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Rappahannock Community College (Rappahannock Community College)

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This application is for 2020 only
Rappahannock Community College
Application: Nursing Programs
For Entry in 2020 Application Due Date: February 28, 4pm
Date of application submission ________________________________________
If applying for guaranteed admission, check here: Guaranteed Admission
If you are not applying for guaranteed admission, select the programs to which you would like to
apply (you may select more than one):
Practical Nursing (PN) PN to ADN Transition (PN to ADN only)
Associate Degree in Nursing (ADN)
READ CAREFULLY: Per VCCS Policy 6.0.5, admission consideration is given to qualified applicants who are residents of the
political subdivisions supporting the College and residents of those localities. Since enrollments are restricted for the nursing
programs, admission consideration will be given to residents of the RCC service area first.
Contact your nursing advisor for questions.__________Initials
APPLICANT INFORMATION
Last Name First Name MI Date
Physical Street Address Apt #
City County State Zip
Mailing Address Apt #
City County State Zip
Home Phone Work Phone Cellular Phone
VCCS Email address Alternate Email Address
VCCS Student ID
Have you ever enrolled in a nursing program? No___ Yes___
If yes, what program and when?
What was the reason for not completing?
Campus Choice: _______________Warsaw _______________Glenns
Note: Students may choose one home campus, but it is not guaranteed. Students must be flexible in the event that course and clinical
scheduling dictates a change in a campus location. Campus locations are not guaranteed. Campus assignment may change each
semester, depending on program space ____________Initial that you have read and understood this statement.
Please list all of your academic history in the spaces below and include any and all degrees or certificates earned.
RCC Nursing Application Information Package, Revised Jan. 2020
Page 1
This application is for 2020 only
ACADEMIC HISTORY
FROM
TO
Last year
attended
GRAD
(Y/N)
Degree if
applicable
Currently in High School
Name of HS:
High School graduate
Name of HS:
GED Completion
College Name*
College Name*
*Please include any additional colleges you have attended on the back of this application.
Y/N
Currently Practicing
Last Date of Practice
License or Certificate #
____Yes ____No
LPN/LVN**
____Yes ____No
**Attach a copy of your license to your application.
CHECKLIST FOR COMPLETE APPLICATION
I am enrolled as a student at Rappahannock Community College. If separated
from RCC for more than 3 years, a new college application is required.
I have completed all required college testing (VPT MTH & ENG) and
developmental course work, if applicable.
I have attended a general information session. If yes, initial in space, if no, state
NO.
I have met with a nursing advisor. If yes, initial in space, if no, state NO
All official transcripts from each college and high school I have attended have
been hand delivered by me in sealed envelopes to my nursing program advisor or
mailed directly by my college to Admission and Records. RCC transcripts do not
need to be official.
I have been placed in the pre-Nursing Career Studies Certificate or pre-Practical
Careers Studies Certificate by college advisors and I know who my nursing
advisor is. Indicate which program in space.
I have completed the Kaplan Admission Test within the last 3 years and the results
are included with this application.
I have a cumulative GPA of 2.0 (PN Program) in all coursework or 2.5 (Advanced
Placement LP to ADN or ADN) or higher in the five prerequisite courses. .
If applying under Guaranteed Admission, I have a 3.0 in all curricular courses
with no repeat attempts in any curricular course.
I have completed all pre-application requirements listed in the application package
for my selected program(s).
I certify that I do not have any conduct violations from RCC or any other college
attended and/or I understand that the Admissions Committee will verify
I certify I have completed the pre-requisite courses for the program(s) selected
with a grade of “C” or higher.
INITIALS
RCC Nursing Application Information Package, Revised Jan. 2020
Page 2
This application is for 2020 only
READ ONLY: Criminal Background Check Statement—A criminal background check and drug screen are
required for admission to the nursing program(s) as required by our clinical affiliates. If you have a criminal
conviction you should contact https://www.castlebranch.com/ to determine if your conviction will prevent you
from enrolling in this program. Initial__________
READ ONLY: Student Accommodations Statement---Nursing programs are committed to the policies set
forth by RCC regarding disabilities and reasonable accommodations. If you require special services or
accommodations, you should contact the RCC Disability Services Counselor on either campus for an
appointment at least 2 weeks prior to the beginning of classes if you are accepted into a nursing program. Your
success is contingent upon your ability to fulfill the core competencies of the pr
ogram.
Initial___________
IMPORTANT NOTE: All prospective students are required to be eligible to participate in all
clinical facilities where we are contracted to provide clinical supervision. Students who are not
eligible for rehire in any facility may be excluded from clinical experiences, and thus may
forfeit their seats in the nursing program. Please complete the following:
I am a current employee, in good
standing, in a healthcare facility in the
following systems: Sentara, Riverside,
Bon Secours or Mary Washington
Yes
No
If yes, what facility?
I am a former employee in a healthcare
facility from the above-listed systems
Yes
No
If yes, what facilities?
List all
As a former employee, I left in good
standing and am eligible for rehire.
Yes
No
If you are unsure, you MUST contact your former employer
for verification
After completion of this application and attachment of all transcripts, make an appointment with a nursing advisor.
You cannot turn this package in until you have a nursing advisor signature below.
Nursing Advisor ____________________________________________ Date:______________________
I certify, under penalty of disciplinary action up to and including automatic withdrawal from the nursing
program, that all of the information is complete and accurate. I agree to supply the nursing program with
supporting documentation related to my application if I am requested to do so. I further understand that
submitting this application does not guarantee admission to a nursing program.
Signature ______________________________ Date _________________________________
RCC Nursing Application Information Package, Revised Jan. 2020
Page 3
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Rappahannock Community College (Rappahannock Community College)

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Completed 27 July 2020

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