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Practical Nursing (Adult)
For adult Practical Nursing students only. For adult applicants, there is a $58.00 application fee. No refund.

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.

Name (First, Middle, and Last) *
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Date of Birth *
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Address (Street, City, State, Zip Code) *
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Phone Number *
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Email Address *
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Explain in 2-3 sentences why you want to take this course. *
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Is this BSTC 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: *
Your answer
Relationship of Emergency Contact *
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Address of Emergency Contact *
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Phone number of Emergency Contact *
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Work and Work Address of Emergency Contact *
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Secondary Education: List high schools attended. Please include vocational training: (Dates/Name of School/City and State/Diploma Received)
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If you hold a High School Equivalency Certificate (GED), please list the STATE in which you received the certificate and the DATE RECEIVED
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Post Secondary Education: List all colleges, universities, nursing and other schools attended: (Dates/Name of Institution/City and State/Credentials or Credits Earned)
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Have you previously applied for admission to this school? *
Accepted:
Attended:
If "Yes", please list dates
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Academic year applying for: *
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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)
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Military Service History *
Are you currently eligible for veteran's educational benefits?
Volunteer and Community Service: *
If "Yes", please explain:
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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)
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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. *
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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? *
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Tell about your computer skills, specifically, Word, Excel, Access, and Powerpoint. How often and in what capacity have you used these programs? *
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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? *
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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 *
Your answer
1st Reference Position or Title *
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1st Reference Address *
Your answer
2nd Reference Name *
Your answer
2nd Reference Position or Title *
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2nd Reference Address *
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3rd Reference Name *
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3rd Reference Position or Title *
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3rd Reference Address *
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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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