Student Portal Registration

* denotes fields that are required.

Step 1: Personal Information

Your Student Portal Username will only be used to log into the Student Portal. We cannot guarantee this will be the same as your assigned computer login name.

Student Portal Username *

First Name *

Preferred Name

Last Name *

BirthDate

Passwords must be at least 6 characters long, contain at least one of each: capital letter, lower case letter, number, special character.

Student Portal Password *

Confirm Password *

Step 2: Contact Information

Address 1

Address 2

City

State

Zip Code

Home Phone

Mobile Phone

Your personal email address will help ensure you can keep your same Student Portal Account if you switch schools or begin a new program. We want to help make your transition from under-grad to graduate seemless. This also gives us the ability to keep you informed on Genesis events post-graduation.

Personal Email *

School Email *

Select your primary email preference. This is the email we will use to send most notifications about the Student Portal.

Personal

School

Step 3: Access Questions

Are you currently, or have you ever been employed by Genesis HealthCare System? *

Yes, I have been, or am currently am.

No, I have never been.

If you are a current student or instructor at Genesis, what is your computer username?

Please upload a work-appropriate photo of yourself. This will be used to help identify you by your instructors and trainers. This is required to gain full-access approval in the system.

Step 4: Enrollment Information

Current School *

Current Role *

Current Program *

Student/Employee ID

Step 5: Emergency Contacts

Primary Contact Name *

Primary Contact Relation *

Primary Contact Phone *

Alternate Contact Name

Alternate Contact Relation

Alternate Contact Phone