Practical Nursing Online Application

Please indicate which semester you are applying for:*

Fall 2025

Full Name (first, middle, last)*

Mailing Address*

City*

State*

Zip Code*

Phone Number

Date of Birth (mmddyyyy)*

Tech T#

Email (ATU address, if you have one)*

Please indicate if your are currently a student of:*

Arkansas Tech University

Arkansas Tech University - Ozark Campus

Not Applicable

Are you a previous Practical Nursing student seeking re-entry?*

Yes

No

Have you previously attended another Nursing Program?*

No

Yes

If you answered yes to the previous question, please answer Name of School attended, Dates attended, Name (if different than application)

By signing below, I acknowledge that I have read and understand the Essential Functions for the Practical Nursing Student. I believe to the best of my knowledge that I have the ability to learn and perform the Essentials Functions**

Without reasonable accommodations

With reasonable accommodations

I, the undersigned applicant to the Practical Nursing Program at Arkansas Tech University-Ozark Campus, understand that participation in the Practical Nursing Program does not guarantee the right to sit for the NCLEX-PN. I also understand that participation in the Practical Nursing Program does not guarantee licensure as a Practical Nurse. I hereby release Arkansas Tech University-Ozark Campus, its employees, and all affiliating agencies from any liability with regard to my licensure as a Practical Nurse following successful completion of the program, and understand that any of the crimes listed in the Arkansas State Board of Nursing Nurse Practice Act may bar me from practicing as a Practical Nurse after program completion. In signing this document, I am also verifying that I have read the information from the Nurse Practice Act in its entirety regarding Criminal Background checks and understand the information contained therein.*

Yes, I understand

No

If you are not currently student at ATU-Ozark or ATU-Russellville, please remember to complete an application for the ATU-Ozark Campus and send all transcripts and from previous schools attended as well as proof of two MMR immunizations to the Office of Student Services, 1700 Helberg Lane, Ozark, AR 72949). School application must be completed before submitting this application. I certify that the above information is accurate and complete to the best of my knowledge.*Name (acting as signature)

Date*