BRG School of Nursing Application

School of Nursing Admissions Application
Personal Information
Have you ever applied to this school? *

Yes No
Name *

First Name Middle Name Last Name
Email Address *
Home Address *

Street Address

Street Address Line 2

City State

Zip Code
Mailing Address (If different than Home Address)

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *
Social Security Number *
no dashes
Are you a US citizen? *

Yes No
If no, what country?
Visa Number
Visa Type

Emergency Contact Information

Persons to be notified in case of an emergency
Emergency Contact #1 *

First Name Last Name
Relationship *
Phone Number *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Emergency Contact #2 *

First Name Last Name
Relationship *
Phone Number *
Address *

Street Address

Street Address Line 2

City State

Zip Code

How did you become interested in Baton Rouge General School of Nursing? *
Do you now hold or have you ever held a license in a health care discipline (i.e. Practical Nursing, Pharmacy, etc.)? *

Yes No
If answered yes, please specify:

Education & Employment Information

List below previous education information: *

	Name	Location (City, State)	Degree Earned	Graduation Date
High School
College
School 3
School 4

If program was not completed, state reason:
Please list any awards and honors you have received:

List below previous employment information: *

	Name of Employer	Location (City, State)	Position	FT/PT
Employer 1
Employer 2
Employer 3
Employer 4

Would you like to upload your Core Performance Standards for Admission and Progression? *

Yes No
Core Performance Standards for Admission and Progression

Browse Files

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What contacts have you had within the healthcare field that are not listed under school or employment? *
Why do you want to be a nurse? *
What qualities do you have that make you a good candidate for nursing? *
What personal accomplishments have given you the most satisfaction? *
You may add any additional information about yourself that you think would be helpful to the Admissions Committee in evaluating your application for admission:

Payment & Application Signature

Payment

BRG School of Nursing Application Fee $ 50.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

I verify that the information in this application is correct and complete to the best of my knowledge. I understand that if it is later found to be otherwise, my application will be invalid, or in the event that I am enrolled, I will be subject to dismissal from the Baton Rouge General School of Nursing.

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