School of Health Sciences Online Application

Please call the School at 484-628-0100 to request a hard copy or to print forms click on Catalogs Forms and Brochures.

School of Health Sciences Application Form

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Program
Which program?


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If Nursing...
Do you plan to
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Are you a former RHSHS seeking re-admission?
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If Yes, which program?


Are you a Licensed Practical Nurse?
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Are you a certified Emergency Medical Technician?
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Citizenship, please choose one

If neither a US citizen nor permanent resident, do not proceed - call the School at 484-628-0100 for further instruction.

Are you a United States citizen?
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Permanent Resident
A copy of permanent resident card is required to complete your application.

Please use your name as it appears on your Social Security card. If the applicant’s name is not correct as shown on the card (for example, because of marriage or divorce) the applicant should request a new card from the Social Security Administration. This is critical for your transcript, financial aid, and eventual licensing processes. The School will continue to use the old name until the applicant shows documentation that the applicant’s name has been changed through Social Security Administration.

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(Month/Day/Year ex: 10/01/2008)
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Are you a permanent resident of Berks County, PA?
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If you are under the age of 21: Name and address of parent(s) or guardian(s)
Criminal history, answer question below

Have you ever been convicted, pled guilty, entered a plea of nolo contendere, been found guilty by a judge or jury, of a felony or misdemeanor, or received probation without a verdict, disposition in lieu of trial, or an Accelerated Rehabilitative Disposition in the disposition of a felony charge, in the course of the Commonwealth of Pennsylvania, the United States, or any other state, territory, possession, or country?
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Optional
What do you consider your ethnic origin?





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Educational Data
High school program pursued


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Are you a home school study student?
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Have you been educated outside the United States?
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List all High Schools and Post-Secondary Schools attended

Please note: Attendance at any other institution must be reported at the time of application. An applicant's failure to disclose to this School that he or she has taken a course(s) from another institution shall result in the denial or revocation of admission, and dismissal from the School, if matriculated.

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Has disciplinary action ever been taken against you at any of the institutions attended?
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Employment Data

(List current or most recent employer)

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General Data
Family member at Reading Health System?
Are you a dependent or an immediate family member of an employee of Reading Health System, or any of its affiliates or subsidiaries?
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Do you plan to work at Reading Health System upon graduation?
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Have you shadowed a healthcare provider?
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Special Circumstances
Understanding
Check to indicate you have read and agree
As an applicant to Reading Hospital School of Health Sciences, I signify that I have reviewed the admission policy on the website. Submission of my application indicates my understanding of all academic requirements and technical standards. I further signify that the information given is to the best of my knowledge, accurate, and correct. Permission is hereby given to Reading Hospital School of Health Sciences to investigate all pertinent information regarding my application. If accepted, I agree to inform the School of any changes to the information I have provided on the application prior to, and after acceptance into the School. Moreover, I understand that giving false information or withholding information prior to or after acceptance into the School may make me ineligible for admission or to continue my enrollment at Reading Hospital School of Health Sciences. I have read and understand the information included in the application. I understand that the application fee of $30 is non-refundable and required for processing my application.
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Please sign the form by entering your initials in the box
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