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					                Clinton Community College
                     Admissions Office




                   Application for Admission
                               to Nursing AAS
                                     Fall 2012




136 Clinton Point Drive, Plattsburgh, NY 12901 (518) 562-4170 (800) 552-1160 www.clinton.edu
Directions: Please complete this application and return to the Admissions Office at Clinton Community
College. In addition, you must complete the CCC application or the SUNY application for admission. An
official copy of your high school transcript is required. A GED will be accepted in lieu of a high school
transcript. If you have previously attended other colleges, you must have official academic transcripts sent
from those institutions.

Filing period: October 15 through February 15. Applications will be reviewed after February 15th.

   1.   Name____________________________________________________________________________
                             Last                                First                               Middle



   2.   Address __________________________________________________________________________
                             No. and Street                                 City                        State                   Zip



   3.   Soc. Sec. No.________-______-________ 4. Telephone No. (______) _______-_________

        (Disclosure of Social Security number is voluntary and is used to facilitate the admissions process.
        Authority to solicit the Social Security number has been established under Section 355 of the Education Law of the State of New York.”)

   5. Email Address: ____________________________________________________________________


   6. U.S. Citizenship: Yes____ No____                                   Date of Birth __________________________
                                                                                               Mo.            Day        Year



   7. List below information concerning high school or other secondary schools attended.

        Name of School                   City/State         Date of Entrance       Date of Leaving            Diploma/Degree Received

        _____________________________________________________________
        _____________________________________________________________
        _____________________________________________________________
   8. Have you previously made an application to Clinton Community College? Yes____ No_____

   9. Have you previously attended Clinton Community College?                                                       Yes____ No_____

   10. Are you currently attending Clinton Community College?                                                       Yes____ No_____

   11. List below information concerning ALL college, university or other post secondary schools
       attended.
        Name of School                   City/State         Date of Entrance       Date of Leaving            Diploma/Degree Received

        _____________________________________________________________
        _____________________________________________________________
        _____________________________________________________________
        _____________________________________________________________
        If program was not completed, state reason:
        _____________________________________________________________
        _____________________________________________________________
      Applicants who have attended another school of nursing, RN or LPN, and left prior to completion
      must request a letter from the Nursing Program Director to be sent to the Clinton Community
      College’s Nursing Program Director indicating the circumstances under which the student withdrew.

      12. Other educational, travel, and/or community service experience:
             _____________________________________________________________
             _____________________________________________________________
      13. Do you have any prior health related experience (nurse aide, medic, LPN, etc)? _______ If yes,
          please describe and include length of service:

             _________________________________________________________________________________

             _________________________________________________________________________________

             _________________________________________________________________________________

      14. How would you rate your own general health?

      15. Excellent_____ Good_____ Fair_____ Poor_____

      16. Have you ever been found guilty of a crime (felony or misdemeanor)? _____If yes, please elaborate:

      17. _________________________________________________________________________________

             _________________________________________________________________________________

      18. Give the names and addresses of three persons, not relatives, who know you and can give information
          about you. For example, you should include a recent teacher, counselor or employer. Supply each of
          these persons with a personal reference form (three enclosed). Be sure to print your name clearly on
          the reference form. The reference form should be returned to the Admissions Office, Clinton
          Community College, 136 Clinton Point Drive, Plattsburgh, NY 12901.

             _________________________________________________________________________________
                   Name                          Address                       Occupation

             _________________________________________________________________________________
                   Name                          Address                       Occupation

             _________________________________________________________________________________
                   Name                          Address                       Occupation



