Name *

First Name

Last Name

Phone *

(###)

###

####

When did you graduate, or what is your anticipated graduation date? *

MM

DD

YYYY

Have you taken the NCLEX Exam? *

Yes

No

If YES, provide your NCLEX exam dates:

1st Attempt

2nd Attempt

3rd Attempt

If NO, when do you plan to take the NCLEX (Approximate Month/Year)?

MM

DD

YYYY

Did you attend any NCLEX review sessions?

Yes

No

What platform did you use for your review?

Face-to-face

Virtual

Fully Online