Fillable Nursing Program Application Checklist (Clovis Community College)

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Nursing Program Application Checklist (Clovis Community College)

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The Nursing Program Application Checklist (Clovis Community College) form is 4 pages long and contains:

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  • 13 check-boxes
  • 30 other fields

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Nursing Program Application Checklist
For the Nursing Program Application to be considered complete, the applicant must have completed the
following list of requirements. Applicants must initial next to each item to indicate their understanding of
the requirement.
INT
CCC Admission Application – If not currently enrolled in CCC, complete an
Application for Admissions to Clovis Community College by JULY 1st. Your Nursing
Program Application will not be processed if you do not have a current application for
admission to CCC on file.
Nursing Program Application – Complete all sections of the Nursing Program
Application and turn into Admissions prior to JULY 1st.
Transcripts – Official copies of all college transcripts must be sent directly to the Office
of Admissions and Records and arrive prior to JULY 1st.
Prerequisite Courses – Applicants must have completed ALL prerequisite courses as
detailed on the ADN degree plan prior to enrollment in to the Nursing program. Applicants
who are enrolled in the last of these prerequisites may still submit their application for the
following semester but will only be considered if they successfully complete the
prerequisite(s) enrolled in.
Applicants who are completing prerequisites at another college, must notify
Admissions when turning in their Nursing application. Official transcripts must
be sent to CCC immediately upon completion of the class. Failure to do so will
results in the application being considered incomplete.
BIOL 2210C, BIOL 2225C, BIOL 2310C (previously BIO 211, BIO 212, BIO
222) must have been completed within five (5) years prior to the semester applying
for. See Degree Plan for more details.
Grade Point Average – Applicants must have a minimum prerequisite grade point
average (GPA) of 3.0, including all colleges and universities attended, to be considered
for the Nursing program.
Academic Advising – Applicants are encouraged to meet with Academic Advising prior
to submitting their application to ensure that all requirements are satisfied.
All of the Health Science Programs at Clovis Community College require criminal
background checks and drug screenings prior to admittance into the clinical setting.
Failure to pass one or both could result in dismissal from the program. Applicants with
felony convictions and certain misdemeanors may not be allowed in the clinical sites.
Disqualifying convictions are determined by the Department of Health and not CCC.
ACKNOWLEDGEMENT
I understand that admission into the Nursing Program is competitive and strictly based
on the prerequisite GPA of all applicants. A minimum GPA of 3.0 does not guarantee
acceptance.
I understand that determinations on acceptances for the Spring semester are not made
until after grades are posted by the CCC Registrar for the Fall semester.
I understand that all correspondence regarding my application and acceptance into the
Nursing Program will be conducted through CCC email. Failure to check my CCC email
may result in missed information or deadlines.
I understand that as a student in the Nursing Program it will be my responsibility to
obtain and maintain all current immunization and compliance requirements.
For students who have successfully completed an LPN program only: I understand
that admission to the RN program is based on class sizes and clinical availability for the
Spring semester.
ADVISING
Applicants are responsible for meeting with an Academic Advisor to file a current Nursing degree plan
and to review the information contained in the Clovis Community College Catalog. The policies and
regulations contained in this catalog apply to all applicants, including those who have filed and are
following degree plan requirements of an earlier catalog. Some policies and requirements may be subject
to change based on program requirements. If you have any questions regarding the degree plan, contact
the Academic Advising Center, located in the Dr. H.A. Miller Student Services Center, or call (575)-
769-4020.
I, _______________________________________, have fully read and understand the application
requirements for consideration for the CCC Nursing Program. I understand that my application will not
be forwarded to the Nursing Program for consideration if I fail to complete any of these requirements.
Applicant’s Signature
Date
Applicant
Information
Nursing Program Application
Fall 2020
Note: If you change your address or telephone number, you must notify the Admissions
and Records Department in a timely manner.
Is this your rst application to the program: Yes_____ No_____
If no, list the year of previous application: ____________________
Have you attended another college since your last application: Yes____ No____
Where did you attend_______________________________________________________
________________________________________________________________________
If yes, you must request an ofcial copy of your transcript(s) to be mailed to the Ofce
of Admissions and Records, or you may walk in an ofcial, sealed copy.
First Middle Last (Maiden)
Date of Birth
Address
City/State/Zip
Application Deadline: JULY 1, 2020
Please print legibly
Primary Phone
Secondary Phone
CCC Email (required)
Name
Phone
Name
Phone
Contact Information Emergency Contacts
LEVEL I (LPN)
LEVEL II (RN/ADN)
Signature
Applicant's Signature Date
Revised
November 2017
C
Male Female
TRADITIONAL PROGRAM ONLY
YEAR ROUND PROGRAM ONLY
EITHER PROGRAM
____ Traditional
____ Year Around
Please indicate 1st and
2nd choice or leave
blank if no preference.
Home
Cell
Home Cell
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signature
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Name
Student ID #
Provisional
Agreement
I understand that my application to the Nursing Program at Clovis Community College is
on a PROVISIONAL BASIS pending receipt of transcripts from the following school(s)/
college(s)
1.
2.
3.
4.
5.
6.
I agree to complete my nursing application file no later than the published deadline for
the semester in which I am applying.
Applicant’s Signature: Date:
C
______ I understand that all corrospondance regarding my application, admission testing
and acceptance into the Nursing Program will be conducted through CCC email. Failure
to check my CCC email may result in missed information or deadlines.
Initial:
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Nursing Program Application Checklist (Clovis Community College)

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Completed 26 July 2020

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