Sponsored Student Membership Form
Greater New York City Black Nurses Association
Sponsored Student Membership Application is only for current pre-licensure students. Applicants can NOT be a RN.
I am:
*
Renewing
New
Do you have an RN license?
*
Yes
No
Are you A New York Resident?
*
Yes
No
Back
Next
Email
example@example.com
School of Nursing
*
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Recruited by:
Gender:
*
Male
Female
Non-binary
Professional Organization Membership:
American Nurses Association
American Association of Critical Care Nurses
National League of Nursing
Chi Eta Phi
American Public Health Association
American Academy of Nursing
Other
Age: (Will Remain Confidential)
*
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Please upload a copy of your nursing school acceptance letter or class schedule.
*
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Please check your email for your GNYC BNA welcome letter
*
Yes
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