RN Program - Spring Application

All fields with an asterisk (*) are required.

If any of the below information is not correct delays can occur in processing and notification.

Personal Information

First Name: *

Middle Name *

Last Name: *

If you've legally changed your name, please list other names that may be associated with your Clark State account:

Phone Number: *

Clark State E-mail: *
@students.clarkstate.edu

Student ID #: *

Street Address: *

City: *

State: *

Zip: *

What program are you applying to? *
NOTE: We cannot guarantee your selection due to space limitations. If your selection cannot be accommodated, you may be placed into a cohort based on each cohort's space limitations.