Clinton Community College, a member of the State University of New York, in recognition of its educational mission, its social concern, its responsibility for the personal development of
individuals, and its concern for the rights of the individual, does hereby express and establish this college policy of Affirmative Action/Equal Opportunity. It is the policy of Clinton
Community College to provide equal opportunity in education, employment, and participation in College activities without regard to race, color, creed, religion, sex, age, national origin,
disability, political affiliation, sexual orientation, veteran or marital status, or other basis prohibited by law, except as such conditions may constitute bona fide occupations or assignment
qualifications. The College’s Affirmative Action Officer, Diane Merkel, is the designated campus contact for matters related to Title IX of the 1972 Education Amendment, Affirmative
Action, and Equal Opportunity. Inquiries should be directed to: Diane K. Merkel, Human Resources/Affirmative Action Officer, Room 223M, Clinton Community College, 136 Clinton
Point Drive, Plattsburgh NY 12901, (518) 562-4137, Diane.Merkel@clinton.edu , or Office for Civil Rights, U.S. Department of Education, 75 Park Place, 14th Floor, New York, NY
10007-2146.
In the space below or on an additional paper, please write an account of (1) your experiences and activities
since you last attended school, if more than six months have elapsed, (2) all the things you have
accomplished that have given you the greatest satisfaction, (3) what you most enjoy doing in your leisure
time, (4) your reasons for selecting nursing as a career, (5) any special reasons for desiring to entering this
school, and (6) your plans and aspirations for the future. Include any data or facts relative to your
application which you feel are important and which may not have been covered elsewhere.




Signature:_______________________________________________Date:____________________________
Nursing Program Admission
The Nursing Admissions Committee at Clinton Community College welcomes applications from all individuals who meet all academic
and health requirements who possess the intellectual, emotional and mechanical capabilities to undertake the curriculum and achieve the
competency level required for safe, effective nursing practice. Applications are encouraged from:

        High school seniors or recent high school graduates with strong science and mathematics achievement
        Current college students attending Clinton Community College or any other college
        College graduates
        Individuals interested in making career changes

The admissions process is very competitive due to the high number of applicants. Candidates are urged to review the general college and
specific admission requirements, which are cited in the college catalog. Each applicant must successfully complete (“C” grade or higher)
all pre-requisite courses before applying for entry into Nursing.

The admissions process requires the following:
All Candidates
     Demonstrate competency in basic mathematics (eligible for Mat 101/103 or higher). Competency may be determined by CCC
        Placement Test, SAT or ACT.
     Candidates for the two-year nursing program must demonstrate competence in college level writing equivalent to Eng 101 –
        English Composition.
     Submit ACT and/or SAT results if available.
     Submit three letters of character reference.
     Submit the Clinton Community College Admissions Application.
     Submit the Clinton Community College Nursing Application.
     Submit official high school transcripts or copy of GED.
     Submit official transcripts from all previous colleges attended.
     Submit required health forms upon acceptance.

For Candidates Who Are Currently in High School
     Completion of a college preparatory high school program which must include for (4) units of English, three (3) units of social
       science, two (2) units of mathematics and three (3) units of natural science (biology and chemistry required). Students are
       expected to have an overall high school average of 80 or better. In order to be competitive, applicants should have high
       achievement in all courses with particular emphasis on Regents Science courses.

Candidates Who Lack High School Course Requirements
    Lacking high school biology – candidates must have a college biology course. CCC equivalent is Bio 101.
    Lacking high school chemistry – candidates must have a college chemistry course. CCC equivalent is CHE 101 or CHE 111.
    Individuals possessing a General Equivalency Diploma (GED) are eligible if they successfully complete college level equivalent
       courses.

In addition to the above requirements, in order to be competitive many candidates choose to complete general education and science
coursework required for the nursing degree prior to entering the nursing program. These courses include English Composition, Human
Development, Intro to Psychology, Intro to Sociology, Anatomy & Physiology I, Anatomy & Physiology II, and Microbiology.
Candidates with the highest grades in Math and Science will be most competitive in the admissions selection process.

The Filing Period for All Nursing Program Applicants for the Entering Fall Semester is: October 15 – February 15. Applications
Received After This Period Cannot Be Guaranteed Review.
The Admissions Committee will begin making admission decisions shortly after the February 15 deadline. Applications will be
considered until the application process is complete and all requested materials have been received in the Admissions Office. Admission
decisions affecting currently enrolled Spring Semester Clinton Community College students may be deferred until final grades are
received. If there are remaining seats available after February decisions are made, new applicants may be accepted by the Admissions
Office until the entering class is filled.

