Fillable LPN PREREQUISITE FORM (Southeast Technical Institute)

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LPN PREREQUISITE FORM (Southeast Technical Institute)

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LPN PREREQUISITE FORM
Please return this form to Southeast Tech, 2320 N Career Ave, Sioux Falls, SD 57107.
Phone: 605-367-6040 or 800-247-0789
Fax: 605-367-8305
Student Name (Please Print) Southeast Tech ID Number (if known)
Thank you for submitting your application to the Licensed Practical Nursing program here at Southeast Tech!
Prior to staring the nursing program students must successfully complete the required prerequisite
courses listed below. Students can either take these courses at Southeast Tech or transfer some/all of these
credits from a previous college or university.
Transferring Courses:
In order to transfer credits to Southeast Tech, students need to provide Southeast Tech with an ocial,
sealed copy of their transcripts from the Registrar of the institution. Only credits with a grade of “C” or
better from an accredited institution are eligible for transferability. All transfer credits are subject to review
and approval by the Southeast Tech’s Registrar.
Taking the prerequisite classes at Southeast Tech:
Students may take some or all of the prerequisite courses as Southeast Tech by enrolling in the semester
prior to the program start date. For example, this may mean taking the prerequisite courses in the Fall
semester (August), and starting the LPN program courses in the Spring semester (January).
Please check the boxes below indicating your plan for the prerequisite courses:
Student Success SSS 100 Transfer this course/complete Take at Southeast Tech
English Composition ENGL 101 Transfer this course/complete Take at Southeast Tech
College Math MATH 100 Transfer this course/complete Take at Southeast Tech
General Psychology PSYC 101 Transfer this course/complete Take at Southeast Tech
CNA HC 106 Transfer this course/complete Take at Southeast Tech
Medical Language HC 117 Transfer this course/complete Take at Southeast Tech
Anatomy/Physiology HC 118
(Lecture/Lab)
Transfer this course/complete Take at Southeast Tech
Based on the information above, the following statement best describes my program plan:
I have completed the all of the prerequisite courses and plan to start directly into the LPN program.
I have not completed one or more of the prerequisite courses and plan to attend a semester before
the LPN program begins.
Prerequisite Start (Fall, Spring or Summer) Program Start (Fall, Spring or Summer)
Signature: Date:
Updated April 15, 2020
SOUTHEASTTECH.EDU
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LPN PREREQUISITE FORM (Southeast Technical Institute)

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Completed 27 July 2020

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