Faculty of Continuing Education
04-21-16
Practical Nursing Program Admission Request Form
Name of attached supporting document or transcript
English: Grade 12 (C) or ENG4 (U) or College English (70%)
Physics or Chemistry Grade 12 (C) (70%)
Mathematics Grade 11 (U) or (M) OR Grade 12 (C) (70%)
Biology Grade 11 (C) (70%)
*Overall Average of 75%
Signed: Date:
Faculty of Continuing Education OFFICE USE ONLY:
Date stamp and forward to:
Attention: Part-time Practical Nursing – Admissions
FREEDOM OF INFORMATION AND PROTECTION
OF PRIVACY ACT
Personal information on this form is collected in accordance with
sections 21, 39 and 49 of the Freedom of Information and Protection
of Privacy Act and under the legal authority of the Ministry of Training,
Colleges and Universities Act, R.S.O. 1990, and the Ontario Colleges
of Applied Arts and Technology Act, 2002, Regulation 34/03, and may
be used and/or disclosed for administrative, statistical and/or research
purposes of the College and/or the ministries or agencies of the
Government of Ontario and the Government of Canada. If you
have any questions concerning the collection and use of personal
information, please contact the Privacy Office at (416) 491-5050
extension 77846 or email privacyoffice@senecacollege.ca.
mm/dd/yy
Requirement
Seneca Student ID: Date of Birth:
Last Name: First Name:
Street Address: Apt./Unit#:
City: Province: Postal Code:
Home Phone: Other Phone:
Seneca Email: Other Email:
Initial Below I confirm my understanding of the following:
I will be notified of acceptance into the program by email.
I must receive the confirmation letter of acceptance (by email) BEFORE registering for professional
Nursing specific courses at Seneca. (I may register for general education courses at any time.)
Listed below are entry requirements to process this application. PROOF of attained credits must be attached.