Students seeking an opportunity to be considered for admission to the Nursing Program, who lack pre-requisite courses or who apply to
the College too late to be considered for the current nursing entering class may be admitted to the College in a Liberal Arts curriculum
and work toward becoming competitive applicants for the subsequent admissions cycle.

Students not accepted into the Nursing Program are invited to pursue other career options offered by the College. The Career Planning
Office and Counseling Office will offer advising and counseling regarding alternative choices in career options.
Criteria for Admissions Decisions
Admissions decisions are based upon the following criteria:
     Weight is given to each applicant’s overall academic achievement, since it is an indication of proven ability and motivation to
         succeed in the Nursing Program.
     Particular emphasis is given to achievement in laboratory science courses since much of the applied clinical coursework depends
         upon a thorough understanding of chemistry, anatomy and physiology as well as microbiology.
     Level of achievement in college level work for those individuals who have prior college level courses.
     The Admissions Committee will use SAT or ACT test scores in consideration of applicants, if they are available, but these test
         results are not required. However, all applicants are required to take the College Placement Test for placement purposes only,
         unless the student has successfully completed college level English and math courses.
     The essay narrative provides the student an opportunity to communicate openly with the Admissions Committee in a personal
         way regarding values, personal and career goals and achievements.
     Personal character and professional references are required and are considered important, due to the high standards of conduct
         expected in the nursing profession.
     Students with an overall GPA of less than 2.5 may not be considered for the program.

Admission Acceptance Methods
Applicants may be accepted in the following manner:
    Accepted to Two-Year Nursing – Selective admission.
    Accepted to Three-Year Nursing – Selective admission that guarantees the student a spot in the clinical portion of the nursing
        program in their second year. Students who are admitted to this option must received grades of “C” or higher in all math and
        science courses to continue to the Two-Year program.
    Accepted to the Liberal Arts/Nursing Preparation – Open admission. Students are admitted to the College. The first year of
        study is identical to the first year in the Three-Year program listed above, except that the student does not receive a guaranteed
        spot for the clinical portion of the program. Students enrolled in Liberal Arts may apply for Fall admission to the Two-Year
        Nursing program in October of their first year or any subsequent application period.

Health Requirements
Accepted candidates must comply with all college and clinical affiliate health requirements prior to the start of the nursing program.
Annual updates also required.

Transfer Credit
Transfer procedures for credit earned at another institution are stated in the College Catalog and should be reviewed. Official transcripts
for prior post-secondary education must be submitted. Students who have attended another nursing school must submit a letter from the
prior school concerning the withdrawal and ability to return. Credit for prior science courses (Anatomy and Physiology, and
Microbiology) will be considered if the course(s) have been completed within five (5) years of admission to Nursing 103. (Ex: science
courses successfully completed in the Fall 2007 semester or later will be considered for Fall 2012 entrance into the program.)

Former Nursing Students Seeking Re-admission to Nur 104, 105, 201, 202, or 203
Returning students may be admitted on a space available basis. A letter of application must be submitted to the Admissions Office by
April 15 for the subsequent fall semester and by November 15 for the subsequent spring semester. The letter must include adequate
evidence to support the re-admission request. Adequate evidence includes:

        Recognition of the deterring factors in the previous program attempt.
        Evidence of remediation of the deterring factors.
        A plan for achieving successful completion of the Nursing Program.

The Department of Nursing will review the student request and determine the readmission status. Re-admission is recommended only on
a space available basis. It is not uncommon for students to be notified just prior to the start of a semester due to unexpected openings.
Students seeking readmission who have been out of the program for two years must re-establish their baseline competency by written and
performance tests.

Former Nursing Students Seeking Re-admission to Nur 103, Fundamentals of Nursing
A letter of application must be submitted to the Admissions Office by February 15 for the subsequent fall semester to be reviewed by the
Nursing Admissions Committee along with all freshman applicants. The letter must include adequate evidence to support the re-
admission request. Adequate evidence includes:

        Recognition of the deterring factors in the previous program attempt.
        Evidence of remediation of the deterring factors.
        A plan for achieving successful completion of the Nursing Program.


