School of Health Sciences Online Application

Thank you for your interest in applying for one of the Reading Hospital School of Health Sciences programs. Please use this form if you are applying for a program. Use this form to submit either via check or credit card. For more information, please contact the school at 484-628-0100.

* Denotes required fields

* Year of Desired Admission

Admission Program

* Program Applicants may choose one or more

AEMT (January enrollment)
AEMT (July enrollment)
Diagnostic Medical Sonography (January Enrollment)
Medical Imaging (January enrollment)
Medical Laboratory Science (July Enrollment)
Nursing (August enrollment)
Paramedic (August enrollment)
PHRN (August enrollment)
Surgical Technology (August enrollment)

If you selected multiple programs, which one would be your primary choice?

* Do you plan to

Commute
Live in Residence Hall

* Are you a former RHSHS seeking re-admission?

Yes
No

* Are you a Licensed Practical Nurse?

Yes
No

* Are you a certified Emergency Medical Technician?

Yes
No

Citizenship

Please choose one. If neither a US citizen nor permanent resident, do not proceed - call the School at 484-628-0100 for further instruction.

* Are you a United States citizen?

Yes
No

Permanent Resident? A copy of permanent resident card is required to complete your applicaiton.

Yes
No

Name of birth country

Contact Information

Please use your name as it appears on your Social Security card. If the applicant’s name is not correct as shown on the card (for example, because of marriage or divorce) the applicant should request a new card from the Social Security Administration. This is critical for your transcript, financial aid, and eventual licensing processes. The School will continue to use the old name until the applicant shows documentation that the applicant’s name has been changed through Social Security Administration.

* First Name

M.I.

* Last Name

* Date of Birth mm/dd/yyyy

* Social Security Number Example: 000-00-0000

Former Name(s)

* Home Phone Example: 123-123-1234 x123

Mobile Phone Example: 123-123-1234 x123

* Email Please be careful to enter your email address accurately. A confirmation email will be sent to you.

* Address

* City

* State Example: NY

* ZIP Code Example: 12345

Temporary Address

Address

City

State Example: NY

ZIP Code Example: 12345

* Are you a permanent resident of Berks County, PA?

Yes
No

* Are you under the age of 21?

Yes
No