All official transcripts from all schools attended must accompany application. By signing this form, the student
gives the School of Nursing permission to forward this transcript to the Louisiana State Board of Practical Nurse Examiners
as part of the application for licensure in Louisiana.
PREVIOUS NURSING SCHOOL ENROLLMENT
Have you ever been dismissed/suspended from a school? Yes ( ) No ( )
If yes, explain. Give name of school, date, reason for action taken.
Have you ever been enrolled in another Nursing Program? Yes ( ) No ( )
If yes, RN ? PN
Reason for leaving: _________________________________________________________________________________
Have you applied to the Delgado Community College Registered Nursing Program?
Yes ( ) No ( )
Have you ever previously applied to, or been enrolled, in Delgado Community College Practical Nursing Program?
Yes ( ) No ( )
If yes, when did you apply? _____________________ When did you attend?
FINGERPRINTING, DRUG SCREENING, CRIMINAL RECORDS CHECK
Are you currently serving a court imposed order of supervised probation with any felony conviction(s), plea agreement, or
any agreement pursuant to Louisiana Code of Criminal Procedure? Yes ( ) No ( )
Fingerprinting and a criminal record check are performed at the beginning of enrollment in the practical nursing
Drug testing and credentials evaluation are performed at the beginning of the program and for cause.
I certify that the answers I have given to each and all of the questions on this application are true. I understand
that falsification of any information on this form may adversely affect my admission to, and enrollment in, the
Please keep this office informed of any changes in the information submitted on this application. Thank you.
PN Application (updated 10/2/14)
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