Please complete the following application completely.  Know that you must also submit, in person, the required documents from the checklist before your application is complete. Incomplete applications will not be accepted. 

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* 1. Today's Date:

Date

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* 2. Program Start Date:

Date

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* 3. First name:

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* 4. Middle name: (Or N/A)

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* 5. Last name:

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* 6. Are you a returning student?:

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* 7. If yes, date last attended:
If no, write N/A:

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* 8. Last 4 digits of social security number:

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* 9. Date of birth: (Month/Date/Year)

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* 10. Street Address:

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* 11. Apt #

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* 12. City:

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* 13. State:

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* 14. Zip:

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* 15. Cell Phone:

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* 16. Other Phone:  (If no other phone, write N/A)

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* 17. E-Mail:

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* 18. Confirm E-mail:

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* 19. The Columbus School of Practical Nursing requires an entrance exam, the HESI A2. Applicants must achieve a 75% composite score for the Reading Comprehension, Vocabulary and General Knowledge, Grammar and Math sections in one exam session in order to qualify. Scores must be no more than 2 years old at the time the application is submitted. For more information regarding HESI please visit our website https://www.ccsoh.us/Page/2202

HESI Entrance Exam Score:

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* 20. Have you previously attended college or a post-secondary school?

We reserve the right to reschedule or cancel any course that does not meet our minimum enrollment requirements. If a course is cancelled or rescheduled, all fees paid are subject to reimbursement or transference, upon presentation of a receipt.

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* 21. The Columbus Board of Education does not discriminate based upon race, sex, sexual orientation, religion, color, national origin, age, gender identity or expression, ancestry, familial status, military status, disability, genetic information, or any other legally protected category (collectively, "protected classes") in its educational programs, activities, treatment of people and employment practices.

Under penalty of perjury, I herewith affirm that my electronic signature was signed by myself with full knowledge and consent and is the legally binding equivalent to my handwritten signature.

Electronic Signature (first and last name)

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