JDR4 Career Center - New Cumberland, WV
HomeLPN CourseCDL CourseCourse OfferingsAdult EducationFinancial AidSkills USANTHS Room SchedulingMap and DirectionsContact Us

2016 – 2017 Online Practical Nursing Application

Program: Practical Nursing

Length of Program: 12 months

Start Date: August 2016

End Date: June 2017

Requirements: You must submit the following upon completion of this application. Your application will not be accepted if all of the following are not received.

  • Official High School Transcript / GED Score, College Transcripts
  • Three (3) Reference Letters
  • Application fee of $25. Application deadline to be announced. Please check with the PN Office at
    304-564-3337, ext. 116.

Pre-entrance Exam 
Educational Resource pre-entrance exam for this PN course is $40. This test score along with interview results will determine your admission into the Practical Nursing Program.

Application Deadline
Call the PN Office at 304-564-3337, ext. 116 for application deadline. Please print and mail applications to the school at JDRCC 80 Rockefeller Circle, New Cumberland, WV  26047    Attention:  Kathy Dray   If you have previously submitted an application on line, please contact Kathy Dray or Dee Chappell at the school.

Tuition and Fees
All fees and entire tuition are due on or prior to Orientation Day (to be announced). All checks should be made payable to JDRCC.

It is the policy of the Hancock County Board of Education to not discriminate on the basis of sex, race, religion, color or national origin in its education programs.


All information on this form is required and must be filled out completely.

Personal Information

First Name
Middle
Last
Maiden
Street Address
City
State  ZIP
County
Home Phone
Work Phone
Cell Phone
 
SSN
Birth Date
   
Email
   
Emergency Contact
Contact Phone
 

Education

High School Name and Address
Entrance Date
Grad Date
GED Testing Facility Name and Address
Year Passed
 
College Name and Address
Entrance Date
Grad Date
Any previous health care education?
YesNo
   
If yes, explain.

Work Experience

1. Employer Name
Employer Address
Position
Start Date
End Date
2. Employer Name
Employer Address
Position
Start Date
End Date
3. Employer Name
Employer Address
Position
Start Date
End Date

Have you ever been convicted, plead guity, or plead no contest to a felony or misdemeanor? If yes, explain:

I verify the information on this application is true to the best of my knowledge. I give permission to the Rockefeller Career Center School of Practical Nursing to verify this information.

captcha
Enter the above code here: