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Student Information
Name
*
First Name
*
Last Name
*
Preferred Name
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
State
ZIP Code
Email
*
T-Shirt Size
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XS
Small
Medium
Large
XL
2XL
Will you need assistance with transportation to OCU?
*
Yes
No
Parent or Guardian Name
*
First Name
*
Last Name
*
Parent or Guardian Email
*
Parent or Guardian Phone
*
In case of emergency, should we contact the parent or guardian listed above, or someone else?
*
Parent or guardian listed above
Someone else
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
Demographic Information (Optional)
Gender Identity
Male
Female
Other:
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I identify as (select all that apply):
Hispanic
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Asian/Pacific Islander
African American
White
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Education Information
High School
*
Grade Level
*
GPA (Weighted)
GPA (Unweighted)
*
High School Counselor Name
*
First Name
*
Last Name
*
High School Counselor Email
*
High School Counselor Phone
*
What activities are you currently involved in both inside and outside of your high school?
*
Have you receive any honors and awards that you would like us to be aware of?
*
Why are you interested in nursing or a career in health care?
*
At OCU, we believe in and teach the “Kramer Way,” using caring, kindness and respect in all that we do in our work with our clients and colleagues. How do you demonstrate caring, kindness and respect in your daily life?
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