Application Form

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Application Form

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1Your Information

2Academic Plans

3Academic History

4Submit Application

Tell us about You

Name

First/Given name*

Middle Name

Last Name*

Suffix

Preferred First Name

Former Last Name(s)

Former name(s) refers to any previous names that you used before your current legal name. This could include a maiden name, a previous married name, or any other name that you legally changed from in the past.

Contact Information

Primary Phone

Type*

Home

Cell

Phone Number*

United States +1

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Email*

This number can receive SMS/Text messages and I opt-in to receive SMS messages.

Yes

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Demographic Information

This section will ask for information that DSHCP needs for reporting purposes, but will not impact your ability to attend school.

Social Security Number (optional)

Please know that for Federal Income Tax purposes, IRS law requires that a student furnish a Social Security Number to the college allowing the reporting of tuition on the Form 1098T. If you do not have a Social Security Number please leave this field blank.

Date of Birth*

MM slash DD slash YYYY

Will you be at least 22 years old when you begin your classes at DSHCP?*

Yes

Gender*

Female

Male

Select one or more of the following racial categories you identify with.*

American Indian or Alaska Native (Not Hispanic or Latino)

Asian (Not Hispanic or Latino)

Black or African American (Not Hispanic or Latino)

Choose Not to Disclose

Hispanic or Latino

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

White (Not Hispanic or Latino)

Are You Hispanic/Latino?*

Yes

A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Additional Information

Are you a first-generation college student? (i.e., the first person in your family to attend college)*

Yes

Please select Yes if you are a first generation college student.

Are you currently in the U.S. military, a veteran, or a dependent of a military member? (Please select the option that applies)*

Yes

Do you have a criminal background? (Please select "Yes" if you have been charged with a felony)*

Yes

Academic Information

Application Type*

Choose the campus you want to attend.*

Select the term you would like to begin.*

Intended Program of Study*

High School Information

Please let us know about your high school.*

High School Information

High School

School Type

Prior College Attendance

Attended College

If you attended college or took college courses, either while you were in high school, or since you graduated from high school, please click the box.

Post-Secondary Educational Institution Information/Prior Colleges Attended (if applicable)

Post Secondary Institution Or College

Name	Graduation Status	Attendance Start Date	Attendance End Date
There are no Post Secondary Institutions or Colleges.

Almost done.

Review the following and sign your application.

Divine School for Healthcare Professionals is approved and regulated by Texas Workforce Commission, Career Schools and Colleges (101 E. 15th Street, Rm. 226T, Austin, Texas 78778-0001. Phone: (512) 936-3100) and Texas Board of Nursing (1801 Congress Ave. Suite 10-200,Austin, TX 78701. Phone: (512) 305-7400 ) to award certificates of completion.

I certify that the information on this application is complete and I understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate disciplinary action.

Please click here to accept the terms and conditions.*

I Agree

Sign your name*

How did you hear about us?*

Application Form