School of Nursing Request for Information

Contact Information

First Name*

Preferred First Name

Middle Name

Last Name*

Birthdate*

Email Address*

Confirm Email Address*

Mailing Address*

Country

Street

City

Region

Postal Code

Primary Phone Number

Program Information

What will be your highest degree earned when you enter UVA?*

What degree are you interested in obtaining?*

What program are you interested in?*

What specialization are you interested in?*

Full-time/Part-time*

Full-Time

Part-Time

Intended Start Term*

Additional Information

US Armed Forces Status

Military Branch

Will you be an RN when you enter UVA?*

Yes

No