Health Sciences - Nursing Admission Application

Health Sciences

Welcome

Is Health Care for Me?

Courses Offered

Apply for a Program

Request for Information

Selected Admission Forms

Basic Nurse Assistant Training Program

Coding Specialist

Emergency Medical Services

Health Information Technology

Massage Therapy

Medical Continuing Education

Medical Assistant

Medical Transcription

Nursing

Phlebotomy

Polysomnography Technology

Radiologic Technology

Respiratory Therapy

Apply for an Allied Health Science Program*

*Health Information Technology, Polysomnography, Radiological Technology, Respiratory Therapy. Links to additional programs are located at the end of the forum.

Please Note: Applications for the Associate Degree Nursing Program are only available at the mandatory information sessions for students interested in applying to the A.D.N. Nursing Program.

General Information

The fields indicated by an asterisk are required.

First Name		*
Last Name		*
Middle Name
Maiden Name
SSN		*
Address		*
City		*
State		*
Zip Code		*
E-mail Address
Home Phone		*
Date of Birth		*
U.S. Citizen		*
If no, type of Visa
High School Attended		*
High School/GED Completion Date		*
Admission
Colleges Attended

I am applying for

Health Information Technology Program
Polysomnography Program
Radiological Technology Program
Respiratory Therapy Program

Choose one of the following options

Option 1 - Use only Moraine Valley credit hours toward grade point average calculation, degree requirements and prerequisite. (If less than 12 hours of college credit have been attempted at Moraine Valley, the high school GPA will be used.)

Option 2 - Use ALL college hours toward GPA calculation, degree requirements and prerequisites.

Ethnic Origin

Check primary race.

Asian
American Indian / Alaska Native
African American
Hispanic or Latino
White
Native Hawaiian / Pacific Islander
Choose not to respond

Please Note: The following Health Sciences Programs do not require a selective admission process! Click the links provided for more information!

Confidential when completed.