*Application Process for Beginning Students Fall 2015*

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1 *Application Process for Beginning Students Fall 2015* Please follow instructions carefully when filling out the application. Provide all information requested. If something does not apply to you, write N/A in the space provided. Also, TYPE or PRINT your response. To apply for the nursing program, please complete and submit the following items: NURSING APPLICATION (see attached, or available online at the Admissions & Records web p at ) 1. Contra Costa College Admissions Application (if applicable) 2. Proof of high school graduation, GED test, OR higher level degree (AA/AS/BA/BS) 3. OFFICIAL college transcripts from ALL INSTITUTIONS ATTENDED (exception: you do not have to submit transcripts from Contra Costa College, Diablo Valley College or Los Medanos College) 4. Work in Progress/Registration Statement (obtain from each college in which you are currently enrolled) The deadline for submitting your application is February 1, Applications are accepted between October 1, 2014 and February 1, Applications postmarked on or before February 1 will be accepted. *To be considered for Fall 2015 admission, all nursing program prerequisite courses must be completed by December, 2014.* ** INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED ** Please mail/walk-in your completed nursing application packet to Contra Costa College: Admissions and Records Student Services Center #115 Attn: Nursing Application Contra Costa College 2600 Mission Bell Drive San Pablo CA 94806

2 *Application Process for Advanced Placement LVN Students* LVN applicants are admitted to the 3 rd semester of the program (Fall 2015 entry). Period for submitting applications to LVN advanced placement: 10/1/14 2/1/15 Psych Tech applicants are admitted to the 2 nd semester of the program (Spring 2015 entry). Period for submitting applications to Psych Tech advanced placement: 7/1/14 10/1/14 Transfer applicants are admitted to the program based on the recommendation of the Nursing Admissions Committee. Period for submitting applications to Transfer advanced placement: 7/1/14 10/1/14 for students entering Spring semester 2015 (January) 10/1/14 2/1/15 for students entering Fall semester 2015 (August) To apply for Advanced Placement as a transfer applicant you must do the following: Submit a nursing application to the Admissions & Records Office with OFFICIAL college transcripts Send a letter requesting admission to the nursing program along with a copy of your unofficial transcripts (with course descriptions) to the attention of: Nursing Admissions Committee, HS Building, Room 103. Request the nursing program bulletin from the Nursing Department (Health Sciences Building, Room 103), (510) , or go to select Nursing Admissions then Nursing Program Bulletin. It is the student s responsibility to request transcripts from any institution attended.

3 Please note deadline dates and requirements. Check List for Nursing Program Admission Please answer the following questions in order to assure that your application is ready for submission to the Admissions & Records Office. 1. Yes or No Completed or Work in Progress** with Group A Courses: (Minimum GPA of 2.75 required) Anatomy - BIOSC 132 Physiology - BIOSC 134 Microbiology - BIOSC 119 or 148 English Composition ENGL 001A or 001B Drug Dos Calculation - NURS 205 Pharmacology for Nurses NURS Yes or No Completed or Work in Progress** with Group B Courses: (Minimum GPA of 3.00 required) Introduction to Sociology- 3. Yes or No SOCIO 220 or ANTHRO 130 Psychology- PSYCH 130 or 220 Human Communication- SPCH 120,121 or 128 Developmental Psych- PSYCH 126,128 or PE 197 Completed a CCC Admissions application (if applicable; application is available online 4. Yes or No Completed a Nursing Admissions application 5. Yes or No Obtained official transcripts (and proof of registration for in-progress courses) 6. Yes or No Obtained Proof of High School graduation / GED / College degree 7. Yes or No Social Security Number is required-- please include this in the space provided on the application. If you answered NO to any of the questions above, complete the requirements and submit your application at a later time. Also, you may schedule an appointment with a counselor at (510) or (510)

4 ** To be considered for Fall 2015 admission, all nursing prerequisite courses must be completed by December, Contra Costa College Nursing Program APPLICATION FOR REGISTERED NURSING PROGRAM Please check the appropriate box for which you are applying: First Semester Nursing Student Advanced Placement ONLY: Transfer from another RN Program L.V.N. to RN - AS Degree option L.V.N. to RN - 30-unit option Psychiatric Technician to RN Did you previously apply to the CCC Nursing Program? Yes or No If yes, list the year you applied Please fill-out Name (LAST) (FIRST) (MIDDLE) (PREVIOUS) Address: (STREET) (CITY) (STATE) (ZIP) Student ID# SSN#(required) Birth date / / Day Phone: ( ) Evening ( ) Cell ( ) address (required): Contact person: (Name) (Telephone #) (Relationship) Citizenship Status: ( ) U.S. Citizen ( ) Permanent Resident ( ) Temporary Resident ( ) Other What State do you regard as your permanent home: When did your stay begin / / High School Attended Dates of Attendance Degree/Date Awarded

5 College(s) Attended Dates of Attendance Degree Earned/Grad. Date Signature: (date) Name: Last First Student ID # 1. Are you applying for Advanced Placement??Yes or?no 2. Are you applying as a Transfer Nursing Student?Yes or?no 3.Are you a Licensed Vocational Nurse? LVN # a copy of your license is required?yes or?no 4. Are you a Licensed Psychiatric Technician??Yes or?no LPT # a copy of your license is required

6 Dear Student: The Board of Registered Nursing is requiring all nursing programs to provide them with the following data. Please complete as accurately as possible. The information you provide will be confidential and not released to any source nor will it affect your application status. Gender Male Female Racial Background Check one American Indian or Alaskan Native Asian or Pacific Islander African American, Non-Hispanic Eastern Indian Filipino Hispanic White, other than Hispanic Other/Unknown Age years of years of years of years of > 56 years of Check one Rev: 09/29/14