Application form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name, license number, email, and phone number in the designated fields. Ensure all information is accurate for verification purposes.
3. Fill in your employer's name and address where you earned your LPN hours. This is crucial for validating your work experience.
4. Indicate the total number of LPN work experience hours and your job title. Be precise as this impacts your application eligibility.
5. Provide a detailed description of your job duties. Use clear language to outline responsibilities that demonstrate your nursing skills.
6. Sign and date the form at the bottom. Your signature authorizes Lane Community College to verify the provided information.
7. If applicable, have your employer complete their section, ensuring they verify the accuracy of your submitted details.

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