Application | Washington Health System

Once this form is submitted you will receive an email confirmation. To complete the application, please print the confirmation and mail along with a $50.00 application fee (payable to The Washington Hospital), to:

Washington Health System School of Nursing
155 Wilson Avenue, Washington, PA 15301

School of Nursing Application

First Name

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Last Name

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Previous Name

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Address

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PO Box

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County

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City

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Zip Code

Valid Zip Code is required!

Home Phone

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Mobile Phone

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Work Phone

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Contact Email

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Re-Enter Email

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Please list high school (G.E.D.) and all post-secondary schools attended

Click the Plus + for additional entries

Institution

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Start Date

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End Date

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City

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If transferring from another school, are you presently in good standing?

YesNo

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Please list all work experience

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Employer

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Position

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Start Date

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End Date

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Have you or are you currently an employee of Washington Health System?

YesNo

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Please feel free to write any comments in support of your application

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Note: According to the Pennsylvania State Board of Nursing, an R.N. license will not be issued to persons who have been convicted of a felony prohibited by “The Controlled Substance, Drug, Device and Cosmetic Act” or a felony related to a controlled substance.

I certify that all of the information provided is correct to the best of my knowledge.

Field is required!

Once this form is submitted you will receive an email confirmation.

To complete the application, please print the confirmation and mail along with a $50.00 application fee (payable to The Washington Hospital), to:

Washington Health System
School of Nursing
155 Wilson Avenue
Washington, PA 15301

Apply

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