Fillable Practical Nursing Application Checklist STEP 1 Go to (East Mississippi Community College)

Fill Online, Printable, Fillable, Blank Practical Nursing Application Checklist STEP 1 Go to (East Mississippi Community College) Form

Use Fill to complete blank online EAST MISSISSIPPI COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Practical Nursing Application Checklist STEP 1 Go to (East Mississippi Community College)

On average this form takes 11 minutes to complete

The Practical Nursing Application Checklist STEP 1 Go to (East Mississippi Community College) form is 4 pages long and contains:

  • 0 signatures
  • 5 check-boxes
  • 43 other fields

Country of origin: US
File type: PDF

U.S.A. forms for East Mississippi Community College

BROWSE EAST MISSISSIPPI COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
STEP 1
Go to http://www.eastms.edu/ and select the “Apply Now!” link to submit an online application
for admission to East Mississippi Community College. Acceptance to East Mississippi
Community College does not guarantee acceptance to the Practical Nursing program. Letters of
pending acceptance will come from the Director of Nursing and Allied Health.
STEP 2
Fill out an application for the School of Nursing (included in this packet). This application should
be returned via email at alliedhealth@eastms.edu. Make sure to include letters of
recommendation, letters of good standing from former nursing directors, and copy of CNA
certification if applicable.
STEP 3
Request transcripts to be sent to EMCC from all other educational institutions you have
attended- this include high school. (Transfer Request Form included in this packet). Make sure
you request transcripts from all schools attended.
STEP 4
Make sure your ACT scores (minimum composite score 16 with a subscore of 16 in Reading)
are on fil
e in the admissions office or schedule and take your ACT before the June 1
st
deadline.
Please note that due to the COVID-19 pandemic, the deadline for the 2020 application is being
extended to June 15.
STEP 5
After the deadline you will be notified if you have been selected for pending admission. If you
accept a slot in the program, you will be sent an information packet to complete. EMCC does not
keep a wait list for admission. If you are not chosen for the program, you must reapply the next
time a class starts. It is your responsibility to be sure that all your paperwork is on file prior to
the deadline. Remember, just because you request a document to be sent to EMCC does not
mean that it was sent or received.
Practical Nursing Application Checklist
Official Transcript Request Form
Pl
ease send an official copy of my transcript to the address checked below.
If you plan to attend the Scooba Campus, Meridian Navy Base Extension, or Macon Extension use this address:
□ East Mississippi Community College ● Office of Admissions ● P.O. Box 158 ● Scooba, MS 39358
662-476-8442
If
you plan to attend the Golden Triangle Campus or Columbus Air Base Extension use this address:
□ East Mississippi Community College ● Office of Admissions ● P.O. Box 100 ● Mayhew, MS 39753
662-243-1900
_______________________________ _______________________________
Last School/College Attended Date of Attendance or Graduation
Name_________________________________________________________________________
(Please use name you were enrolled under)
Student’s Current Address__________________________________________________________
(Number or Street) (City) (State) (Zip)
Student’s Email Address___________________________________________________________
Date of Birth _______________ Social Security Number ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Signature ________________________________________ Date ________________________
Please send transcript: □ Immediately □ After grades are posted □ After graduation
No
te: On high school transcript, please show date of graduation, ACT/ SAT scores, and principal’s
signature.
**********************
************************************************************************
Do Not Mail This Form Back To EMCC. Complete It And Mail To Last School Attended. Make
Sure You Send The Appropriate Transcript Fee With This Request. Athletes Must Provide
Transcripts from All Colleges Previously Attended
NURSING DEPARTMENT APPLICATION
PRACTICAL NURSING
Please return application to:
Nursing Department - Practical Nursing East Mississippi
Community College P.O. Box 100
Mayhew,
MS 39753
EMAIL COMPLETED APPLICATION & DOCUMENTS TO
alliedhealth@eastms.edu
PLEASE TYPE OR PRINT
PRACTICAL NURSING
Due to the COVID-19 global pandemic, the application deadline for 2020 will be extended to June 15.
Personal Information
Name: __________________________________________________________________________________________
Last, First, Middle, Maiden
Social Security Number: ___________________________________________________________________________
Address: ________________________________________________________________________________________
Street/Apt. #/ P.O. Box, City, State, Zip Code
Email address: ___________________________________________________________________________________
Home Phone: ____________________________________Cell: ____________________________________________
EMERGENCY CONTACT INFORMATION
Name: _______________________________ Relationship: __________________ Contact number: ______________
Academic Information*
High School Attended _________________________________________ Graduation Date _____________
School Address, City, State_________________________________________________________________
GED Test ____ yes ____no
List all colleges attended (including EMCC)
Name and location of
institution
Dates attended
Major or area of Study
Degree Awarded
* An official transcript from all educational institutions attended and/or GED results must be mailed to
Admissions, EMCC
P.O. Box 100
Mayhew, Mississippi 39753
Have you ever been convicted of, pled no contest to, or are charges pending against you for a felony or
misdemeanor in any state/ jurisdiction?
YES ______ NO _______
Have you ever attended nursing school in this or any other program?
Yes ______ NO _______
Please list all schools and dates attended. You must have a letter of good standing from your previous
nursing school Director in order to be considered for this program. You are not eligible for consideration
if you have had more than one attempt in any nursing program.
Have you filled out an application for admission to EMCC within the last 12 months?
Yes ______ No __________. If not, you must apply to the school for admission before being
considered for the nursing program.
Successful completion of the nursing program does not guarantee eligibility to sit for the NCLEX
exam or application for licensure. A Board of Nursing may, at its discretion, refuse to accept the
licensure application of any person who has been convicted of a felony or misdemeanor or has
charges pending on such issues.
I state that the foregoing statements in this application are true and accurate. I am aware that any false,
misleading, or incomplete statements made on this application could be grounds for non-admission to, or
later dismissal from, the nursing program.
Signed _____________________________________ Date____________________________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Practical Nursing Application Checklist STEP 1 Go to (East Mississippi Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document