Online & Lancaster Program Application

What is your intended program of study?

For persons interested in EMU at Lancaster’s Nurse Aide Training program. All application requirements must be submitted 3 weeks prior to the start of your session.

Personal Information

Prefix

First Name

Note: If you are an international student, please enter your name exactly as it appears on your passport

Middle Name

Last Name

Suffix

Preferred First Name

Former Last Name(s)

Gender

Date of Birth

Marital Status

Social Security Number

Please enter your nine-digit Social Security Number with no extra characters. Social Security Number is not required at this time but recommended to expedite the financial aid process

Email

Mobile Phone Number

Include country code for numbers outside USA and Canada. Your phone number is the primary way that EMU will communicate with you. Please provide the best number to reach you.

Home Phone Number

International Phone Number

May we contact you via text messaging?

Citizenship

Citizenship Status

Country of Citizenship

Visa Type?

Alien Registration Number

Address(es)

Have you lived in the State of Pennsylvania full-time for the last two (2) consecutive years?

Please add your permanent address below. If you have additional addresses to add, please click 'Add another address'.

Address Type

Country

Street Address

Street Address Line 2

City

State/Province

Postal Code

Ethnicity Details

Federal reporting regulations require that we report the ethnic composition of our student body. This will in no way affect the admission decision.

Do you consider yourself to be Hispanic/Latino?

Select one or more of the following racial categories to describe yourself:

Religious Details

Please begin typing the name of your place of worship in the field below and use the address below to verify it is the correct place of worship. If you do not find your place of worship in the list, please check the box below to indicate it does not exist and enter the information.

Religious Background

Answer will not affect admission decision

What place of worship do you currently attend?

I do not attend a place of worship.

My place of worship is not in the list.

Please enter your place of worship name and address if it is not in the list above.

Place of Worship Name

City

State

Lead Owner ID

Undergraduate Division

Non-credit Division

Graduate Division

Financial Aid

Financial Aid Questions

Do you plan to file the Free Application for Federal Student Aid (FAFSA)?

Will your employer reimburse your tuition?

YesNo

Will your church reimburse your tuition?

YesNo

Education Background

High School (or GED) History

Please begin typing the name of your high school in the field below and use the address below to verify it is the correct school. If you do not find your high school in the list, please check the box below to indicate it does not exist and enter the information.

Most Recent High School

If you have a GED, select "GED" for your most recent high school.

High School Graduation Date

School Counselor First Name

School Counselor Last Name

School Counselor Email

My school is not in the list.

Please enter your high school name and city, state and postal code if it is not in the list above.

High School Name

City

State

Postal Code

High School ID Number

College/University History

Please enter the most recent college/university you have attended. If you have attended multiple, select the checkbox to enter the additional schools.

Last College/University Attended

Attended from

Attended to

GPA

My school is not in the list.

Last College/University ID

Please enter your college/university name and address if it is not in the list above.

School Name

Street Address

City

State

Postal Code

What is the highest degree you've earned?

Your Family

Do you consider yourself a first generation college student, meaning neither of your parents/guardians attended a college or university?

Do you have parent(s)/guardian(s) information you want to include?

YesNo

Parent/Guardian Information

Please provide information about your Parent(s)/Guardian(s) below. To add additional individuals please click on 'Add another parent/guardian' below. If you do not have a Parent/Guardian to enter, please select 'Not Applicable'.

Relationship

Salutation

First Name

Last Name

Suffix

Occupation

Email Address

Parent Mobile Phone Number

Parent Home Phone Number

This individual is an alum of EMU.

This individual is employed by a Mennonite school. This includes a College, University, High School or Elementary school.

Employer's Name

Same mailing address as applicant?

YesNo

Country

Street Address

Street Address Line 2

City

State/Province

Postal Code

References

Please provide contact information for your nursing manager/supervisor (or recent nursing instructor). They will be contacted by email to complete an electronic recommendation form.

Please provide contact information for your reference contact (non-family member). They will be contacted by email to complete an electronic recommendation form.

Identify two people who are in a position to judge your potential as a graduate student. Teachers provide one reference from a building-level administrator/supervisor, as well as someone in a supervisory capacity. An electronic reference form will be sent to each contact.

Reference 1

Name 1

Title and Organization 1

Email 1

Phone 1

Eastern Mennonite University keeps the confidential recommendation for six months after an admissions decision. I agree that the recommendation I am requesting will be held in confidence by officials of Eastern Mennonite University and I hereby waive any rights I may have to examine it.

Yes

No

Reference 2

Name 2

Title and Organization 2

Email 2

Phone 2

Eastern Mennonite University keeps the confidential recommendation for six months after an admissions decision. I agree that the recommendation I am requesting will be held in confidence by officials of Eastern Mennonite University and I hereby waive any rights I may have to examine it.

Yes

No

Employment Information

Employer

Employer Name

Title/Position Held

Street Address

City

State/Province

Start Date

End Date

Supervisor Name

Supervisor Phone

Almost Finished

How did you first learn about EMU?

Acknowledgement

Students entering the nursing program will be required to undergo the following background clearances: state police criminal record check, child abuse history clearance, and FBI fingerprint check. No student will be retained in the program with a disqualifying criminal history or child abuse clearance. Additionally, students must maintain an active, unencumbered registered nurse license for the duration of the program.

Applicants should be aware of these limitations prior to entering the nursing program. Status of licensure is checked as part of the admissions process.

Initial below to confirm that you have read and understand these requirements.

As an applicant to this program, I acknowledge that I have read and understand the essential qualifications.

I acknowledge that I am capable of performing the abilities and skills outlined in this document with or without reasonable accommodation and understand that my status as a student in this program depends on my continued ability to successfully demonstrate these abilities and skills.

I understand that if I am no longer able to meet these essential qualifications I will immediately notify the program director.

Initial below to confirm that you have read and understand the program admission criteria as posted on the EMU website

I hereby certify that the information given by me on this application form is complete and truthful. I understand that if any information furnished by me is found to be untrue, I may be denied admission, or if admission has been granted, I may be subject to disciplinary action, including dismissal from Eastern Mennonite University.

Please type in your full name here. This shall represent your signature.

Application Fee

An application fee is required to finalize submission of the application. If you have been provided a discount code, please use the field below to enter it.

I have a discount code.

Discount Code

Application Fee

International Fee

Transfer Fee

PreDiscountFee

DiscountAmount

Credit Card Information

First Name

Last Name

Card Number

Do not include dashes in the credit card number

Code

Expiration Month

Expiration Year

Billing Address

Billing Country

Billing Street Address

Billing City

Billing State/Province

Billing Postal Code

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