School Nursing Certification Application
Please read through all questions below first before beginning the application process. You must sign at the bottom of this page to ensure submission of your completed application.
Start Term
*
Please Select
Spring 2026
Name
*
First Name
Last Name
Preferred First Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
Home Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Legal sex
*
Please Select
Male
Female
Have you ever been: Convicted of or plead to a misdemeanor and/or felony, suspended or expelled by a prior institution, or been disciplined through or named a respondent in a Title IX or sexual misconduct process?
*
Yes
No
Education
BSN School
*
Year Graduated
*
Are you currently employed with the WV Department of Education?
*
Yes
No
If yes, what county?
Transcripts
Official college transcripts are required to complete your application. Please upload all completed collegiate coursework for consideration into the program
*
Browse Files
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Choose a file
Cancel
of
Signature
*
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