Fall 2016 Program Entry. Have you previously applied to the GCC ADN Program? YES / NO. Please circle: YES / NO

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1 Associate Degree Nursing (ADN) Program Application Greenfield Community College Office of Admission, Attn: Laura Earl One College Drive, Greenfield, MA Phone: (413) Fall 2016 Program Entry Name GCC Student ID# Mailing Address City/State/Zip Report all mailing address changes to the Office of Admission to avoid delay of important correspondence and/or final decision letter. is required if you would like to receive confirmation of receipt of your Program Application. Preferred phone # Have you previously applied to the GCC ADN Program? YES / NO Year? _ Are you currently still in High School? Please circle: YES / NO Did you enroll in courses during the fall 2015 semester and/or January 2016 intersession? YES / NO (circle one) at GCC not GCC Deadlines Transcript deadline: Official transcripts will only be accepted if postmarked or delivered by February 1, Application deadline: Program Applications will only be accepted if postmarked or delivered between September 1, 2015 and February 16, Instructions 1. Complete requirements #1 through #8. Check the appropriate item in each section. 2. If you are a high school student pay special attention to the instructions at the top of page DO NOT send resumes, recommendation letters or any extra documents not required for application. 4. DO submit the GCC ADN Health Requirements Form to the Health Records Office, available from the website at web.gcc.mass.edu/admission/health-careers/ or from the Office of Admission. Health records that are not attached to the proper GCC ADN Health Requirements Form will NOT be considered complete. 5. Health forms and records that are faxed will NOT be considered official or complete. 6. If you have ever taken classes at GCC your GPA must be 2.0 or higher to apply. 7. After you have completed all requirements, and completely filled out this form, sign and submit this application to the address at the top of this application (program applications that are not complete will be returned). 8. Incomplete applications will be returned to the student by mail with an explanatory letter. Returned applications may be resubmitted upon completion, but no later than February 16, 2016.

2 Page 2 of 6 Application Requirements Requirement #1: GCC Application for Admission _ Submit a GCC online application located on the college website at web.gcc.mass.edu/admission/. Your Program Application and your transcripts (if applicable) will not be reviewed until you have submitted a GCC application. If you are already enrolled at GCC it is highly recommended to choose Liberal Arts/Health Science with Nursing intent as your major to ensure proper advising as you work on your Nursing requirements. To change your major obtain the Change of Major/Advisor Form from the Academic Advising Center, room C118. Requirement #2: High School Transcript _ Submit official high school transcript with graduation date to the Office of Admission (graduation date required). Requirement #3: Transfer Credit Evaluation (check only one) Submit official transcripts of all previous colleges attended to the Office of Admission. The final transcript deadline is February 1, All transcripts must be postmarked or delivered by this date in order to be considered no exceptions. After your transcripts have been reviewed, transfer credit will appear in your MyGCC record, and an will be sent to your GCC student address regarding placement testing requirements. If testing is required call the Testing Center to schedule at (413) It is your responsibility to check to ensure all transfer credit has been applied. If you have questions on your transfer credit, please contact Laura Earl (413) or [email protected]. I have not attended another college. I have only attended GCC, or I am still in high school. DO NOT SEND IN YOUR PROGRAM APPLICATION UNTIL YOU HAVE RECEIVED YOUR TRANSFER CREDIT . Requirement #4: Math (check only one) Complete the placement assessment in math with scores of 67 or higher in arithmetic and 91 or higher in Algebra within five years prior to entering the program, OR Complete Intermediate Algebra (MAT 096) or higher level math course at GCC, with a grade of C+ or better within five years prior to entering the program, OR Complete an equivalent or higher level math course at a previously attended college with a grade of C+ or better within five years prior to entering the program. Requirement #5A: English (to be completed only by applicants who have graduated from high school) Complete English Composition I (ENG 101, 103 or 105) at GCC, or an equivalent course at a previously attended college, with a grade of C or better. Note: Eligibility to take English Composition I is determined by taking placement tests in English with a score of 88 or higher in sentence skills and a score of 77 or higher in reading. If your scores are below those noted, you must complete developmental level English (ENG 090 and/or ENG 094) before English Comp I. Requirement #5B: English (to be completed only by applicants who are still in high school) Complete the placement assessment in English with scores of 88 or higher in sentence skills and 77 or higher in reading. If your scores are below those noted, you must complete developmental level English (ENG 090 and/or ENG 094) to fulfill this requirement.

