Practical Nursing Online Application

Make sure to also complete the:

If you see this don't fill out this input box.

Please indicate which semester you are applying for:

Spring

Fall

Full Name (first, middle, last)*

Mailing Address*

City*

State*

Zip Code*

Social Security Number

Phone Number

Date of Birth (mmddyyyy)*

Tech T#

Email (ATU address, if you have one)*

Please indicate if your are currently a student of:

Arkansas Tech University

Arkansas Tech University - Ozark Campus

Not Applicable

Are you a previous Practical Nursing student seeking re-entry?

Yes

Have you previously attended another Practical Nursing Program?

Yes

If you answered yes to the previous question, please answer Name of School attended, Dates attended, Name (if different than application)

If you are not currently student at ATU-Ozark or ATU-Russellville, please remember to complete an application for the ATU-Ozark Campus and send all transcripts and from previous schools attended as well as proof of two MMR immunizations to the Office of Student Services, 1700 Helberg Lane, Ozark, AR 72949). School application must be completed before submitting this application. I certify that the above information is accurate and complete to the best of my knowledge.*Name (acting as signature)

Date*