NORTHWEST FLORIDA STATE COLLEGE
NURSING AND ALLIED HEALTH PROGRAMS
ONLINE APPLICATION FOR ADMISSION

IMPORTANT:

  • Application must be submitted by program application deadline – please submit only 1 application. You may apply for more than one program on the same form.
  • If you are a new student, you must submit NWF State College application and residency forms.
  • If you have not taken college credit classes at NWF State College within the past one (1) year, you must submit NWF State College readmission application and residency forms.

Please complete all applicable fields and click Submit at the end.

You must have a NWF State College ID Number to complete this application.
Date of Birth (mm/dd/yyyy): NWF State College ID Number:

Last Name: First: MI: Maiden:

Address must match official NWF State College records on file with the registrar’s office.  If it has changed, fill out a Change of Status form at any NWFSC campus location or update through RaiderNet at www.nwfstatecollege.edu
 

Street: City: ST: Zip:

Home Phone: Work Phone: Cell Phone: Email:
Current Place of Employment:
Emergency Contact Name: Relationship: Phone:
Programs

Mark "YES" all programs for which you want to apply.
Nursing (AS/RN): Radiography:    
Nursing (LPN to RN):
Note: LPN required prior to
course enrollment 		Dental Assisting:
EMT: 		Paramedic:
EMT# and Exp Date:
      
 

Are you a... beginning student, or a transfer student from another nursing or allied health program?

If you are a transfer student, please complete the following fields.

  • Program area previously enrolled in:
  • Dates of Attendance:
  • Name/Location of School:
  • Reason for leaving program:
Do you have a current CPR card? yes       no
Are you currently enrolled at another institution? yes       no
If yes, where?
LICENSE CERTIFICATION - Complete this section if you are currently licensed or hold certification in applicable area.


Certification or License: License Number:

  • Issued by which State Agency:
  • Date Issued (mm/dd/yyyy):      Expiration Date (mm/dd/yyyy):

Certification or License: License Number:

  • Issued by which State Agency:
  • Date Issued (mm/dd/yyyy):      Expiration Date (mm/dd/yyyy):
Additional Requirements
The following items must be sent to the Office of Enrollment Services no later than the application deadline.
  • Admissions application and residency documents
  • Official college transcripts from all institutions previously attended, including AP and CLEP credits
  • Official high school transcripts or GED certificate or score report, as applicable
  • Verification of all testing (FCPT, TABE, HPI) and completion of all college prep courses as applicable to the program
  • Verification of NWF State College orientation completion - complete online at www.nwfstatecollege.edu/orientation
  • If you are transferring from another program, letter from former program director verifying good standing

By clicking submit below, I attest that the information provided on this application is true and accurate. I understand that any falsification or information invalidates my application. I understand that I am responsible for submitting all of the above information and any omission may result in denial of my application.

Please note: If you receive an error page when you click SUBMIT, please use your browser's BACK button and return to this form, making sure all relevant fields are complete. If you continue to experience problems, please call Nursing and Allied Health at 729-6400.