LAST NAME
FIRST NAME
MIDDLE NAME
STUDENT ID
@student.phsc.edu
PHSC STUDENT EMAIL ADDRESS
PREVIOUS NAMES
ADDRESS
CITY
ZIP CODE
PLEASE COMPLETE
APPLICANT CERTIFICATION
LIMITED ACCESS HEALTH PROGRAMS
APPLICATION for AS-DEGREE IN NURSING (RN): AS-NGT
JANUARY ADMISSIONS West Campus in New Port Richey
Once you have met all of the program requirements for admission as listed in the Application Information Checklist, submit this application to the Admissions
and Student Records Office no later than 7:30 p.m. on the deadline date of September 01, 2020. Once an application packet is submitted, it cannot be
amended. Prior to submitting this limited access application to the Admissions and Student Records Office, please pay the non-refundable $25 application fee
by calling the West Campus College Store (727-816-3304) and obtain a copy of the receipt to submit with your application.
Reminder: Please provide a clear, enlarged copy of your driver’s license (must be active and valid) and the signed Application Information Checklist in
addition to other requirements as listed on checklist. All materials should be submitted together either by emailing admissions@phsc.edu or via USPS mail to:
PHSC Admissions
10230 Ridge Road
New Port Richey, FL 34654
HOME or PRIMARY PHONE
WORK PHONE
CELL PHONE
I CERTIFY that all statements given in this application are true and accurate to the best of my knowledge. Any falsified information
may result in my dismissal from the program. I have READ and SUBMITTED the information and requirements on the enclosed
SIGNED Application Information Checklist regarding application policies, requirements, prerequisites, selection process, and other
information concerning the Nursing (RN), Generic program at PHSC. I understand that OFFICIAL correspondence will be sent
only to my PHSC student email address listed above.
SIGNATURE DATE
FOR OFFICE USE
FOR COLLEGE STORE USE
DATE STAMP:
DATE:
CASHIER:
RECEIPT NO:
AMOUNT:
SAR-61A (Rev. 06/20)
WEST CAMPUS APPLICATION ONLY (SPRING TERM)
IMPORTANT
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LIMITED ACCESS HEALTH PROGRAMS CHECKLIST for
AS-DEGREE IN NURSING (RN): AS-NGT
JANUARY ADMISSIONS West Campus in New Port Richey Submit
complete application packet to: admissions@phsc.edu
Important Information
Applying
Applicants must submit ALL limited access program admission requirements listed below in order to be considered for review.
Once an application packet is submitted, it cannot be amended.
Incomplete
Applications
Students who attempt to submit an incomplete application will not be processed and must reapply to the program and repay
the limited access application fee once all requirements have been met.
Deadline
Complete applications are due NO LATER THAN 7:30 PM BY THE DEADLINE DATE. If the deadline date falls on a Friday or a
day that the College is closed, the application will be accepted no later than 7:30 PM on the next business day.
No Response/
Failure to Enroll
Applicants who do not respond to an offer of admission by the date indicated on the acceptance letter or who fail to enroll
for the term for which admission is offered must reapply for a future date.
All official correspondence will be addressed to your PHSC student email address
Admission to
Multiple Programs
If an applicant is selected to multiple programs offered at different campuses, the student acknowledges that they will only
be offered a seat at their preferred campus selected in subsection #16 below. If no preferred campus is selected, the student
will be assigned based on the zip code listed on their application.
#
INIT
Limited Access Program Application Requirements
1
PHSC application with a $25 non-refundable fee for new students or a PHSC Readmission application for returning PHSC students
not enrolled for more than 3 consecutive terms (1 Year).
2
AS Degree in Nursing (RN), Generic application.
3
Copy of receipt of payment of the $25 non-refundable limited access application fee payable at college store.
4
Clear, enlarged copy of current driver’s license indicating a physical mailing address (PO Box addresses will not be used for
residency preference in the selection process). If a driver’s license, or equivalent, does not prove Pasco or Hernando County
residency, it will be processed as a non-resident (out-of-county) application.
5
Copy of current TEAS test scores with Proficient or Higher in the ATI Academic Preparedness Category. Applicants may only
submit ONE valid set of scores taken within the past two years of the application submission. Scores submitted with the
application will be the only ones considered.
Office Use Only: C - R - M - S - E - Date:
6
Official high school transcript with graduation date indicating receipt of a standard high school diploma or an official transcript
of GED
scores indicating receipt of a high school equivalency diploma, if not already submitted. Current high school students that are pending
May graduation are allowed to submit an application for August admissions. Admission will be contingent upon high school
student providing PHSC an official high school transcript by June 15
th
4 p.m.
7
Official transcripts from each U.S. College and university attended other than PHSC.
8
Official scores from external agencies as appropriate for prerequisite courses (i.e. AP, CLEP, IB, etc.).
9
Confirmation that any needed course substitutions have been approved by the application deadline date.
Transfer Credits: If the course prefix and number of an evaluated transfer course is not equivalent to PHSC’s course prefix and number
(ex. transfer course does not indicate BSC1085), then you will have to meet with an advisor
to complete a course substitution.
10
A cumulative grade point average of 2.0 or higher.
11
Complete the following prerequisite courses with a combined GPA of 2.5 or higher with at least a grade of “C” or higher:
BSC1085 Human Anatomy & Physiology I CGS1100 Microcomputer Applications
BSC1085L Human Anatomy & Physiology I Lab MCB2010 Microbiology
PSY1012 Introduction to Psychology MCB2010L Microbiology Lab
Acknowledgements
12
I understand that any previous unsuccessful attempts in nursing courses may result in being denied entry per guidelines outlined
in the Nursing Programs Student Handbook.
13
Graduation: If selected, I understand that I must have both an overall GPA of 2.0 and a PHSC program GPA of 2.0 in order to
graduate from the selected program.
14
Tobacco Use: I understand that the use of tobacco at all PHSC campuses is prohibited and that I will refrain from all tobacco use.
15
Orientation Requirement: If selected, BLS for Health Care Providers CPR Certification (PHSC Course NCH0050) taken at PHSC or from a
PHSC Training Site due at Orientation.
16
PREFERRED CAMPUS PROGRAM (Enter Y for preferred):
West Campus
East/Porter Campus
North Campus (Jan only)
Selection Process
Applicants who meet minimum requirements as of the deadline dates will be ranked based upon TEAS test scores and prerequisite GPA. Residents of
Pasco and Hernando Counties will receive preference over out-of-county residents.
SIGNATURE PRINT STUDENT ID DATE
I certify that I have read and understand the statements above and that I am submitting all items listed under the Limited Access Program Application Requirements section.
SAR-61 (Rev 6/20)
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