New Online Application For Admission

HOMESTEAD SCHOOLS, INC.

23800 HAWTHORNE BLVD. SUITE 200, TORRANCE, CA 90505

Online Application For Admission

Application for entry in Year:

Which group do you most identify with:

American Indian

Asian

Black/African American

Pacific Islander

White

Hispanic

Can you provide proof of a high school diploma or GED certification?

Yes No Not Selected

School and location:

Do you have any other vocational/professional license?

Yes No Not Selected

List your educational qualifications:

1. Name of Institution

1. Degree/Cert recd.

2. Name of Institution

2. Degree/Cert recd.

3. Name of Institution

3. Degree/Cert recd.

Please provide two references with complete address and phone number.

1. Address, City, State & Zip

2. Address, City, State & Zip

Please list any working experience:

Start with the most recent employment information.

1. Dates of Employment

2. Dates of Employment

3. Dates of Employment

4. Dates of Employment

Do you have any chronic or recurring illnesses, emotional problems, or physical disabilities that might require special accommodations while in school or in clinical rotations?

Yes No Not Selected

If yes please explain:

Do you have a current CPR card from the American Safety and Health Institute, the American Heart Association or the American Red Cross?

Yes No Not Selected

(Proof of current CPR card is required for this program.)

Please upload a scanned copy

A criminal background check is required for enrollment in this program. Have you ever been summoned, arrested, taken into custody, indicted, convicted or tried for a violation of any law or ordinance or the commission of any felony or misdemeanor (including traffic violations)?

Yes No Not Selected

If yes, please explain:

How do you plan to pay for school tuition?

Cash

Federal Student Aid

Sallie Mae Smart Option Loan

How did you hear about us?

Philippine Tribune

Craiglist

BVNPT

Online

Letter from us

Word of mouth

Referred by someone

Other

If, referred by someone:

APPLICATION FORM FOR RN-BSN PROGRAM

Only continue to fill out if applying for RN-BSN Program.

Welcome!

Before Completing this Application Please Answer the Following Question with a Yes or No.

I have an associate RN degree or a diploma in nursing from an accredited nursing institution in the United States of America.

Yes No Not Selected

I have a current and active RN license to practice in the United States of America.

Yes No Not Selected

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Address of Next of Kin:

Phone and Email Contact of Next of Kin:

If not a US Citizen Proof of Legal Residency:

Please upload a scanned copy of your documents.

High School/Location:

1. College/Location:

2. College/Location:

3. College/Location:

Unofficial Transcripts

Attached a Resume, Unofficial Transcripts, or Payment

Yes No Not Selected

Do you have a Criminal Background History:

Yes No Not Selected

The information completed above is true and accurate to the best of my knowledge.

Enter the above code

Required

HOMESTEAD SCHOOLS, INC.

Online Application For Admission

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List your educational qualifications:

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Please provide two references with complete address and phone number.

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Please list any working experience:

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Background Check

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APPLICATION FORM FOR RN-BSN PROGRAM

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