Supplemental Application for the Nursing Program (RN)

Nursing Division

BEFORE SUBMITTING A SUPPLEMENTAL APPLICATION FOR A HEALTH SCIENCE PROGRAM, YOU MUST SUBMIT AN ADMISSION APPLICATION

This application, all transcripts, and any applicable test scores must be received by the January 15 or July 15 deadline to be eligible for the program. Program facts: Program begins in August or January. Notification regarding acceptance into the program is mailed in mid-March (for August) or mid-September (for January). A minimum of 23 credits must be completed or in progress at the time of application to the program to be eligible for admission. The courses include ENG 101 English Composition, MAT 101 College Algebra, SOC 101 Introduction to Sociology, PSY 201 General Psychology, PSY 204 Developmental Psychology: Lifespan Human Development, BIO 103 Human Anatomy and Physiology I, and BIO 104 Human Anatomy and Physiology II. Additional information can be accessed at the Advising office or in the HCC Catalog. Starting July 16, 2010, all nursing applicants (LPN and RN) must complete the nationally-normed test for nursing students known as the Test of Essential Academic Skills (TEAS).

Additional Information:

Program Information

I am interested in the following semester for admission: *

Fall

Spring

I am interested in the following year for admission: *

Personal Information

First name: *

Middle initial:

Last name: *

Date of Birth: *

Email: *

Student ID number:

Former name:

Address: *

City: *

State: *

Zip: *

County: *

Telephone: *

Is this a new address?:

Additional Information

Have you taken any nursing course work at another college?: *

If, yes, indicate name of school(s) and date (s) below:

Which of the following do you have?: *

Have you completed or do you plan to complete coursework at another college?: *

If so, please make sure that all official transcripts have been sent to HCC

Any healthcare experience?: *

If yes, # of years:

Current Employer:

Check all that apply: *

I understand that I will be considered for the indicated program during the year specified on this application. If I wish to defer consideration to a later year, it is my responsibility to submit a new application to the Office of Admissions and Registration.

I understand that the program that I am applying for is selective, and that acceptance is not guaranteed. I also understand that preference may be given to students residing in Washington County.

I have met individually with an academic advisor or program coordinator concerning the requirements of the program I am applying for.

I understand that it is my responsibility to ensure all application materials are received by HCC by the published deadline, and to inform HCC of any address or name changes immediately.

Is English your first language?: *

Yes

No

Office Use Only

Received by:

Received on:

Coded in Datatel by:

Coded in Datatel on:

Curriculum Change processed by:

Curriculum Change processed on:

Received by Program Coordinator:

Received by Program Coordinator on:

Notes: