Fillable RN And Career Ladder Nursing Application Registered Nursing Application - Pasadena City College

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RN And Career Ladder Nursing Application Registered Nursing Application - Pasadena City College

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The RN And Career Ladder Nursing Application Registered Nursing Application - Pasadena City College form is 6 pages long and contains:

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PASADENA CITY COLLEGE REGISTERED NURSING APPLICATION
Incomplete Applications will not be processed
Name: _______________________________________________________________________________________________
Last Four Digits of Social Security Number: _________________________________________________
PCC ID: _____________________________________________________________________________
PCC student Identification numbers are not accepted in place of a social security number
Address: _____________________________________________________________________________
City and Zip Code: _____________________________________________________________________
Cell Phone: ___________________________________________________________________________
Home or Alternate Phone: ________________________________________________________________
Email: ________________________________________________________________________________
Students will only be notified of their status by email. Please type carefully.
One official, sealed, unopened transcript of ALL colleges including PCC and high school/GED you
attended must be submitted with this application even if the coursework is not applicable to the
Nursing Program. The Health Sciences Division will not retrieve scanned transcripts.
Official U.S. High School transcript GED Foreign Equivalency Report
Your last name while in High School: ______________________________________________________
College degree(s) received: Associates Bachelors Masters
List all colleges attended:
•
•
Are you a U.S. Veteran or spouse of a U.S. Veteran?
YES (must provide a copy of your DD214. Spouses must also submit a copy of the marriage certificate).
No I am not a U.S. Veteran or spouse of a U.S. Veteran.
Upon selection students are required to complete a health clearance including drug screen and background
check in order to attend clinical experiences, which are required for program completion. A social security
number is currently required by all clinical sites to access patient records. Hospitals and health care
providers require a clear background check and a negative drug screen. Students who have questions or
concerns about the background check are encouraged to make an appointment with the Nursing Program
Director. Submission of an application does not guarantee acceptance. Details regarding these clearances
will be provided to selected candidates with the acceptance packet.
In the event there are an equal number of students with equivalent points that exceeds the number of seats
available, those students will be placed in a lottery for selection. Individual applications are private and
scores will not be discussed as per The Family Educational Rights and Privacy Act (FERPA).
Selection Criteria
Total Number of Points for Admission: ______________________________________________
Add all six categories to obtain total admission points
Category 1 Enter Number of Points for Category 1: ____________________________________________
25 points for 4.0 GPA; 20 points for 3.5-3.9, 15 points for 3.0-3.4 GPA, 10 points for 2.5-2.9 GPA
GPA for pre-requisite courses (A=4pt, B=3pts, C=2pts) total points/number of units
Course: List Course Title
and Number
College Name
Term/Year
Units
Grade
Points
Anatomy
Physiology
Microbiology
English 001A
College Chemistry
Prerequisite GPA is equal
to total grade points
divided by the total course
units
Category 2 Enter number of points for category 2: _______________________________________
25 points for 85 to 100 TEAS score, 20 points for 78 to 84.9 TEAS score, 15 points for 71 to 77.9 TEAS score,
10 points for 64 to 70.9 TEAS score, 5 points for 62 to 63.9 TEAS score
Note: The Assessment/Readiness Test (TEAS VI) is required to be taken prior to applying to the Nursing
Program. The test assesses reading, math, and English skills necessary for success. A minimum score of 62
must be met to begin the program.
TEAS 6 Score:__________________________________________________________________
Category 3 Enter number of points for Category 3_______________________________________________
Five Points for each co-requisite course completed
Course Name and Number
College Name
Term/Year
Units
Grade
Nutrition 11
Psychology 24
Sociology 001
Speech Fundamentals
Statistics 50
Critical
Thinking
-
Category 4 Enter number of points for Category 4________________________________________
Licensed Healthcare worker = 5points: License Number: _______________________________
CNA, HHA, EMT = 2 points: License Number: _______________________________________
Veteran or spouse with DD214 = 5 points: VA Number: ________________________________
PCC LVN program graduate = 2 points:
License Number and Date Graduated: _________________________________________
BS/BA/MS/MA = 5 points: College Attended_______________________________________
Date and Degree Awarded: _______________________________
Category 5 Life Experience/Special Circumstances ________________3____________________
All students are awarded 3 points for life experience and/or special circumstances.
Category 6 (2 points max) Enter number of points for Category 6 _______________________________
Enter 2 points for successful completion of level 2 of the same language in college or self-reported
fluency in reading, writing, and speaking a language other than English.
List Languages you can speak, read, and write ___________________________________________
OR List College Language Courses ____________________________________________________
Additional Required Classes:
Course Title and Number
College
Term/Year
Units
Grade
US History (CSU Transferable)
Political Science
001 (CSU
Transferable)
Humanities
Physical Activity(2
units required)
Physical Activity
My typed signature below indicates that I have provided true and accurate information on
this application and that I understand that final acceptance to the program will be based on
my background check, medical clearance including drug screen, and ATI TEAS test results.
Signature ________________________________________________________________
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RN And Career Ladder Nursing Application Registered Nursing Application - Pasadena City College

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Completed 1 November 2019

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