Southside College of Health Sciences : Online Application

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.
First
Middle
Last
Birthdate
Email Address
Confirm Email
The new minimum PIN requirements are as follows: Must be 8 characters long; have at least one type of each of the following characters: Uppercase (A-Z), Lowercase (a-z), Number (0-9), and Symbol (!, #, $, etc.); case sensitive; should not include part of your name or username; and new password may not have been used previously.
PIN
Confirm PIN
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