Admission Application

CHRISTIAN INTERNATIONAL SCHOOL OF HEALTHCARE PROFESSIONS
Application for Admission





Program	*	BSN ASN PN PN Flex
First Name	*
Middle Name	*
Last Name	*
Maiden Name
Gender	*
Birth Date	*
SSN	*
Address 1	*
Address 2
City	*
State	*
Zip	*
Country	*

Home Phone	*
Work Phone
Other Phone
Email	*
Contact Preference		Home Work Other Email

Ethnic Origin	*	Asian or Pacific Islander Am. Indian Black White Hispanic Alaskan
Citizen Of	*
Type of Visa	*
Marital Status	*

High School Information
Name of High School	*
Graduation Year	*
City	*
State	*
Zip Code	*
If you are not a high school graduate, have you completed the GED?		Yes No
If yes, you must request your official GED results be sent to the CISHP Office of Admissions

College Transfer Information

List the colleges you attended and all the degrees earned beginning with the earliest one and ending with the most recent one attended
College
Start Date
End Date
Degree Earned
Program

College
Start Date
End Date
Degree Earned
Program

College
Start Date
End Date
Degree Earned
Program
Have you ever been convicted of a felony?	*	Yes No
Military Veteran	*	Yes No


Honor Code: Christian International School of Healthcare Professions is committed to developing the intellect and moral character of its students. To that end, all instances of plagiarism, cheating, and other forms of academic misconduct shall be punished in accord with CISHP policy. Any knowledge of conduct of this nature should be reported to the proper authorities.

If you are accepted as a student at this institution, there are certain performance tests you may be required to take during your academic career. It is a requirement of admission that you agree to take any test deemed necessary by CISHP. In those instances where tests are administered by an external entity, you hereby agree for the results to be released to CISHP.

AHCA Regulation: As a condition of admission to CISHP, students will be required to undergo a Level II background check and fingerprinting in compliance with AHCA regulations. In addition, urine drug screening may be requested. The results of this testing will become part of the permanent student record.

Social Security Number: In accordance with the privacy act of 1974, applicants for admission and enrolled students are advised that the requested disclosure of their Social Security numbers to CISHP is voluntary. Students who do not provide CISHP with their Social Security numbers will be assigned a special nine digit numbers. This number or the Social Security number will be used: (a) to identify such student records as application for admission, registration, course enrollment documents, grade reports, transcript requests, certification requests, and permanent academic records, and (b) to determine eligibility, certify school attendance, and report student status. Students are notified however, that only the Social Security number may be used as an identifier for grants, loans, and other financial aid programs according to federal regulations. The student's Social Security number will not be disclosed to individuals or agencies of CISHP except in accordance with the institutional policy on student records.

I understand the policies outlined above and I hereby certify that all statements in this application are correct and complete.	*






Christian International School of Healthcare Professions 7633 131st Street Seminole, Fl.33776 +1 727 498 8200 Phone +1 727 498 8251 FAX