ARNOT OGDEN MEDICAL CENTER SCHOOL OF NURSING
600 Roe Avenue, Elmira, NY 14905
(607) 737-4153
www.arnothealth.org
.
Please note:
· A $50.00 non-refundable application fee, résumé, and essay must accompany this
completed/signed application.
· Application deadline is July 31
st
.
Please check one:
Regular Admission
Nursing Transfer
LPN-Advanced Standing
Date of application: __________________ Academic year for which you are applying: ________________
Name:
_________________________________________________________________________________________
(Last)
(First)
(Middle)
(Maiden)
Social Security No. ________ - ________ - ________ Telephone number: (_______) _____________________
Address:
_______________________________________________________________________________________
(Street and Number)
_______________________________________________________________________________________
(City)
(State) (Zip Code)
Email address: ____________________________________ Cell phone: ( ______) _____________________
Citizenship:
U.S.
Non-U.S.
If non-U.S., give Permanent Alien Registration No:_____________________________________
Have you ever been convicted of a felony? Yes No If yes, explain in a separate letter.
Any individual who has been convicted of a felony may not take the licensing examination until the
New York State Board of Nursing has reviewed the case.
Have you been dismissed from another educational institution? Yes No
If yes, please explain in a separate letter. (Please note: Answering yes to this question does not
automatically disqualify you from admission)
Have you previously applied for admission to this school? Yes No
If yes, when? __________ Last name at that time: _______________________________
Are you an Arnot Ogden Medical Center employee? Yes No
If yes, please indicate department _______________________ extension _____________
Are you related to an Arnot Ogden Medical Center employee? Yes No
If yes, please indicate employee name/relationship _______________________________________
APPLICATION FORM
