ADMISSIONS PROCESS INSTRUCTIONS CONT.
Department of Nursing
Virginia State University
140 Hunter McDaniel
P.O. Box 9059
Petersburg, VA 23806
804-524-6722 - Office
804-524-5218 - Fax
GENERAL INFORMATION : (Please Type)
Name
__________________________________________________________________________________________________
Last First Middle Maiden
Permanent Address
___________________________________________________________________________________________________
Number Street Apt. #
_______________________________________________________________________________(_____)_____________
City State Zip Phone Number
Local Address ( if different from above)
___________________________________________________________________________________________________
Number Street Apt. #
_______________________________________________________________________________(______)__________
City State Zip Phone Number
E-mail Address ____________________________________
Check One:
Incoming Freshman __________Currently Enrolled Student ___________Transfer Student ___________
Signature________________________________________ Date ___________________________
|