Application for School of Nursing

Application for School of Nursing
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Campus Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Last four of Social Security Number*
Program Type Applying For:*
If selected RN to BSN please list RN License Number
Colleges/Universities Attended
I understand admission to the Traditional BSN program is competitive based on ACT and GPA. I understand that if admitted to the School of Nursing, I must pass a background check and a clean drug screen prior to beginning classes. A $100 fee will be collected prior to the background check.
Complete listing of prerequisite courses posted on BMC School of Nursing website noting the institution, semester and year along with grade received.

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Signature*

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Date*

MonthDayYear
Date
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