Nursing Application Fee Waiver Request

Nursing Application Fee Waiver Request
Submit your request for a waiver of the nursing program application fee. Please complete all required sections and provide supporting documentation as needed.
Applicant Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you currently enrolled in an educational institution?
Name of Current or Most Recent Educational Institution
Intended Nursing Program
Primary reason for requesting a fee waiver
Other (please specify)
Please explain your circumstances for requesting a fee waiver
Upload supporting document(s) (e.g., proof of income, unemployment letter, government assistance, etc.)
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Applicant Signature
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