ASSOCIATE DEGREE NURSING PARAMEDIC TRANSITIONAL NURSING PROGRAM APPLICATION

2017

NAME __________________________________________ DATE / / . ADDRESS ___________________________________________________________________ PHONE: Home Cell . Student ID # __________________ Please check all description(s) which apply to you: ____ High School Transcript ____ Paramedic Program Transcript ____ Copy of Paramedic certificate and letter from employer ____ I have completed all developmental courses required by my placement exam. (Accuplacer, ACT) ____ I have completed BIO2110, BIO2112, BIO2120, ENG1110, MAT1110, PSY1120 and PSY1130. ____ I have submitted BCII and FBI background checks to the nursing department – (by March 3, 2017). ____ I will complete all course requirements by the deadline for admission – at the end of spring semester, May 5, 2017. Have you been an Ohio resident for the last 12 months? ____ Yes ____ No Do you plan to work during the nursing program? ____ Yes ____ No If Yes: Full-time ____ Part-time ____ This application must be received by the Academic Specialist for Health & Public Services by 12:00 p.m., MARCH 3, 2017 to be considered for admission to the Summer term, 2017. (Classes are offered depending on adequate enrollment)