3 Page 3 of 6 Requirement #6: Meeting with the Health Occupations Admission Office (for current high school students only) Call (413) to schedule a meeting with Laura Earl. Enter meeting date here: Admission signature: 2016 High School Graduates only - You may be eligible to waive Requirements #7 below if: 1. you will be graduating from high school in 2016, AND 2. you have an average of B (80%) or higher, AND 3. you rank in the upper third of your graduating class. High school students whose native language is not English and those who have not completed grades K-12 in the United States must demonstrate English proficiency by having completed English Comp I with a grade of C+ or better or complete one of the following tests. TOEFL- Paper administration-560; Computer based- 220; Internet based- 83 with a speaking score of 22 OR IELTS-Overall band score of 6.5 with a minimum of 6.0 in all modules Submit your ADN Program Application and an official high school transcript at the end of the fall 2015 semester, but no later than February 16, Final acceptance will be contingent upon maintaining your GPA and class ranking upon graduation. You will be required to submit a final high school transcript indicating the above three requirements at the end of your high school year. Requirement #7: General Education Courses: (Check all courses that you have completed.) You must complete at least ten (10) credits from the list below, including at least one of the BIO classes, before submitting this application. Additional courses taken in fall 2015 will be added to your profile after grades are reported. Be sure to circle the correct items on Page 1 if you are enrolled in fall courses to ensure review. BIO Anatomy & Physiology I (4 cr) C+ required within 5 years* BIO Anatomy & Physiology II (4 cr) C+ required within 5 years* BIO 205 Microbiology (4 cr) C+ required within 5 years* ENG 112, English Composition II (3 cr) C required 114, or 116 SOC 101 Principles of Sociology (3 cr) C required PSY 101 Principles of Psychology (3 cr) C required PSY 217 Human Growth & Development (3 cr) C required within 7 years* Humanities elective See course codes below ** (3 cr) C required + Formerly BIO 195 and BIO 196. * Currency exams are available for courses that were successfully completed more than five years prior to the beginning of the program. Call (413) to check on your eligibility for these exams. ** Humanities elective may be any course with one of the following course codes: AHS, ART, ASL, DAN, ENG (excluding ENG 090, 094, and English Comp I or II), FLK, FRE, GGY, HIS, HUM, LAT, MUS, PHI, PCS, SPA, or THE.

4 Page 4 of 6 Requirement #8: Submit your completed ADN Health Requirements Form to the Health Records Office Read the information below carefully before completing this requirement. You must download the GCC ADN Health Requirements Form from the college website at web.gcc.mass.edu/admission/health-careers/ or request one from the Office of Admission. Health records not attached to the GCC Health Requirements Form will not be considered complete. The date of your Physical Exam must be on or after September 10, Exams completed before this date will not fulfill the application requirement. Remember to bring your Health Requirements Form to your appointment. You must receive at least two doses of the Hepatitis B vaccine before submitting your Health Requirements Form. You must provide documentation of your third dose upon completion of the series. All other immunizations must be fully completed as listed on the immunization page. You, not your doctor, are responsible for submitting your health records on time. Health forms and records that are FAXED will NOT be considered official or complete. If your records are submitted early you may request a preliminary review by the Health Records Office to ensure that your health documents are properly reported. This courtesy will be provided only as time allows. Preliminary reviews will NOT be provided during the last two weeks before the deadline. Applications with incomplete health records will be returned, and may be resubmitted upon completion, but no later than February 16, Section VI, the Tuberculin Skin Tests (PPD/Mantoux), may be withheld until you are accepted to the ADN Program. Accepted students will complete this between June 1 and July 15. NOTE: The Massachusetts Board of Registration in Nursing s regulation 244 CMR 6.04(3) stipulates that all candidates for admission to a nursing program are required to provide satisfactory evidence of compliance with the immunization requirements as specified by the Massachusetts Department of Public Health. Candidates are also required to meet the standards set by the student nursing practice facilities. All sections of my Health Requirements Form are complete, and all documentation has been submitted to the Health Records Office. ADDITIONAL INFORMATION - Previous Education or Training: It is not required to complete a degree or special training prior to applying to the ADN Program. However, such experience will enhance your overall application profile. If you have previously completed any college degrees and/or health-related certificates/licensures, please list them below. (Do not send copies of your diplomas or certificates.) College Degree Major Year of Graduation Certificates/Licensures Completion Date PLEASE DO NOT SEND ANY ADDITIONAL DOCUMENTS WITH YOUR PROGRAM APPLICATION SUCH AS RESUMES, RECOMMENDATION LETTERS, CPR CARDS, CORI FORMS, OR CERTIFICATIONS.

