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Fall Application Nursing (Los Angeles Southwest College)

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LOS ANGELES SOUTHWEST COLLEGE ●1600 West Imperial Highway●
Los Angeles, California 90047-4899
(323)241-5461 ● SoCTE, Room 132
Associates Degree Nursing Program Fall 2020 Application
De
ar Nursing Program Applicant:
The fall 2020 application period is from January 15, 2020 to February 13, 2020. A completed application packet must
include; the application, official sealed transcripts from all colleges attended, supplemental documents as outlined in
the application, and all TEAS test results (including results from all previous attempts, if applicable). To be
considered for admission a completed application must be received no later than February 13, 2020 by 4pm.
Qualified applicants must take the Test of Essential Academic Skills (TEAS) prior to Final Deadline. Students must
achieve a score of 62.0% overall or higher on the ATI TEAS test on his/her first attempt to qualify for admission. If
minimum score is not achieved in 1
st
attempt, 62% is required on each section thereafter (Reading, Mathematics,
Science, and English/Language Usage). Students who do not score 62% in all sections on their second
attempt are NOT eligible to apply to the Nursing Program at Los Angeles Southwest College.
Please request an ATI TEAS official transcript from ATI’s website to be sent to Los Angeles Southwest College
Nursing Department, which must be received by our office no later than the final deadline of April 14 to April 17.
Students who are selected to take the ATI TEAS exam at LA Southwest College do not need to order this transcript.
TEAS 6 (ATI TEAS) is required for fall 2020 applicants.
Your completed nursing application packet must be hand-delivered to the Nursing Department (do NOT mail or email
any documents to the Nursing Department) no later than February 13, 2020 by 4pm. (Only complete applications
will be considered)
NOTE: You must have one set of official sealed transcripts from each college attended in your application. It is the
student’s responsibility to ensure that the application packet is complete with all necessary documents (see checklist)
prior to the deadline for the review by the Nursing Selection Committee. Incomplete &/or late applications will not be
processed.
Final selection status will be sent via LACCD student email ONLY, by end of April 2020.
We look forward to receiving your complete application and wish you the best in your pursuit of a nursing career.
Los Angeles Southwest College Associate Degree Nursing Program
Fall 2020 Application
PLEASE NOTE: Submission of Incomplete Applications Will NOT be processed. Each applicant must turn in his/her own application in
person at the LASC Nursing Department Front Office. Please read the entire application carefully.
DO NOT USE ANY STAPLES FOR YOUR APPLICATION – Please Paperclip – THANK YOU.
□ Essay
Type a double-spaced essay with a minimum of 300 words. Include your name and date, and on each page of your
essay.
Question:
What skill/attributes do you have that will enhance your success in this program and your
professional role as a nurse?
□ Required Documentation for Verification
Submit copies of documents below with application. Applications missing copies will not be processed.
□ California ID or Driver’s License (front & back)
□ LVN License* (if applicable)
□ Official Transcripts
o The most current, official, sealed transcripts from all college coursework outside the LACCD
o Unofficial LACCD Transcripts
o U.S. High School, GED, California Exam
o U.S. College or University Degree
o Foreign Report from approved agency by the Commission for Foreign Transcript Evaluation (to be used for highest
level of education).
□ 1 Self-addressed stamped Manila Envelope (9” x 12”) with 4 (55¢ or forever) stamps
□ 2 Self-addressed stamped Business Size Envelope (size 10 or 4 1/8" by 9 1/2") with 1 (55¢ or forever) stamp
□ Cumulative & Science GPA Disclaimer
Please be aware that to be eligible to apply to the Nursing Program, students must have a minimum cumulative GPA of 2.5 for all college
coursework taken in the U.S. and a minimum overall 2.5 GPA for the core sciences, Anatomy, Physiology and Microbiology with no grade
less than a “C”, and no more than one repetition of any of these courses (“W' s” count as repeats). All courses must meet or exceed the
4 unit minimum with a laboratory component, as required by the California Community College Chancellor’s office.
□ Important Information
• Submission of this application does not guarantee selection into the ADN program
• Please check LACCD email on a weekly basis for any news and updates regarding the LASC ADN program
• You will be required to attend a mandatory orientation if accepted into the program. Date TBA
*PLEASE KEEP FOR FUTURE REFERENCE*
Los Angeles Southwest College Registered Nursing Program APPLICATION for Fall 2020
Last Name First Name Middle Name Student ID Number
Other names used, if applicable:
Have you applied to this program before?
□NO □YES
When did you apply?
Home Address City Zip Code
LACCD Email address
@student.laccd.edu
Primary Number □ Home □ Cell
Social Security Number/ITIN
Age
Sex
□M □F
Emergency Contact
Relationship
Contact Number □Home □Cell
Highest level of graduation? □ High School/GED □ Associate’s Degree □ Bachelor’s Degree □ Master’s Degree □ Doctorate Degree
From? □United States of America □Foreign
Name of Institution: Date of Graduation: (MM/YY)
Have you taken the TEAS? □YES □NO
If yes, how many times (include all
versions)?
