Nursing Program Application
Completed applications must be received by Nursing between February 1
st
and April 15
th
for Fall
and between August 1
st
and October 15
th
for Spring.
Date:
Name:
Address:
City:
(Last)
(Street)
(First)
RCC ID #:__
______ Apt #: _____ PO Box #:
State: Zip:
___
___
___
Phone:
(Home) (Cell)
RCC email:
I am applying for: (choose one)
O Nursing Admission
OR
_______________@sunyrockland.edu
O LPN Pathway to RN:
O I have attached a copy of my LPN license.
I have attached: (required)
O ATI TEAS score report (Must be dated within one year of application deadline date.)
I am applying for: (choose one)
O day clinicals
O evening clinicals
I am applying as a: (choose one)
O full-time student
O part-time student
O male
O not identified
Demographic Data: (optional)
O Asian American O Black/African American O Hispanic/Latino
O Native American and Alaskan Native O Native Hawaiian/Pacific Islander
O White O two or more races O unknown
Highest degree currently held: O Associate degree
O Bachelor’s degree
O Master’s degree
O Doctoral degree
Completed applications may only be submitted to Nursing via email at
nursing@sunyrockland.edu.
Applications that are faxed will not be accepted.
Incomplete applications will not be processed.
