Applicant Information

Did your employer direct you to fill out an application form?
Salutation:
First Name:*
Last Name:*
E-Mail:*
Home Phone:*
Mobile:*
Gender*
Birth Date:*
SIN*
Do you hold a current Nursing Licence?
Nursing License Number
Nursing License Province

Please upload and attach:

  • Nursing License if applicable
  • if under the age of 21, upload your highschool diploma
  • A passport sized photo - REQUIRED

Documents
  
Country:*

Address in Canada

Address1:
Address2:
City:
Province/State:
Postal/ZipCode:

Program Information

Program of Interest?*

What is your desired start Year and Month.
We will confirm your actual start date based on the registration process completion.

Desired Start Date

Additional Information

High School Grad Date
Higest Level of Completed Education*
By submitting this form, I agree that Atlantic College of Applied Health Sciences may call, text and/or email me about their educational services