1
st
Attempt: % Version:
Taken at:
2
nd
Attempt: % Version:
Taken at:
LVN □ YES □ NO
LVN License #
Expiration Date
Years of Work Experience
Have you ever been enrolled or accepted in any R.N. nursing program, please state: □ ADN □BSN □MSN □N/A
(If yes, visit the Nursing office for a Transfer Recommendation Form or call the office for further information)
College: Year(s): Director Name:
Reason for withdrawal:
Are you a U.S. Veteran? □YES □NO Are you spouse of a U.S. Veteran? □YES □NO
(If yes to either question above, please attach a copy of your DD Form 214)
Are you a relative/friend of any of the staff/faculty of the LASC Nursing Department? □YES □NO
If yes, whom? Relationship:
Have you ever been convicted of any offense other than a minor traffic violation? □YES □NO
Have you had a misdemeanor in the last 7 years? □YES □NO
Are you currently on any type of probation? □YES □NO
(If yes to any of the above questions, submit a formal typed letter to Dr. Azubuike, Program Director, and attach to application. A copy of expungement
documentation must also be attached.)
If you are a current CNA or LVN, have you ever committed or been accused of healthcare fraud? □YES □NO □N/A
If yes, was your license revoked or suspended? □YES □NO
(If yes to any of the above questions, submit a formal typed letter to Dr. Azubuike, Program Director, and attach to application)
I, (print full name) , certify that the answers I have given are true and
correct and I have not withheld any facts or circumstances. I understand that all answers given are subject to verification, and any falsification,
misrepresentation, or omission of facts are sufficient reason for dismissal upon discovery at any time during enrollment in the nursing
program.
X
Signature Date
OFFICE USE ONLY
Application: OK Inc Transfer Reapply
TEAS: Invite Decline TS Tx
CA ID/DL: Y N
TRF: Y N
Veteran: Y N
Offense/Felony: Y N Letter Submitted: Y N
Denial Reason: |TS Score | TS Seat | TS Tx | Other:
OFFICE USE ONLY
Forwarded to
Committee: Y N
Significant Other
Reset Form
ASSOCIATES DEGREE NURSING PROGRAM APPLICATION
Below, please list all completed courses, including all repeats / withdrawals, for core science classes (Anatomy, Physiology & Microbiology). An
overall
cumulative 2.5 GPA in all general education college courses is required and a 2.5 GPA in Anatomy, Physiology and Microbiology with no
more than one repeat, including “W”’s.
REQUIRED PREREQUISITES
COURSE NAME/
NUMBER
UNITS
GRADE
SEM/YR
COLLEGE/UNIV
NO. OF
REPEATS?
OFFICE
USE ONLY
ANATOMY 1 + Lab
PHYSIOLOGY 1 + Lab
OR BIOLOGY
20 +Lab
(ANATOMY/PHYSIOLOGY I & II)
MICROBIOLOGY 1 or 20 + Lab
ENGLISH COMPOSITION
PUBLIC SPEAKING
GENERAL PSYCHOLOGY
LIFESPAN PSYCHOLOGY
INTRO SOCIOLOGY
MATH 125
or placement in transfer level
Math or meeting Math Competency Exam
before entering the program.
Additional general education graduation requirements for the ASSOCIATE DEGREE. Although you may complete these courses while in the Nursing
program, it is highly recommended that you complete as many of the following courses prior to entering the R.N. program. Waived for students who
have a Bachelor’s degree or higher from a regionally accredited institution in the United States.
AMERICAN INSTITUTIONS
(HISTORY / POLITICAL SCIENCE)
HUMANITIES (Art/Hist, Lang, Hum,
Mus, Phil, Theat)
KINESIOLOGY (1 UNIT)
List all Colleges /Universities attended. If you are an LACCD student, you don’t have to list all colleges in the district (write LACCD).
College/University
OFFICE USE ONLY
UNITS ATTEMPTED POINTS GPA
1.
2.
3.
4.
5.
6.
7.
8.
UA TOTALS:
GP TOTAL:
CUM GPA:
I, (print full name) , certify that the answers I have given are true and correct and I have not
withheld any facts or circumstances. I understand that all answers given are subject to verification, and any falsification, misrepresentation, or omission of facts are
sufficient reason denial during the application process or dismissal upon discovery at any time during enrollment in the nursing program.
X
Signature Date
OFFICE USE ONLY
Transfer: Y N TRF: Y N
LACCD Tx Printed: Y N
US Degree: AA/AS BA/BS MA/MS
Science GPA:
Date Processed: Notification Sent: Y N
HS Diploma: Y N Foreign Tx: Y N
No. of Repeats:
Reason for denial:
Last Name
First Name
Ml Student ID Number
OFFICE USE ONLY
Forwarded to Committee: Y N
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Completed 22 July 2020

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