USC Aiken SoN HAS Application

School Of Nursing H.A.S. Application

First Name*

First Name

Last Name

Gender*

Male Female

Marital Status*

Single Married

Permanent Address*

Address Line 1

Address Line 2

City

State

ZIP Code

County*

VIP ID*

UofSC Aiken Email*

Number of Dependents*

Number of Hours You Work Per Week*

List All Nursing Courses You Are Currently Enrolled In*

List Your Memberships & Professional Activities (NSNA, SNA, etc.)*

List Board Positions Held in These Organizations

List Committee Member or Chair Positions Held in These Organizations

List Any Other Current Extracurricular Activities