Online Application

Student Information
Legal Name - Must match name on social security card
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Legal Name - Must match name on social security card
Legal Name - Must match name on social security card
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High School Information

List your high school information and request official transcripts to be sent directly to the Admissions Office. Current high school students should have a transcript sent now and another after graduation is noted on the transcript. All transcripts must be official and sent via mail or through an electronic transcript exchange. Faxed transcripts will not be accepted. ACT/SAT scores may be included with your high school transcript.

High School Equivalent Exam

For those who have completed a high school equivalency exam, complete the following information. If we can access your transcript online, we will do so. If not, you will need to request an official transcript be sent directly to the Admissions Office.

Postsecondary Education

List EVERY college, university, and vocational postsecondary school you have attended. You must request official transcripts from every school to be sent directly to the Admissions Office. Students currently enrolled at another school should ask the school to send a transcript now and one after current courses are completed. All transcripts must be official and sent via mail or through an approved electronic transcript exchange. Faxed transcripts will not be accepted.

Failure to list a college or university and provide official transcripts may void your admission or prohibit you from receiving financial aid.

Civil or Academic Discipline

Please note that a career in healthcare is a highly responsible profession requiring you to be trustworthy and reliable. While a criminal record will not necessarily disqualify you from being admitted to a program, misrepresentation or omission of any criminal offense that appears on your background check will disqualify you. We encourage you to disclose anything that may appear on your background check.

Have you ever been suspended or dismissed from any school/college/university?
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Have you ever been placed on academic or disciplinary probation?
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Have you ever been charged, convicted, or plead guilty to any criminal offense?
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Student Classification
Please select one of the following:



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Equal Education Opportunity

Answers to the following questions will not be provided to those making an admission decision. They are not used in deciding admission and will not be released except as group statistics for federal, state, and other reports. Questions regarding gender, race, and marriage status are important in determining the effectiveness of efforts related to the provision of equal education opportunity.

Did you ever attend our Healthcare Camp while in high school?
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Gender
How did you learn about our school?






Citizenship (We are not authorized to admit other immigration classifications)
Marital Status



Ethnicity





Employment Status
Will you continue to work when enrolled?
Are you currently a SoutheastHEALTH Employee?
Do you plan on using Veteran’s benefits while you are in school?
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Military Status
Academic Program(s) Applying For

NOTE: The application fee for each program applied for is $50.

Beginning Any Semester
Beginning Summer 2021








Beginning Fall 2021
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Have you previously applied for admission to this college?
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Checklist Review

  • Fully completed application
  • Program Specific Eligibility Form
  • $50 Application Fee
  • Test Scores
  • High School Transcripts
  • College Transcripts if applicable

I understand that my application will not be considered complete and therefore not reviewed until the above materials are submitted:
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Signature
I affirm that all information supplied is complete and accurate. I understand that any misrepresentation or change of facts could be cause for refusal of admission, cancellation of admission, or suspension from the College. I am aware that this application will not be considered until all required admission items are received by the College.
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