Rockefeller Career Center School of PN Application-JDRCC

Rockefeller Career Center School of PN Application

Program: LPN Length of Program: 11 Months Estimated Start Date: August 4th, 2025 Estimated Ending Date: June 30th, 2026 Requirements: Application fee of $25. Application deadline to be announced, please check with LPN Office at (304)-564-9006, Ext. 2731 Pre-Entrance Exam: Educational Resource pre-entrance exam for this LPN course is $75. This test score along with interview results will determine your admission into the Practical Nursing Program. Application Deadline: Call LPN Office at 304-564-9006 Extension 2731 for application deadline. Tuition and Fees: All fees and entire tuition is due on Orientation Day. All checks should be made payable to: JDRCC

First name

Last name

Address

Phone Number

SS# (no dashes needed)

Birth Date

Emergency Contact

Relationship to Emergency Contact

Emergency Contact Phone Number

High School Name & Address

Entrance Date

Graduation Date

GED Testing Facility Name & Address

Year Passed

College Name & Address

Entrance Date

Graduation Date

Previous Health Care Education?

Yes

If Yes, Please Explain:

Employer Name

Position

Employer Address

Start Date

End Date

Employer Address

Position

Start Date

End Date

Have you ever been convicted, plead guity, or plead no contest to a felony or misdemeanor? If yes, explain:*

I verify the information on this application is true to the best of my knowledge. I give permission to the Rockefeller Career Center School of Practical Nursing to verify this information.