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Practical Nursing (High School Student)
Thank you for your interest in joining our esteemed nursing program.  As you embark on this journey, it's important to recognize that becoming a nurse carries significant responsibilities.   This application is your first step in demonstrating your commitment to the profession and your readiness to embrace the duties that come with it.  

Nursing requires a high level of dedication, professionalism, and ethical standards.  As a nurse, you will be responsible for the well-being and care of your patients, making it crucial to uphold the highest standards of integrity and accountability.  By applying to this program, you are taking the initial step in learning to be responsible, not only to yourself but the the patients and communities you will serve


High school Practical Nursing student applicants must be a at least a Junior in high school to apply. 

Part of being a great nurse is the ability to follow instructions in a timely manner.  The following is a checklist of information that you are responsible for submitting before the deadline of DECEMBER 4TH for consideration for admission to our nursing program.  No late information will be accepted and your application will be rejected. 

Administrator office hours - Mon 8-12
                                                  Wed 11-3
                                                   Fri    8-12
 

 CHECKLIST OF ADMISSION REQUIREMENTS 

The following requirements MUST be met completely in order to move forward in the application process.

 Mail or email all of these to freda.spencer@bedford.k12.va.us or drop them off at Susie G Gibson Science and Technology Center, 600 Edmund Street, Bedford, VA 24523. 

* Completed online application (I will print this an begin a file for you)

* 3 references mailed to: Susie G Gibson Science and Technology Center
                                            Attention:  Freda Spencer 
                                            600 Edmund Street, Bedford, VA 24523 

* Proof of High School Education -  one of the following  
     High School Transcripts OR 
     Official evidence of GED score

* Proof of US Citizenship or legal immigrant status: 
     Government issued ID/immigration documents 

* Completed current Physical form signed by a physician, PA or NP (this can also be your sports physical)

* Documentation of Vaccinations: 
      Hepatitis B (3 vaccinations or a titer level proving immunity) 
      MMR ( 2 vaccinations or a titer level proving immunity) 
      Varicella (2 vaccinations or a titer level proving immunity) 
      Tdap 

Tuberculin two step skin test is required within six months prior to clinical rotations. The Quantiferon TB Gold will also be accepted. 


Equal educational opportunities shall be available for all students, without regard to sex, race, color, national origin, gender, ethnicity, religion, disability, ancestry, or marital or parental status. Educational programs shall be designed to meet the varying needs of all students. No student, on the basis of sex or gender, shall be denied equal access to programs, activities, services, or benefits or be limited in the exercise of any right, privilege or advantage or be denied equal access to educational and extracurricular programs and activities. To view a current list of compliance officers and how they can be reached, visit the Bedford County Public Schools website at http://www.bedford.k12.va.us.
Email *
First Name *
Last Name *
Parent/Guardian Name *
Parent/Guardian Email *
Base School *
Grade *
Are you currently a SGSTC student? *
If you selected "yes" to the previous question, what class are you currently enrolled in?
Date of Birth *
MM
/
DD
/
YYYY
Address (Street, City, State, Zip Code) *
Phone Number *
Email Address *
GPA *
How many days of school did you miss last year? *
Reason for absences:
Explain in 2-3 sentences why you want to take this course. *
Student ID Number (If homeschooled, enter N/A) *
Is this SGSTC course your 1st, 2nd, or 3rd choice? *
How did you hear about this course? *
Are you a U.S. Citizen? *
Are you a Bedford County/City Resident? *
Person to be notified in case of emergency: *
Relationship of Emergency Contact *
Address of Emergency Contact *
Phone number of Emergency Contact *
Work and Work Address of Emergency Contact *
Have you previously applied for admission to this school? *
Accepted:
Clear selection
Attended:
Clear selection
If "Yes", please list dates
Academic year applying for: *
Work History: List all work experience, both full and part-time, beginning with the most recent. (Date/Company or Firm/Address/Job Title/Phone Number)
Volunteer and Community Service: *
If "Yes", please explain:
Have you ever been convicted of a felony and/or  Misdemeanor since the age of 18? *
If "Yes", please give details (offenses/dates/sentences/etc)
Being successful takes hard work. Tell about a time when you had to work very hard to reach your goals. Be specific about what you achieved. *
Give an example of a time when you put forth a special effort to understand another person's situation or dilemma. How did you show sympathy or compassion to that person? *
Tell about your computer skills, specifically, Word, Excel, Access, and Powerpoint. How often and in what capacity have you used these programs? *
Give an example of a time that you feel that you "went above and beyond the call of duty" to help out your team/friends/coworkers? *
You will be required to give the names and addresses of three persons, not relatives or friends, who know you and can give information about you (for example, you may include a recent teacher, counselor, or employer). Please print out three applicant reference forms and have the appropriate person complete and return the form to the School of Nursing. REFERENCE FORMS CAN BE FOUND NEXT TO THE RESPECTIVE COURSE APPLICATION. Please acknowledge that you have read and understand this by choosing "I understand" below. *
1st Reference Name *
1st Reference Position or Title *
1st Reference Address *
2nd Reference Name *
2nd Reference Position or Title *
2nd Reference Address *
3rd Reference Name *
3rd Reference Position or Title *
3rd Reference Address *
I hereby formally make application for admission to the Bedford County School of Practical Nursing and assert that the information given in this application is true and accurate to the best of my knowledge. I understand that any misstatement of facts will cause forfeiture of all rights to admission to/ or dismissal from the Bedford County School of Practical Nursing. To agree to the terms above, please type your FULL NAME below. *
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