Students must meet all admission requirements. Complete the admission application form and

submit same to Diversity Nursing Academy electronically or in person. A member of the faculty

will then contact the student for further instructions, regarding background checks and other

medical tests deemed necessary for entry. Credits from previous Nurse Aide courses are not

Diversity Nursing Academy Nurse Aide Program Application

Please answer the following questions.

 

Please provide the following information.

6) Do you consent to having the following checks performed?

Please provide a copy of your vaccination card.

Please note that clinical facilities require vaccination for entry. If you are not vaccinated, you may not complete clinical rotations and no other accommodations may be made (Failure to comply with the above screens will be grounds for not being admitted to the program).

Application Fee: $100.00

Please supply two forms of identification.

 

I understand that all the information submitted in the application is true and I am the responsible party. My signature below also indicates that I have received and agreed to the enrollment agreement. I understand that any falsification of information is grounds for dismal. I agree that if I am accepted into the program an application fee is required. I also agree to comply with all school and state requirements. Please sign below to indicate your consent for all procedures as listed on the application. Students agree that by signing this document the school does not transfer or use credit from another institution.

Signature and name of parent (if below 18 yrs