JDR4 Career Center - New Cumberland, WV
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2018 - 2019 Online Practical Nursing Application

Program: Practical Nursing

Length of Program: 12 months

Start Date: August 2018

End Date: June 2019

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.


Enter the above code here: