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Brockton Hospital School of Nursing
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Create Online Application
Complete and submit this form to create an online application. All fields are required. If you have ever been issued an ID and PIN at this school you may use them to create a new application by using the form below.
Required *
First Name
Middle Name
Last Name
Pref. Pronouns
They/Them
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She/Her
He/Him
Birthdate
Email Address
Confirm Email
Passwords must be between 16 and 32 characters. Minimum of one uppercase, one number and one special character. Please follow all requirements when updating your passwords. Passwords expire every 90 days.
PIN
Confirm PIN
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If you have ever been issued an ID and PIN at this school you may use them to create a new application. Otherwise complete the form above.
ID
PIN
Email Address
Submit
Clear