LNA Application for Admission

We are glad you have chosen to take this first step toward a rewarding career in healthcare.

Please note that you should ONLY complete this application if you are seeking direct admission to the LNA program at RVCC. If you are interested in admission through the paid training program with our partner Dartmouth Health, you must apply through them. Go here to learn more and apply to that paid training program.

Name*
First Middle Last
Former names listed on school records
(i.e. maiden name, previous married name, etc. - enter 'None' if not applicable)
Date of Birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Mailing Address (if different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Preferred Phone*
The phone where we may contact you about your application or enrollment.
May we text you at this phone?
- Yes
- No
Are you a U.S. Citizen*
- Yes
- No
If No, are you a permanent resident?
- Yes
- No
If you are not a legal resident, what is your current visa status?
Race/Ethnicity/Optional
You may check as many as apply.
- American Indian/Alaskan
- Asian
- Black, Non-Hispanic
- Hispanic
- White, Non-Hispanic
Sex Assigned at Birth (Optional)
- Male
- Female
Emergency Contact Information
Name*
First Last Relationship
Phone*
May we text your emergency contact at this phone?
- Yes
- No
High School Last Attended
High School Info
School Name City State / Province / Region Country
Date of Graduation or Year of G.E.D./HiSET award
New Hampshire Residence Information
I have always lived in New Hampshire*
- Yes
- No
If No, what month and year did you move to NH?
Current state of residence if not New Hampshire
What is/are your preferred campus(es)?*
RVCC offers its LNA program on each of its campuses (Claremont, Keene and Lebanon) on a rotating schedule based on demand and instructor availability. Which campus would be your preferred location? You may indicate more than one campus if you are willing to commute. We will keep you updated about when dates are scheduled for the campuses you choose.
- Claremont
- Lebanon
TO BE SIGNED BY ALL APPLICANTS
The information provided by the applicant on this admission application form shall be held confidential to the extent determined by Federal Law and College Policy. River Valley Community College reserves the right to deny admission to any applicant who, in the judgment of the college officials, does not qualify for admission. The College also reserves the right to require withdrawal of any student who does not satisfy the ideals of citizenship, character, or scholarship. In accordance with the terms and conditions set forth in its publications, and if accepted to abide by the rules and regulations set forth in the publications and in the Student Handbook, I also agree that the College has permissions to use any College sponsored pictures in which any likeness appears. I certify that I have read and agree with the above, and that all information provided herein is true and complete.
Signature*
Date*
MM slash DD slash YYYY