* = Required Information
*Before applying please read, print and sign. Submit this form on your interview date.
Agape Angelicum School of Nursing Arts is committed to students' success. You have 80 hours to accomplish your goal to receive your Nurse Aide license from the Board of Nursing. It is with utmost importance to accept students that are willing to focus on the tasks ahead.

We at Agape Angelicum School of Nursing Arts strive to help you reach your potential to be your best. We expect your full cooperation in working with us. We value a good team players and good work ethics. The following are essential elements to your success.
1. All "clinical "requirements for the program must be satisfied on the first week of class.
2. All school policies must be followed (If you have difficulty following policies please reconsider other alternative schools).
3. Our school has strict uniform policy (If you do not like uniforms please consider other schools that do not require uniforms). Tattoos must be covered and No visible body piercing. Pair of stud earrings is allowed.
4. The Nurse Aide training program is taught entirely in English. The instructions are delivered in a considerable fast phase. The ability to read and understand written English is therefore extremely important!
5. Different Skills are taught on different days and are taught before the "clinical phase of training" can begin.
6. All classroom evaluation tests and assignments must be completed within the 62 hours prior to "clinicals". No students will be allowed to go to clinicals without completing all school required tasks.
7. No students will be allowed in "clinicals" if skills are not fully mastered.
8. Attendance is extremely important to your success in the program.
If you do not feel you can accomplish the tasks (with our required 80 hours) or your schedules do not warrant your full focus to the curriculum; please reconsider other programs from other schools that can provide your logistics/and other needs.

We strive to keep our tuition cost low. We also know that is still a considerable amount for most students. By signing our application form, you are agreeing to the above requirements and are able to communicate well in English and have the language skills to attend our school.

Once accepted in the program there will be no refunds.
Student Application Form
Female Male
Previous Education
No college or university
Some college or university, no degree
Associate degree
Bachelor’s degree
High school diploma
GED certificate
Currently enrolled
Home taught
No Diploma or GED and age 18 or over
No Diploma or GED and under age 18
Note: Students under 18 requires permissions to enroll parents/guardian signatures needed.
Prepare for employment
Improve my skills at my present job
Learn new skills for a better job
Prepare for a career change
For my personal interest or self- improvement
Preparation for college (Nursing etc.)
Employment History

Personal References (Person who can vouch for your character and work ethics)
AGAPE ANGELICUM School of Nursing Arts does not discriminate on the basis of race, color, sex, age, national origin, religion, handicap, Veterans status or any other characteristic protected by Federal or State Law. All of the information on this form is confidential and in compliance with the Family Education Rights and Privacy Act of 1974.

I hereby authorize the administrators of the AGAPE ANGELICUM School of Nursing Arts an investigation of my past employments, references and statements contained in this application and release all liability and responsibility from persons, companies or corporations supplying such information. Further, it is my understanding that any false statement made by me on this application shall be grounds for dismissal should I be accepted in the AGAPE ANGELICUM School of Nursing Arts.
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