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

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School of Nursing Application

First Name
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Last Name
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Previous Name
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Address
123 Awesome St.
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PO Box
Please provide street address also
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County
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City
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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
- Select One -
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Zip Code
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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

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Institution
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Start Date
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End Date
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City
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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
- Select One -
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Diploma/Degree
  • - Select One -
  • Diploma
  • Degree
  • Not Applicable
- Select One -
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If transferring from another school, are you presently in good standing?
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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?
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Please feel free to write any comments in support of your application
Comments...
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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.

Field is required!
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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