Nevada Rural Hospital Partners Foundation

Nurse Apprentice Program ARPA Grant 

Bank EFT Account Request

Hello , Thank you for submitting your bank information, we will be enrolling you in our US Bank EFT system.

Name of Facility:  

Name of Person Authorizing: , Email : , Phone Number:  

Bank Name:

Bank APA Routing Number:   

Bank Account Number:  

Bank Account Type:  

You have provided validation via an uploaded deposit slip or voided check as attached here :  

I, the undersigned, represent that I am duly authorized to represent and that I agree the information provided is accurate and complete.