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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Date of Birth
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Social Security Number
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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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State
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Zip Code
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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
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Diploma/Degree
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  • Diploma
  • Degree
  • Not Applicable
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If transferring from another school, are you presently in good standing?
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Intended Start Date
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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
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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.

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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
Field is required!
Field is required!
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