St. Luke's University Health Network

Application

In order for you to submit this application, be prepared to attach your resume.  

You will also need to request:

  • Official transcripts from your high school and all attended colleges
  • Two professional references (form here)

If you have any questions, please contact the Admissions Office at 484-526-3443.

* Required Fields

Page 1

Personal Information

Legal Name

(mm/dd/yyyy)
(123-12-1234)
County
(123-123-1234)
(123-123-1234)

Demographic Information

THESE ITEMS ARE OPTIONAL – This information is requested for statistical use only in accordance with applicable federal regulations.









Emergency Contact Information

(123-123-1234)

Educational and Character Information

(mm/yyyy)
Have you previously applied to or attended St. Luke's School of Nursing?
(mm/yyyy)
Do you work or have your ever worked at St. Luke's University Health Network?
(mm/yyyy)
Are you fluent in any of the following languages?





Are you a U.S. citizen?

Is your first language English?

Please note: Test of English as a Foreign Language (TOEFL) may be required for applicants who are non-native speakers of English to measure their ability to use and understand English as it is spoken, written and heard. Please contact the Admissions Office at 484-526-3443 for more information.

Page 2

Educational and Character Information Continued

All applicants must hold a high school diploma or high school equivalency certificate (GED). Please indicate which applies to you:

Starting with your most recent school, please fill out the relevant information for any educational institution you have attended. Please enter the name of the school, entrance and exit dates, and the degree you received (if applicable).

List any and all high schools and post-secondary schools attended, regardless of whether you graduated. Please note: Attendance at all institutions must be reported at the time of application. An applicant's failure to disclose that he or she has taken a course(s) from another institution shall result in the denial or revocation of admission and dismissal from the School.

High School

(mm/dd/yyyy)
(mm/dd/yyyy)

(mm/dd/yyyy)
(mm/dd/yyyy)

GED

(mm/dd/yyyy)

College/Technical School

(mm/dd/yyyy)
(mm/dd/yyyy)

(mm/dd/yyyy)
(mm/dd/yyyy)

(mm/dd/yyyy)
(mm/dd/yyyy)

(mm/dd/yyyy)
(mm/dd/yyyy)

(mm/dd/yyyy)
(mm/dd/yyyy)

(mm/dd/yyyy)
(mm/dd/yyyy)

(mm/dd/yyyy)
(mm/dd/yyyy)

(mm/dd/yyyy)
(mm/dd/yyyy)

Page 3

Education and Character Information Continued



If question is not applicable, please indicate "N/A"

Please limit the file to a single Word (.doc file NOT .docx file), RTF, text or PDF document.


No Current Resume File Stored

Page 4

Compliance Information

NOTICE OF NON-DISCRIMINATION POLICY

The St. Luke’s School of Nursing is in compliance with applicable federal, state and local laws, regulations and ordinances governing equal opportunity and non-discrimination, including without limitation, Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Americans with Disabilities Act of 1990, and the Age Discrimination Act of 1975. The School of Nursing provides equal educational opportunity to qualified applicants and students and does not discriminate on the basis of age, sex, ancestry, race, color, national origin, religion or disability in recruitment and admission, educational programs and policies, housing, scholarships and loans programs, or nonacademic services such as recreation, counseling, or social activities. The Director is responsible for the implementation and coordination of equal opportunity in the School of Nursing.

APPLICANT ACKNOWLEDGEMENT

As an applicant to St. Luke's School of Nursing ("St. Luke's"), I understand that all of the information I have provided on my application for admission and otherwise in connection with the application process will be relied upon by St. Luke's to determine my qualifications for admission. I hereby acknowledge that all of the information I have provided in response to inquires on this application for admission and all information I have provided otherwise in connection with the application process are true, correct and complete. I understand that any false, misleading, or incomplete answer, statement or implication made by me in connection with this application or the application process, or any failure to disclose any relevant information, shall result in the denial and/or revocation of admission to St. Luke's, including dismissal from St. Luke's, if matriculated, and may also lead to future denial and/or revocation of licensure in Pennsylvania as a Registered Nurse.

I hereby grant St. Luke's permission to investigate my personal, criminal, educational and employment background and history and to contact persons, organizations, institutions or government agencies who may have knowledge of me. In consideration for St. Luke's reviewing my application for admission, and intending to be legally bound, I hereby release St. Luke's School of Nursing, its parent, subsidiaries, affiliates, trustees, officers, employees and agents (collectively hereinafter referred to as "St. Luke's"), from any and all claims or liability, known or unknown, arising from St. Luke's investigating my background and all persons, organizations, institutions or government agencies supplying such information.

Finally, it is my understanding that I shall not be considered for admission to St. Luke's until I have submitted all credentials and otherwise satisfied all requirements for a timely and complete application for admission. I further understand that an applicant who satisfies all application requirements is not guaranteed admission into St. Luke's diploma program. I agree to inform St. Luke's of any changes in the information I have provided on this application or otherwise in connection with the application process. If St. Luke's offers me admission, and I decide to matriculate, I agree to comply with any and all of St. Luke's policies, rules and regulations, as amended from time to time.

Page 5

Payment Information

Credit Card Information

The application fee for the St. Luke's School of Nursing application is $25.

Billing Address

(NY)
(12345)

Credit Card Information

The application fee for the St. Luke's School of Nursing application is $25.
(1234-1234-1234-1234)