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Applicants must complete the Associate of Science Application form and submit it, along with other required documentation in Nursing (ASN) Program to the
address shown on page 4 by 5 pm (EST) August 17, 2020, to be considered for selection for the fall 2021 cohort. Note: this is a fillable PDF; please type in your
responses, and then, once completed, print this form out to be submitted. Candidates who submit incomplete application packets will not be considered in
the admissions process for the ASN Program.
Last First Middle
LTC Student ID Number* Birth Date Social Security #
*Note: You must be an accepted & admitted LTC student prior to submitting an ASN Program Application
Street/Road/PO Box City State Zip Code County
Phone (Mobile) Phone (Other)
LTC Student Email Personal Email
Applicants must complete the Test of Essential Academic Skills (TEAS) for Allied Health to be considered for selection. The TEAS may be taken no more than 2
times in a calendar year, with at least 30 days between each attempt. No TEAS score greater than six years old will be accepted. Please list the score and
date for each time you have taken the TEAS. Note: If you have taken the TEAS at a testing site outside of Lanier Technical College, you must request your official
TEAS score report be sent from ATI to Lanier Technical College.
Score Date
Score Date
Score Date
Score Date
Forsyth Campus
3410 Ronald Reagan Blvd.
Cumming, GA 30041
Admissions (Forsyth) 678-341-6610
ASN Program contact:
ASN-Program@laniertech.edu | 678-341-6604
Associate of Science in Nursing (ASN) Program Application
Cohort Beginning FALL 2021
**(NOTE: This is not an admissions application to Lanier Technical College)**
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Attendance at an ASN Information Session within one year of the ASN application deadline is mandatory; please list below the date that you
attended an ASN Information Session. To register for a session, go to the ASN webpage, which may be found at
Completion of the following courses with a grade of ‘C or higher in each course and a cumulative grade point average of 3.0 or higher of
these courses is required. Please list the grade(s) you have for each of the courses. List the highest grade for courses that have been retaken;
these grades will be verified alongside the applicants’ official transcript(s).
ENGL 1101 (Composition and Rhetoric)
ENGL 1102 (Literature and Composition
BIOL 2113 (Anatomy & Physiology I)*
BIOL 2113L (Anatomy & Physiology I Lab)*
BIOL 2114 (Anatomy & Physiology II)*
BIOL 2114L (Anatomy & Physiology II Lab)*
BIOL 2117 (Introductory Microbiology)*
BIOL 2117L (Introductory Microbiology Lab)*
PSYC 1101 Introductory Psychology
MATH 1111 (College Algebra)
Area IV: General Education Core class
*Note: All courses with the “BIOL” prefix may be no more than six (6) years old on the application deadline.
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I hereby apply for admission to the ASN Program for fall semester 20 _____ and certify this application and the accompanying documentation is
both correct and complete. I have read the application packet, and the ASN Program information (which may be found at
https://www.laniertech.edu/programs/healthcare-nursing/associate-of-science-in-nursing/), including the essential skills necessary for the ASN
Program, and I understand the application and selection processes. I further understand that any failure on my part to comply with these processes
will result in the invalidation of my application. I am aware of the competitive nature of the application process for the ASN program and understand
that meeting all minimum requirements does not guarantee admission into the program.
Signature __________________________________________________________________ Date ______________________________________________
Continue reading for application submission instructions and supplemental documentation checklist.
Associate of Science in Nursing (ASN) Program Application
Signature Page
click to sign
click to edit
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Please mail the completed application packet (pages 1 3) and all required documentation to the address
Lanier Technical College
Attn: Program Application for Admission
Associate of Science in Nursing Room C209A
3410 Ronald Reagan Blvd
Cumming, GA 30041
ONLY mailed application packets will be accepted. ONLY complete application packets that include the required supplemental
documentation will be processed. Hand delivered application packets will not be accepted and incomplete applications will not be
Application Status: Please do not call or email to inquire about the status of an application. Once your application packet has been received, you
will receive a confirmation email; confirmation may be delayed if the College is closed for any reason. If you desire a secondary confirmation that
your application packet was received, please mail the application certified via the US Post Office. Mailing the admission packet this way allows you
to receive a delivery confirmation from the postal service. If you wish to know if your application is complete, please read all directions and utilize the
checklist below.
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Checklist for required documentation for completed ASN Application Packet:
ATI TEAS Score Report [NOT the ATI TEAS V (five) test]
Include an unofficial copy of your TEAS Score Report with your application, and you must request that the official ATI transcript
be sent to Lanier Technical College. Scores are automatically sent to the location where your test was administered (no cost);
therefore, if you take the TEAS at a Lanier Technical College campus, you will not need to have the official TEAS test results
transcript sent in with your application documents.
TEAS information & registration through ATI testing: https://www.atitesting.com/teas/register
Completed ASN application, postmarked by Monday, August 17, 2020
Sent as certified mail (optional) if you want it to be tracked
Legible printout/copy of current American Heart Association BLS for the Healthcare Professional certification (course must
include hands-on training; must be active throughout the entire ASN program)
Legible printout/copy of current, ACTIVE licensure/certification from the official issuing organization (for LPN/LVN, certified
Paramedic, certified EMT-I/A-EMT, Certified Medical Assistant, Registered Medical Assistant, and Certified Nursing Assistant):
Paramedicine Must have attended a state-approved and accredited Paramedicine
program, completed a clinical practicum, and passed the NREMT
Certification Examination
EMT-I/AEMT Must have attended a state-approved and accredited Paramedicine
program, completed a clinical practicum, and passed the NREMT
Certification Examination
Medical Assistant CMA/RMA applicant must have attended a CAAHEP or ABHES accredited program,
completed a clinical practicum, and passed the CMA (AAMA) or RMA (AMT) Certification
Examination (CCMA is not accepted)
Nursing Assistant CNA applicant must have completed a program that includes classroom education, a clinical practicum, and passed
the National Nurse Aide Assessment Program (NNAAP)