Nurse Apprentice Program ARPA Grant EFT

Nurse Apprentice Program ARPA Grant – Banking EFT Account Setup

Date

Facility Name(Required)

Please enter Facility Name(Required)

Facility Name – Current Doing Business As

(optional)

Facility Name – Previously Known Name

(optional)

Contact(Required)

First Last

Please provide your contact information in case we have questions

Email(Required)

Phone(Required)

Bank Name(Required)

Bank Routing Number ( ABA )(Required)

Bank Account Number(Required)

Bank Account Type(Required)

Savings

Checking

Deposit Slip / Voided Check Upload(Required)

Max. file size: 20 MB.

Required for validation

Notes / Effective Date

Please include any notes for us here.
For example, indicate the effective date for this change, such as: “New Ownership – Apply this for NAP Salary reimbursements beginning June 2024.”

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Nevada Nurse Apprentice Program

Nurse Apprentice Program ARPA Grant – Banking EFT Account Setup