Application for Pre-Practical Nursing Program

Thank you for your interest in the Ballad Health Academy Pre-Practical Nursing Program. Please complete the following application in full. Incomplete applications may result in delayed processing.

Application deadline is Friday, April 25, 2025.

If you have questions, please email Ballad Health Academy at balladacademy@balladhealth.org.

Personal Information

First Name*

Please enter your legal first name.

Middle Initial*

If you do not have a middle initial, please enter "NA".

Last Name*

Please enter your legal last name.

Preferred Name

The name we should use when speaking with you or writing to you.

Date of Birth*

Gender*

Gender data is for reporting purposes only and will not be used to make admission/enrollment decisions.

Male

Female

Street*

Please enter your mailing address

City*

State*

Zip*

Student's Email*

Parent/Guardian's Email*

Parent/Guardian's Phone Number*

Phone

Educational Background

Current Grade*

Please select your current grade level in school.

8th grade

9th grade

10th grade

Current School Type*

Select

Middle School*

Select

High School You Plan to Attend*

Select

Academic and Extracurricular Recognitions

Please list any academic and/or extracurricular recognitions you received while in middle school.

High School*

Select

Courses Completed

Please check all courses below that you have completed for high school credit.

Geometry

Algebra

Health Science

Other

Extracurricular Activities*

Are you involved in any extracurricular activities or sports?

Yes

Extracurricular Activities List*

Please list all extracurricular activities (i.e., band, sports, etc.) in which you are involved.

Healthcare Experience

Healthcare Experience*

Do you have any healthcare experience such as job shadowing or health camps?

Yes

Type of Healthcare Experience*

Personal Statement

Personal Statement*

Share your "why" with us by uploading a brief essay (250-500 words) that could potentially address the following questions:

• What inspires you to pursue a career in nursing?

• How have your personal, educational or professional experiences prepared you for this program?

• What are your long-term career goals after completing the Pre-Practical Nursing program?

Drag and drop files here or

Signature and Acknowledgement

Student Signature*

By typing my full legal name below, I certify all the information and answers provided on this application are true and correct to the best of my knowledge.

Parent Signature*

By typing my full legal name below, I confirm I am the legal parent/guardian of the student named above and hereby give permission for my son/daughter to apply to the Ballad Health Academy Pre-Practical Nursing Program.

Submission Date*

Please enter today's date.

Send me a copy of my responses

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