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
Last Name
Previous Name
Address
PO Box
County
City
State
  • - Select One -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Zip Code
Home Phone
Mobile Phone
Work Phone
Contact Email
Re-Enter Email

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

Click the Plus + for additional entries
Institution
Start Date
End Date
City
State
  • - Select One -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Diploma/Degree
  • - Select One -
  • Diploma
  • Degree
  • Not Applicable
If transferring from another school, are you presently in good standing?

Please list all work experience

Click the Plus + for additional entries
Employer
Position
Start Date
End Date
Have you or are you currently an employee of Washington Health System?
Please feel free to write any comments in support of your application

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.

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