Street

City

State/Province

Zip/Postcode

Cell phone

Email

Gender

Ethnicity

Birth Date

Residency Status

Social Security No

Proof of Graduation Type

Check all that apply

Vocational Nursing basic checklist

18 years or older

Possess a high school diploma or G.E.D?

Posses a valid Social Security Card

Posses current government issued photo identification

Posses TEAS composite score of 75% or higher

Posses no criminal record

Posses complete/up to date immunization record

Posses current Basic Life Support CPR Certification

Please answer all of the following

Have you completed a physical examination in the last 6 months?

Are you a former student

Yes No Not Selected

If so, what course did you attend?

Enter the above code

Required

The Institute of Allied Healthcare