Editing previous response:

Please fix the highlighted areas below before submitting.

Seat Reservation Form

practical nursing logo

We are providing you the convenience to pay online when submitting the form information.

If you have questions please contact Jacqueline Kemp at (518) 746-3508 or [email protected]

Student Legal First Name*

Answer Required

Student Legal Last Name*

Answer Required

Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Phone*

Number Required

Non-Refundable $100 Seat Reservation Fee*

Price: $100.00

Confirmation Email

Confirmation Email *

Email Required