Riverside City College School o
f Nursing Registered Nursing Application
DUE August 3, 2020
Download this application to your computer, then open and fill it out with Adobe Acrobat Reader. You must have the latest version of Adobe Acrobat Reader (free) in
order to save and submit this application; https://get.adobe.com/reader/. Email the completed application to nursing@rcc.edu. Save this application to your
using the following naming format: "YourLastName_YourFirstName_YourRCCDStudentID.pdf". Tablets, Ipads and Apple computers do not always work
with this application. Do not use Google chrome or MS Edge to fill out the application. Some devices or browsers do not format the application properly. The
application may only be submitted via email.
By submitting this application, I certify that all the information contained in this application is true and correct to the best of my knowledge and I understand that I
am responsible for turning in all Official Transcripts to the Admissions & Records office before the end of the application deadline or by the end of Summer semester
if enrolled in Summer courses.
Notifications of enrollment will be sent via school RCC email be the end of December 2020. You will receive more details regarding the application process via RCC
email within 2 weeks of submitting your application.
Check the box for each program you are applying for:
sociate Degree (RN) 2 year Concurrent Enrollment ADN/BSN Advanced Placement VN-RN 30 unit VN-RN Petition Transfer
Last name First name Middle name RCC Student ID
Previous Name(s)
Phone/Cell Number RCC email address (Required)
Note: F
ailure to list all colleges attended or failure to submit all official transcripts will invalidate your application. If you have previously submitted finalized
transcripts to Riverside, Norco or Moreno Valley you do NOT need to re-submit them. Transcripts from Riverside, Norco and Moreno Valley are NOT needed. You
may log into your portal or Webadvisor to see if your transcripts are on file.
List all colleges attended:
Have you
ever been enrolled in another Registered Nursing Program? Yes No
If yes, indicate what college: Applicants who have failed a prior RN program are not eligible
Do you hav
e a Bachelor’s degree or higher from a regionally accredited US college? Yes No
Where did you earn this degree? (Associate’s degrees do not count)
Do any of t
he following life experiences or special circumstances apply to you? Yes No
*Low family income
*First generation of family to attend college
*Need to work
*Disadvantages social or educational environment
*Difficult personal and family situations or circumstances
Do you spea
k, read and write a language other than English? (Including ASL) Yes No
Are you a US military veteran or currently serving in the armed forces? Yes No
(DD214 showing character of service or letter from commanding officer required)
Did you volun
teer in healthcare facility? Yes No
Must submit proof of 200 or more hours of patient care from with last 5 years. Documentation from your volunteer supervisor showing your dates of
ng and hours volunteered is due by August 3, 2020.
Do you have 1000 or more hours within the last 5 years of paid employment as a LVN, paramedic, Respiratory Therapist, CNA, EMT or military medical experience
(medic or corpsman)? Yes No
Documentation of your active California certificate or license and letter from your supervisor or human resources showing your title, dates of employment and
hours worked is due by August 3, 2020.
Have you passed the ATE TEAS (version 6) Yes No
Only ATI TEAS-TEAS 6 is accepted. Applicants with the highest science grades will be invited to take the TEAS at RCC. If you are not invited, take the TEAS
elsewhere then submit the TEAS to RCC by early September. Our code with ATI is RIVERSIDE CC ADN. The TEAS is required for the 2 year ADN and the ADN/BSN
concurrent enrollment, not the VN-RN.
Have you taken NXN-84, NRN-93 or NXN-78? Yes No In progress
The Blue section is only for VN-RN applicants:
What is your California LVN # Did your graduate from the RCC VN program Yes No
Have you completed NRN-18 Yes No In Progress Fall 2020
VN-RN applicants must contact the School of Nursing (951-222-8407 or alexis.brucks@rcc.edu
) to be authorized to enroll in NRN-18. VN-RN students who have
completed most or all of their other pre-Nursing courses may take NRN-18. After NRN-18 is completed VN-RN students must pass the Advanced Placement exam to
be eligible for VN-RN. More information on the VN-RN exam will be given in NRN-18.
DEMOGRAPHIC DATA: for data analysis only, NOT a factor in
admission Date of Birth (DOB):
Ethnicity: American Indian or Alaskan Native
Filipino Hispanic White, other than Hispanic
Other Decline to state
Pacific Islander Asian
Sex: Female Male
ssociate Degree Nursing
Pre-Nursing Courses
The form below must be completed to the best of your knowledge and submitted with this application in order for your application to be complete. You must fill out
this page if you are applying for the 2 year ADN program, VN-RN, 30 unit option or transfer. Petitioning students may skip the sections below and proceed to emailing
the form to nursing@rcc.edu
CCD Course Listing Equivalent Course you completed College Completed or in progress? Grade
A&P 1 - A&P 2a or Bio 50a
A&P 2 - A&P 2b or Bio 5ba
Microbiology - Mic 2a or Bio 50a
Chemistry Che 2a, 3 or 1a
Lifespan Development -Psy-9
English Eng 1a
Speech Com 1 or 9
American Institutions (US hist or Poli sci 1)
Sociology or Cultural Anthro (Soc 1 or Ant 2)
Humanities/Arts (arts, music, phil, hum, etc)
Statistics (Mat 12)
is page ONLY for Concurrent Enrollment ADN/BSN applicants.
ALL RCC Nursing and CSU transfer requirements must be complete by the end of summer semester in order to qualify for Concurrent Enrollment with California State
University. This program allows students to complete ADN and BSN coursework at the same time. The BSN degree is earned 6 to 12 months after the ADN. The
ADN/BSN concurrent enrollment program is currently not open to the VN-RN program. A cumulative GPA of 2.75 is minimum for CEP. Applicants holding a US
Bachelor's degree are waived from the CSU General Education requirements. Students with a bachelor’s degree are waived from all general education courses, except
for Statistics, Psy-9 and the physical/biological sciences.
glish Composition (Eng 1A)
Course College Grade
ical Thinking (Eng 1b, Com 2 or 3, Phil 11 or 32, or Reading 4)
Course College Grade
al Communication (Com 1 or 9, public or interpersonal speech)
Course College Grade
atistics (mat-12)
Course College Grade
ts and Humanities (at least 4 courses, with at least one from Arts and one from Humanities. 9 semester or 12-15 qtr units)
ARTS (Music, dance, theater, art, etc)
Course College Grade
HUMANITIES (Foreign languages, philosophy, literature, humanities, etc)
Course College Grade
One additional Arts or Humanities course (you may crosslist US history)
Course College Grade
ial and Behavioral sciences (At least 3 courses from at least two academic disciplines. 9 semester or l2 - l5 quarter units)
Lifespan Development (Psy 9)
Course College Grade
Sociology 1 or Anthropology 2
Course College Grade
Other Social/Behavioral Science Course (Anthro, ADJ, Soc, etc OR Pol 1 may be crosslisted)
Course College Grade
ysical and Biological Sciences
Anatomy and Physiology 1 (Bio 50a or Amy 2a)
Course College Grade
Anatomy and Physiology 2 (Bio 50b or Amy-2b
Course College Grade
Microbiology (Bio- 55 or Mic 1)
Course College Grade
Chemistry (Che 2a, 3 or 1a)
Course College Grade
Constitution and American Ideals
US History (One course from His 6, 6h, 7, 7h, 11, 12, 14, 15, 28, 29, 31, 34, Hum 16, Mil Sci 1 or 2)
Course College Grade
US Political Science (Pol 1 or 1h)
Course College Grade