University of Hawaii at Hilo
Baccalaureate Nursing
Student Information Update
for Pre-Nursing (PRNU) Students
Please fill out this form so that we can update our files:
NAME: __________________________________________ ID #: ___________________
Current Local Information:
Mailing Address:______________________________________________________
City/State:
____________________________________ Zip Code: __________
Phone: ________________(Home)
________________(Cell)
_________________(Work)
_________________(pager)
Do you have access to a personal computer? Yes or No
E-mail:________________________________________________________________
(You are required to use your Hawaii.edu email address when accepted into the BSN Nursing Program.)
Advisor’s Name:_______________________
Anticipated entry into upper division nursing (semester/year) ____________
Gender: M or F (circle one)
Information for statistics (OPTIONAL):
Ethnicity ______________________________________________________
Highest grade attended by parents ______________________________
Dated:_________________
Forms-Labels/BSN Forms
06/08/04
_______________________________________________
Signature
Student: Please fill out & return to BSN
Nursing Office.