MSN Information Request

Full Name: *

Address: *

City : *

State: *

Zip Code: *

Primary email address: *

Phone number: *

Are you currently an RN?:

Yes

No

Do you currently have a BSN?:

When do you plan to start?: *

Spring 2012

Summer 2012

Fall 2012

Other (Please specify):

What program are you interested in?: *

What kind of contact are you interested in receving?:

Program brochure

Information appointment with an Admissions Counselor

Visit the Mission Valley campus

Information on upcoming events

Application packet

Any other questions or comments?:

Events