Virtual Student Membership Application

Full Name

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email address

Submit Proof of Student Status

Note: In order to qualify for a student membership, you must be a student working toward your initial RN license. In the field below, please attach any of the following for confirmation: student ID (with current enrollment year identified); unofficial transcript; etc. Since this documentation may be available on a mobile device, we will accept a screenshot of the documentation.
One file only.
20 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.