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  • Home
  • Education
  • Adult Education
  • 10-month LPN Program
  • LPN Program Enrollment
  • Licensed Practical Nursing (LPN) Program Application

Licensed Practical Nursing (LPN) Program Application

LPN Application.

Step 1 of 4

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Student Information

Select the location you wish to attend.(Required)
Select the CTE Center you wish to attend.
Student Name(Required)
Enter your first, middle, and last name.
Enter your work phone number.
Enter your primary phone number.
Enter your most used email address.
Date of Birth(Required)
Enter your birthday in the mm/dd/yyyy format.
Gender(Required)
Please note that the data we report each year only allows us to report two genders.
Martial Status(Required)
Enter your martial status as of completing this form.
High School Graduate or Equivalent (GED Test, etc.)?(Required)
Please select "Yes" if you have a HS diploma, GED or equivalent. Select "No" otherwise.
Enter the year you graduated from the high school you attended or completed your GED test, if applicable.
Enter the high school you graduated from or attended, if applicable.

Student Information 2

Optionally, please enter your social security number.
Mailing Address(Required)
Enter your mailing address.
Emergency Contact(Required)
Enter your emergency contact by first and last name.
Enter your emergency contact's primary phone number.
Emergency Contact Relationship(Required)

Please specify the relationship with your emergency contact.

Demographic Information

Race(Required)
Please indicate your race(s).
Employment Status
Please check all that apply.
Economic Status
Please check all that apply.
Disability Status
Please check all that apply.
Funding Source(s)(Required)
Please check all that apply.

CABOCES Adult Education & Workforce Development can qualify for funding from the New York State Department of Education if we serve enough economically disadvantaged students. In our experience, most of our students are not aware that they qualify because they do not know the way it is figured out.

You will need to know the following information to answer the following question: The number of people whose permanent address is your residence; and your gross income, either for the year or by paycheck.

Federal Income Guidelines
Are you economically disadvantaged?(Required)
Please look at the table on the left to determine.

Application Essay

In the space below, please discuss in a short paragraph your reasons for applying to our LPN program.
Please print your full name below.
Sign this form with your signature below.
Date Signed
Please enter the date you completed this form in the mm/dd/yyyy format.

NOTE: YOUR APPLICATION FOR LPN IS NOT CONISDERED COMPLETE UNTIL WE HAVE RECEIVED TRANSCRIPTS PROVING YOU GRAUDATED FROM HIGH SCHOOL OR OBTAINED THE EQUIVALENT. PLEASE CONTACT US IF YOU HAVE ANY QUESTIONS.

Notice of Non-Discrimination The Cattaraugus-Allegany-Erie-Wyoming Board of Cooperative Educational Services does not discriminate on the basis of an individual’s actual or perceived race, color, religion, creed, ethnicity, national origin, citizenship; status, age, marital status, partnership status, disability, predisposing genetic characteristics, sexual orientation, gender (sex), military status, veteran status, domestic violence victim status or political identity, gender expression, and religious practices or any other basis prohibited by New York State and/or federal non-discrimination laws in employment or its programs and activities. The District provides equal access to community and youth organizations. Inquiries regarding the District’s non-discrimination policies should be directed to: Civil Rights Compliance Officer, Human Resources, Cattaraugus-Allegany BOCES, 1825 Windfall Road, Olean, NY 14760, 716-376-8237. Email: CivilRightsCompliance@caboces.orgcreate new email

This field is for validation purposes and should be left unchanged.

NOTICE OF NON-DISCRIMINATION

The Cattaraugus-Allegany-Erie-Wyoming Board of Cooperative Educational Services does not discriminate on the basis of an individual’s actual or perceived race, color, religion, creed, ethnicity, national origin, citizenship status, age, marital status, partnership status, disability, predisposing genetic characteristics, sexual orientation, gender (sex), military status, veteran status, domestic violence victim status or political identity, gender expression, and religious practices or any other basis prohibited by New York State and/or federal non-discrimination laws in employment or its programs and activities. The District provides equal access to community and youth organizations. Inquiries regarding the District’s non-discrimination policies should be directed to: Non-Discrimination / Anti-Harassment

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