Application for Admission to VSL Nursing & Allied Health Programs

Program Applying for:

Have you taken the TABE?

What was your TABE Score? (Enter number 1-10)

Please submit your TABE test results.

You must have taken the TABE and score at least a NRS 4 or higher to continue with the application.

Please contact Mrs. Eve Anderson for remediation at Eve.Anderson@fletcher.edu or 985-448-5926.

Which semester are you applying for?

When would you prefer your labs?

OLD --- Are you currently enrolled in an Adult Education Program at Fletcher or Bayou Cane Adult Ed?

Name

First NameLast Name

Please list all previous names/aliases

Type N/A if not applicable

Fletcher Student ID (LoLA Number):

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number (cell)

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Birth date

Date

T-Shirt Size

Applicants must possess a high school diploma or equivalency to apply to this program. Please input date high school diploma or equivalency was awarded

Ex. 05/1996

Applicants must possess a nursing license to apply to this program. Please upload your licensure.

Are you presently a student at Fletcher?

Are you a LCTCS employee?

Are you currently employed as a Sterile Processing Technician?

Are you currently employed as a Phlebotomist?

If yes, where are you employed?

If no, have you met the required 400 hours of experiencing in an SPD in the last 5 years?

Have you met one of the following requirements below?

Calculation

I am a...

If you are a CNA/MA you will also need to upload proof for High School Diploma/GED/HiSET

License and/or High School Proof Upload

Background Checks:

Background checks are required for the following programs:

Nurse Assistant
Medical Assistant
Electrocardiograph Technician (ECG)
Ophthalmic Assistant
Pharmacy Technician

Click here to submit your background check.

Instructions:

Click here for Instructions

If I receive funding from an outside source and that funding is discontinued before the full amount is paid, I understand that I am responsible for paying the remaining balance. Additionally, I acknowledge that if I withdraw from, am dismissed from, or am unsuccessful in the class/program, my eligibility for continued outside funding may be affected, and I will be responsible for paying any remaining balance.

Are you self paying?

Please provide your institution's name for invoicing

*Payment of $550.00 includes book and certification exams.

Payment

USD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Application for Admission to VSL Nursing & Allied Health Programs

Payment*

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