ADMISSION APPLICATION TEST FORM

This is a test form. All application information WILL NOT BE SUBMITTED AS A VALID APPLICATION

1 Personal info
2 EDUCATION
3 Demographic
4 Payment
Select the campus you're applying to
Are you enrolling Full-time or Part-time?
Are you currently a faculty/staff at Pacific College.
Are you currently employed in healthcare?
Does your employer offer tuition benefits such as tuition reimbursement?
Are you a member of the 1199 union?

Personal Information

Have you applied previously to Pacific College?
Your Address
Gender
Citizenship
US Citizen
Do you have a Social Security Number?
Do you have or will you apply for a student (F-1 or M-1) Visa?
The i-20 should be sent to the address the above?
What resource(s) will you use to fund your education?
Sponsorship
Will you be bringing your spouse and/or children?
Prior Education

Please chronologically list your high school and all colleges and universities attended

Have you completed your secondary education?
Have you previously attended a nursing program?Failure to disclose this could result in being disqualified
Select your highest level of education
Demographic info
Racial/ Ethnicity status
Have you ever been convicted of a felony or a first degree misdemeanor?
Have you served in the military?

I hereby make Application for Admission to Pacific College of Health and Science, and certify that all information given on this application is true.


I authorize Pacific College to investigate all statements on my application.


By signing this application electronically, I certify under penalty of perjury that my selections are correct and complete to the best of my knowledge.


I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Thank you for your service! Your application fee is waived.
$ [field81]
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Pacific College Accepts:

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