Nurse Entrance Test (NET) by mpm74462


									                  HARMONY HEALTH CARE INSTITUTE, INC.

                       Nurse Entrance Test (NET)
                         Registration Form
   • Type or Print, using black ink or maker
   • Sign the completed application form
   • Nurse Entrance Test fee of $60.00 (money order or bank-check made payable to Harmony Health Care
       Institute) must be paid upon submission of registration form for testing
   • Nurse Entrance Test Study Guide: $40.00 (optional)

Nurse Entrance Test Result:
  • NET result will be mailed once receive by regular mail or email within 7-10 business days of test date
  • Computer-based NET results will be available for pick-up as soon as the test is completed.

Last Name                    First Name                    Middle Initial

Email Address                                      SS#

Mailing Address                     City                          State          Zip Code

Home Phone                                  Cell Phone or Work Phone

Are you currently enrolled as transitional or non-matriculating student in Harmony Health Care Institute
student?      Select one that apply: YES ____________ NO ________________

Have you ever taken the NET before?      Select one that apply: YES _________ NO ___________
If yes, how many times? _________
Have you ever taken the NET at Harmony Health Care Institute? Select one: YES ________ NO _______
If yes, when? Date(s): ___________________________________________________________________

I have paid the REQUIRED FEE of $60.00. I am aware that this fee is non-refundable and non-
transferable. Payment must be submitted with registration form.

Applicant’s Signature: _________________________________ Date: _________________________

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