Fillable Edited March 2020 MOBILITY NURSING PROGRAM APPLICATION For (Coastal Alabama Community College)

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Edited March 2020 MOBILITY NURSING PROGRAM APPLICATION For (Coastal Alabama Community College)

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Edited March 2020
1
MOBILITY NURSING PROGRAM APPLICATION
For Current LPNs and Paramedics
Instructions: This application is for current Alabama licensed LPNs, LPNs with multi-state licensure, and
Alabama licensed Paramedics who would like to complete the Associate Degree in Nursing. This program is
offered each fall semester. Please check the campus desired to complete the entire Mobility program.
Students who are willing to drive the distance and would like their application considered for more than one
campus, must rank the campus selections in order of admitting preference (1
st
, 2
nd
, 3
rd
). Do not select more
than one campus, if the distance to another campus is too far to drive. Applicants are only considered for the
campus(s) selected. If no campus is chosen, or all campuses are chosen but not ranked, the applicant will be
considered for the campus closest to the mailing address provided on this application. No changes are made
to campus location after entry into the program except in extenuating circumstances.
FALL semester applications are accepted from APRIL 1 to JUNE 1. Choose campus(s) below.
___ Bay Minette Campus ___ Thomasville Campus ___ Brewton Campus
I. PERSONAL DATA Date:
Last Name: _______________________ First: ____________________ MI: ___ Maiden:
Social Security Number: __________________________ Student Number:
Mailing Address:
City: _____________________ State: ___ Zip Code: ___________ Telephone: (___)
Coastal E-mail: ________________________________________________________________________
Personal E-mail: _______________________________________________________________________
Emergency Contact: ___________________________________ Telephone: ( )
II. EDUCATION
List all colleges attended including current college. (Add separate page as necessary)
Name of College (DO NOT ABBREVIATE)
Year(s) attended
Degree (if completed)
If you are an LPN, where did you attend your practical nursing program? __________________________
What year did you graduate? __________
Have you been admitted to a nursing program since completion of your practical nursing or paramedic
degree? YES ___ NO ____
(If YES, a letter from that program Dean/Director must be sent to the Bay Minette campus nursing
department indicating you have not been dismissed for disciplinary or unsafe practice).
Are you currently enrolled in Coastal Alabama Community College? YES ___ NO ___
(If NO, go to Coastal Website; Admissions; Apply Online; Update Application)
Edited March 2020
2
___ A COPY OF YOUR ALABAMA LPN, MULTI-STATE LPN, OR ALABAMA PARAMEDIC
LICENSE MUST BE SUBMITTED WITH THIS APPLICATION
___ A COPY OF ONE OF THE FOLLOWING ACT RESULTS MUST BE SUBMITTED WITH THIS
APPLICATION:
___ official high school transcript with documented ACT scores
___ official ACT score from ACT.org
___ official ACT Residual score from Alabama’s Community College System
Your name as listed when tested: ____________________________________________
College transcripts are not accepted for ACT score, student copies of transcripts, and unofficial transcripts
are not acceptable forms of ACT scores. There is no date limitation for the ACT results.
I understand that completion of this application is a component of the student profile and does not in itself
grant admission to the Nursing Program. I understand a new application must be submitted if I am not
selected and wish to reapply. I certify that the information given in this application is true and correct. I
understand that providing false information may be deemed sufficient reason to dismiss the student and/or
to refuse admission. All application materials become the property of Coastal Alabama Community
College. It is the sole responsibility of the applicant to ensure that the Nursing Department has received all
the requested documentation.
All information must be submitted by the appropriate deadline or the application will be considered
incomplete. It is recommended that applicants check with the Admissions Office, at (251) 580-2111, to
confirm active status and confirm all transcripts are on file and up to date. CHECK THE MINIMUM
NURSING ADMISSION STANDARDS BEFORE SUBMITTING YOUR APPLICATION.
___________________________________ ________________________________
Applicant’s Signature Date
All applications are submitted by US postal service or emailed/scanned to the Bay Minette
nursing office regardless of campus for which student is applying.
Address: Coastal Alabama Community College Nursing Department
1900 Hwy 31 South
Bay Minette, AL 36507
Email: Allison.spillman@coastalalabama.edu
APPLICATION DEADLINES:
Applications are accepted April 1-June1. All applications must be received by the end of the
business day, June 1, in order to be considered.
Edited March 2020
3
MINIMUM ADMISSION STANDARDS
___1. Resubmit an application to the college, if not currently enrolled in a course
___2. Original transcripts from all colleges attended must be received in the Bay Minette
Registrar’s Office by the nursing application deadline. Unlike routine college admission,
the nursing department does not allow one semester to receive transcripts. Transcripts must
be sent directly from the institution’s registrar to Coastal Alabama’s registrar. Hand
delivered or student copies of transcripts are not accepted.
___3. A completed nursing mobility application must be turned into the Bay Minette Nursing
Department by appropriate deadline
___4. A minimum of 18 ACT composite score (writing component not required), National or
Residual, is required. The ACT results must be attached to this application. There is no
expiration date on ACT for this nursing program application. ONLY the following are
accepted for ACT score:
• Copy of score from ACT.org national website
• Copy of official high school transcript with documented ACT results
• Copy of the ACT residual score from the test given at Coastal Alabama Community
College, or another Alabama Community College
___5. A minimum 2.5 GPA is required on a 4.0 scale based on the eight academic core courses
required for the nursing program. The core college courses are English Composition I,
Intermediate College Algebra (or higher level math such as Pre-Cal, Finite Math, or
Statistics), Anatomy & Physiology I, Anatomy & Physiology II, Microbiology, Human
Growth & Development, Speech, and a Humanities elective (Art or Music Appreciation,
Philosophy, Theater, Religion, or a foreign language).
___6. Prerequisite Courses:
• MTH 100 – Intermediate College Algebra, or higher level Math
• ENG 101 – English Composition
• BIO 201 – Human Anatomy and Physiology I
• BIO 202 – Human Anatomy and Physiology II
• SPH 106 or 107 – Fundamentals of Speech
• PSY 210 - Human Growth and Development
___7. A valid, unencumbered Alabama PN license (printed from ABN website), multi-state license, or
Alabama Paramedic license is required
___8. Good standing with the College including a minimum overall, cumulative GPA of 2.0
___9. Meet the Essential Eligibility Criteria for nursing
Edited March 2020
4
You will receive notification of your admission status within approximately 4 weeks of the
application cycle deadline. A letter will be sent to the mailing address listed on your application.
Again, thank you for your interest in Coastal Alabama Nursing!
Sincerely,
Coastal Alabama Community College; Division of Nursing
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Edited March 2020 MOBILITY NURSING PROGRAM APPLICATION For (Coastal Alabama Community College)

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