Level I
Revised February, 2020
I understand that any false or misleading statements made by me on this application will prevent my acceptance into the
program or will be cause for dismissal if accepted.
I understand and accept that after being admitted to the program, I must pass a physical examination approved by Danville
Area Community College. I understand that I will be asked to authorize the release of my health and demographic information to the
clinical sites utilized by the nursing program.
As required by the clinical affiliates, students must undergo criminal background checks before entering the program. This
form will be sent to you upon your acceptance to the program. I also understand that if the results of the background check prevent me
from participating at the clinical sites, I will not be able to enter the program. At DACC, we updated all of our program manuals to
state: “DACC does not rely on drug test results to deny access to any academic program for any student who is 21 or over and tests
positive for marijuana. However, most clinical sites require a test for marijuana and do not allow students to complete clinicals if the
test is positive. The clinical is a requirement of this program, and thus if DACC does not have a clinical partner that allows positive
tests, students may not be able to complete the program.
If you have any questions relative to interpretation of any part of this application, please email nursing@dacc.edu.
Signature:__________________________________________ Date: ____________________
Return to: Danville Area Community College
Mary Miller Complex, Health Care Professions Room 172
c/o Office Assistant
2000 East Main Street
Danville, Illinois 61832
If using US Postal Service, please obtain acknowledgement of receipt. Hand delivery is recommended.
CHECKLIST FOR SUBMITTING APPLICATION
Please initial next to the number above, or note “N/A” for those items that are not applicable, once the item has
been completed. (Documentation is required for each section of this checklist.)
1. Applied to Danville Area Community College (if applicable)
2. Applied (3 pages) to the Nursing Program
3. $65.00 Application fee made payable to DACC at the cashier’s office. The Health Professions
Office cannot accept payment of any type. Once payment is made at the cashier’s office, a
receipt of the payment is to be submitted with this application.
4. Provided proof of residency: Copy of valid Driver’s License, State Identification Card, or a
Voters Registration Card with your address
5. All Official Transcripts from other institutions must be on file with the Records Office at
DACC.
6. Submit unofficial copies of all transcripts, including DACC transcripts with nursing application.
You are responsible for obtaining copies of transcripts and submit with application.
7. If applicable, provided proof of active unencumbered health care related licenses/certificates
(listed on point sheet).
8. Completed Point System Criteria Table (Attachment A)
