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Practical Nurse Form
Name
*
Phone
Email
*
Do you have a high school diploma?
*
Yes
No
Name of the high school you graduated from
*
State
*
Country
*
USA
Outside of USA
Which program are you interested in?
*
LPN Full-Time (12-month Program)
LPN Part-Time (18-month Program)
Are you a citizen of the United States?
*
Citizen of the United States
Permanent Resident
None of the above
Do you have any education after High School?
*
None
Associate or Higher from USA
Associate or Higher from outside USA
Please pick one time slot that works for you for our admissions coordinator to contact you during the weekdays:
*
9:00 am to 11:00 am
11:00 am to 2:00 pm
2:00 pm to 4:00 pm
4:00 pm to 6:00 pm
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