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KU School of Nursing Career Ladder

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*First Name  
Middle Initial
*Last Name  
Date Of Birth (mm/dd/yyyy)  
Race
*Email Address  
*Street Address  
*City  
*State  
County
*Zip Code  
Home Phone Number
Work Phone Number
Nursing Employer
Year Last Enrolled
Semester Last Enrolled
Last School you were enrolled in
Program of Last Enrollment
City where you were last enrolled
State where you were last enrolled
Career Plans
Educational Plans
Program of Interest
MS Track of Interest
Gender
Items denoted with an asterisk (*) are required to be filled out before submitting the form.