Mail to: Campus: Bakersfield
1801 Panorama Drive
Bakersfield College – Associate Degree Nursing Program
Bakersfield, CA 93305 Application Form
Admission to: Fall Semester Spring Semester Year:
Nursing Semester: 1st Semester 2nd Semester 3rd Semester 4th Semester
Last First M.I. Previous Last
Street Address Apartment/Unit #
City State ZIP Code
Day Phone: ( ) - Alternate Phone: ( ) -
Student ID #: @ Birth Date: / /
U.S. Citizen? Yes No **Do you have a valid Social Security or Tax payer ID Number? Yes No
Have you ever applied to a Bakersfield College Nursing Program? Yes No
If Yes, Under what name? When?
Have you ever enrolled in a Nursing Program? Yes No Where? When?
Have you taken the TEAS? Yes No Were you previously an Alternate? Yes No
I have completed all steps of the remediation plan and have attached proof of each required
course. Yes N/A
Have you already attained a college degree? No AS AA BS BA Major:
If applicable, attach proof of college degree.
College Name City/State Dates Attended Degree Earned
If you have completed equivalent course work at another college, you must request equivalency certification
from the BC Admissions and Records Office and submit this equivalency in the form of an unofficial
Bakersfield College transcript to the program during the application-filing period. Failure to have transcripts
evaluated will result in ineligibility to the Bakersfield College ADN Program.
**The California Board of Registered Nursing requires possession of either a Social Security number or Tax payer ID number to apply for
licensure. Please provide a copy of your Tax payer ID Card if you do not have a Social Security number.
Please Complete Reverse Side
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Demographic Information (optional)
Please complete the following survey.
Your age (please mark one of the following)
< 24 years of age
25-30 years if age
31-40 years of age
41-50 years of age
51-60 years of age
> 61 years of age
Racial background (please mark one of the following)
American Indian or Alaskan Native
Asian or Pacific Islander
White, other than Hispanic
ESL _____ Yes _____ No
This form, plus transcripts showing equivalent coursework, must be received before your application form
will be processed. The filing periods are March 1- March 31 for application to the fall semester and
September 1 – September 30 for the application to the spring semester.
It is the applicants responsibility to keep the Allied Health Office informed of any changes in address or
I certify that to the best of my knowledge all information provided on this document is complete and
accurate. I understand that any false or omitted information, intentional or otherwise, will result in
removal of consideration for the program.
Release of Information (optional)
By signing below, I agree to allow the Bakersfield College Associate Degree Nursing Program to release
my name, telephone number and ranking to area hospitals for possible acceptance into the hospital
sponsored seats in the Bakersfield College ADN Program.
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