Licensed Nursing Assistant Application
MM slash DD slash YYYY
New Hampshire Residence Information
Application Process:
The information provided by the applicant on this admission application form shall be held confidential to the extent determined by Federal Law and College policy. 51ºÚÁÏÍø reserves the right to deny admission to any applicant who, in the judgment of the college officials, does not qualify for admission. The College also reserves the right to require withdrawal of any student who does not satisfy the ideals of citizenship, character, or scholarship.
In accordance with the terms and conditions set forth in its publications, and if accepted, I agree to abide by the rules and regulations set forth in the publications and in the Student Handbook. I also agree that the College has permissions to use any College sponsored pictures in which any likeness appears. I certify that I have read and agree with the above, and that all information provided herein is true and complete.
MM slash DD slash YYYY
*For compliance purposes, the Community College System of New Hampshire and its colleges collects names and social security numbers from all students attending the college. For example, the Internal Revenue Code requires the college to produce a 1098-T tax form. The college's use of social security numbers will be limited to legitimate educational purposes. The college will ensure the security of the student's social security number and will not disclose it to anyone outside the college, except as authorized by federal or state laws or applicable purposes.
Notice of Non-Discrimination
51ºÚÁÏÍø does not discriminate in the administration of it admissions and educational programs, activities, or employment practices on the basis of race, color, religion, national origin, age, sex, disability, genetic information veteran status, sexual orientation, political affiliation or marital status. This statement is a reflection of the mission of the Community College System and 51ºÚÁÏÍø and refers to, but is not limited to, the provisions of the following laws: Title VI and Title VII of the Civil Rights Act of 1964, as amended, the ~ The Age Discrimination Act of 1967 (ADEA) ~ Title IX of the Education Amendment of 1972 ~ Section 504 of the Rehabilitation Act of 1073 ~ The Americans with Disabilities Act of 1990 (ADA) ~ Section 402 of the Vietnam Era Veterans’ Readjustment Assistance Act of 1074 ~ Genetic Information Nondiscrimination Act of 2008.