5 Page 5 of 6 ADDITIONAL REQUIREMENTS for ENROLLMENT For students accepted to the ADN Program for fall 2016 Enrollment in the ADN Program is conditional upon completion of the following items. Detailed information about completing these requirements will be sent to students with their program acceptance packet. The information below will help you to plan ahead for the timely completion of requirements in the event you are accepted. The deadlines posted in the students acceptance packet are strictly enforced. Students who do not have these items completed by the posted dates WILL BE REPLACED by students on the waiting list! 1. Criminal Offender Record Information (CORI) Request Form. 2. Proof of CPR certification (Health Care Provider level). 3. Mandatory attendance at orientation. In summer, date announced in April after acceptance letters are sent. 4. Completion of Tuberculin skin tests (PPD/Mantoux) between June 1 and July 15, GCC grade point average (GPA) of 2.0. Only applies to students who have completed coursework at GCC. 6. Drug testing, flu vaccination and fingerprinting may be required once in the program. ******************************************************************************************* Required Signature: All of my application requirements for the ADN program are complete. Student s signature Date Students selected for the ADN Program will be mailed letters of acceptance by the end of April A waiting list of qualified applicants will be established for fall 2016 entry only. Students who are not selected for fall 2016 must reapply if interested in entering in a subsequent year. If you have any questions about the completion of the attached requirements, please contact Betsey Cronin in the Office of Admission at (413) or [email protected] or Laura Earl in Student and Academic Affairs at (413) or [email protected]. Please note that the requirements and procedures for application to health occupation programs are subject to revision. It is the responsibility of the student to maintain contact with the Office of Admission, or visit the GCC website, for the most up to date application form and information regarding changes to requirements and procedures. Extra Resources for Students: High School Students For students who are applying directly from high school, you can begin taking support courses the semester or year before entering. This will lighten your course load during the Nursing Program. Math Studio This service is intended to help students who have difficulty in math related to, math, science, information technology and business courses to succeed. Services include peer tutoring and Math Studio drop-in hours. The Math Studio coordinator is available to meet with individual students to discuss tutoring and math advising. Non-Native English Speakers - Students who feel as though they would like to strengthen and/or improve English-language speaking skills may contact Kit Carpenter ([email protected] or ) in the ESOL program for more information about language support options.

6 For Office Use Only: Date received by the Office of Admission _ Signature/ Admission Staff Second submission date, if applicable _ Signature/ Admission Staff Greenfield Community College is an affirmative action/equal opportunity employer and does not discriminate on the basis of race, color, national origin, sex, disability, religion, age, veteran status, genetic information, gender identity or sexual orientation in its programs and activities as required by Title IX of the Educational Amendments of 1972, the Americans with Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, Title VII of the Civil Rights Act of 1964, and other applicable statutes and college policies. The College prohibits sexual harassment, including sexual violence. Inquiries or complaints concerning discrimination, harassment, retaliation or sexual violence shall be referred to the College s Affirmative Action and/or Title IX Officer, Peter H. Sennett, at or [email protected], the Massachusetts Commission Against Discrimination, the Equal Employment Opportunities Commission, or the United States Department of Education s Office for Civil Rights. Revised 7/15