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PERSONAL INFORMATION
Class Desired*
- August 2022
First Name*
Middle Name*
Last Name*
Maiden Name
Address*
Street Address City State ZIP Code
Phone*
Email*
Date of birth*
Month
Day
Year
Social Security Number**
Are you a U.S. citizen?**
- Yes I am a U.S. Citizen
- No but I am an eligible non-citizen
- No I am not a citizen or eligible non-citizen
EMERGENCY CONTACT
Name
First Last
Phone
Relation
Address
Street Address City State ZIP Code
EDUCATION
Name of High School*
Date graduated or obtained GED*
Month
Day
Year
College
Dates attended college
OPTIONAL INFORMATION
IS IS NOT MANDATORY TO FILL OUT THIS SECTION. THE FOLLOWING QUESTIONS ARE VOLUNTARY AND ARE NOT USED IN THE SELECTION PROCESS.
Gender
- Female
- Male
- Prefer Not to Answer
Ethnicity
Marital Status
How did you hear about us?
EMPLOYMENT INFORMATION
Present employer
Position
Dates of employment
Previous Employment
Please write a short statement of why you want to be a practical nurse.*
Have you ever been convicted of any criminal offense in any state or in federal court (other than for minor traffic violations?*
- Yes
- No
If yes, please contact the Admissions Specialist.
I understand that false statments or omission on any part of the application may be considered sufficient cause for denial of admission or dismissal from the program.*
- Yes, I understand.
Have you lived in any other state besides your current state of residence within the passed five years?*
- Yes
- No
If you answered yes to the previous question, please list all out of state addresses within the passed five years below.*
By checking the box below, you acknowledge and agree that the Capital Area School of Practical Nursing Application Fee of $75.00 is non-refundable. No application will be reviewed without payment. You acknowledge and agree to not submit registration for pre-entrance exam until Application Fee has been received.*
By checking the box below, you acknowledge and agree that the Capital Area School of Practical Nursing Application Fee of $75.00 is non-refundable. No application will be reviewed without payment. You acknowledge and agree to not submit registration for pre-entrance exam until Application Fee has been received.
- I agree to the statement above regarding my payment
Application fee

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Admission Forms
Adult CNA Courses
CPR Course Information
CPR Registration
Expenses
TEAS Testing
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Opportunities for CASPN Students

Admissions packet

In addition to your online application, we’ll also need several other documents completed and returned to us. You may download and print the documents here.

2201 Toronto Road, Springfield, IL 62712

(217) 585-1215

info@caspn.edu

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