Information Sessions - Registration Form

Please complete the following form and you will get a confirmation of your registration by email.

First Name:
Last Name:
Address:
City:
State:
Zip:

Day Telephone:

Eve Telephone:

Cellphone:

Fax:
E-mail:

Best method to contact you: Telephone     E-mail
If by phone, best time to contact you:

How did you hear about Abington Memorial Hospital Dixon School of Nursing?
(check all the apply)
Friend or Relative     Mailing    E-mail   
School Counselor/College Fair    Abington Memorial Hospital
Radio AD     Newspaper AD     Web site     Other

Are you interested in applying to nursing school for entry in:
Year     day option    Eve/weekend option
Undecided at this time

Which of the following best describes your situation:
A high-school student graduating in
A student with a post-secondary degree (not necessarily medical related)
A LPN looking for RN completion
A transfer student from another college, university, or nursing school
Non-USA citzen with Permanent USA Residence
Other

I have questions about the following:
Day Option
Evening/Weekend Option
Financial Aid Assistance

Which Information Session do you wish to attend?

Information Sessions
2008:
Monday, May 19, 2008, 5:30 PM to 7:00 PM - Male Nurse Open House
Monday, June 16, 2008, 5:30 PM to 7:30 PM
Monday, September 8, 2008, 5:30 PM to 7:30 PM
Monday, November 10, 2008, 5:30 PM to 7:30 PM

Abbreviated Information Sessions
2008:
Wednesday, May 14, 2008, NOON to 1 PM
Wednesday, August 6, 2008, NOON to 1 PM
Wednesday, October 15, 2008, NOON to 1 PM
Wednesday, December 3, 2008, NOON to 1 PM