10/2011
                           CLINTON COMMUNITY COLLEGE
                                                                136 Clinton Point Drive
                                                              Lake Shore Road, Rt. 9 South
                                                                    (518) 562-4170

PERSONAL REFERENCE FOR _______________________________________________
                                      (Print Name)

The individual presenting this reference to you is applying for admission to the Nursing Department. A successful
Nursing student must possess a high degree of intelligence, reliability and adaptability. Good mental and physical
health are also necessary.

Using the scale below as a guide, please rate this candidate as he/she compares with their peers by placing
an "X" in the appropriate category.
                                            Unable to                                Above                            Below
                                            Evaluate             Outstanding         Average        Average           Average   Unsatisfactory
Character (Integrity, Forthrightness)
Personality (Ability to get along)
Academic Achievement
Persistence and Drive
Leadership Potential
Self-Confidence & Self-Control
Ability to Express Self
Alertness (Decision Making Ability)


Please indicate below your knowledge of this candidate:
_____Acquainted personally outside of class _____Has been in my employ               _____Have been his/her advisor

_____Have known him/her well as a student               _____Limited classroom knowledge       _____Do not remember him/her

_____Other (Please explain)

Please write below a brief personal estimate of the candidate that may be available to the Admissions
Committee. Include any information which you think might be useful in evaluating this candidate. (Please
print in ink or type). Use additional sheets if necessary.




DATE:__________________________________NAME:_____________________________________

PLACE OF EMPLOYMENT_________________________________SIGNATURE_____________________

POSITION:________________________________________________

NOTE: When you have completed this form, please return it directly to the Director of Admissions, Clinton
Community College, 136 Clinton Point Drive, Route 9 South, Plattsburgh, New York 12901.

                                        DEADLINE FOR SUBMISSION: FEBRUARY 15, 2012.
                           CLINTON COMMUNITY COLLEGE
                                                                136 Clinton Point Drive
                                                              Lake Shore Road, Rt. 9 South
                                                                    (518) 562-4170

PERSONAL REFERENCE FOR _______________________________________________
                                      (Print Name)

The individual presenting this reference to you is applying for admission to the Nursing Department. A successful
Nursing student must possess a high degree of intelligence, reliability and adaptability. Good mental and physical
health are also necessary.

Using the scale below as a guide, please rate this candidate as he/she compares with their peers by placing
an "X" in the appropriate category.
                                            Unable to                                Above                            Below
                                            Evaluate             Outstanding         Average        Average           Average   Unsatisfactory
Character (Integrity, Forthrightness)
Personality (Ability to get along)
Academic Achievement
Persistence and Drive
Leadership Potential
Self-Confidence & Self-Control
Ability to Express Self
Alertness (Decision Making Ability)


Please indicate below your knowledge of this candidate:
_____Acquainted personally outside of class _____Has been in my employ               _____Have been his/her advisor

_____Have known him/her well as a student               _____Limited classroom knowledge       _____Do not remember him/her

_____Other (Please explain)

Please write below a brief personal estimate of the candidate that may be available to the Admissions
Committee. Include any information which you think might be useful in evaluating this candidate. (Please
print in ink or type). Use additional sheets if necessary.




DATE:__________________________________NAME:_____________________________________

PLACE OF EMPLOYMENT_________________________________SIGNATURE_____________________

POSITION:________________________________________________

NOTE: When you have completed this form, please return it directly to the Director of Admissions, Clinton
Community College, 136 Clinton Point Drive, Route 9 South, Plattsburgh, New York 12901.

                                        DEADLINE FOR SUBMISSION: FEBRUARY 15, 2012.
                           CLINTON COMMUNITY COLLEGE
                                                                136 Clinton Point Drive
                                                              Lake Shore Road, Rt. 9 South
                                                                    (518) 562-4170

PERSONAL REFERENCE FOR _______________________________________________
                                      (Print Name)

The individual presenting this reference to you is applying for admission to the Nursing Department. A successful
Nursing student must possess a high degree of intelligence, reliability and adaptability. Good mental and physical
health are also necessary.

Using the scale below as a guide, please rate this candidate as he/she compares with their peers by placing
an "X" in the appropriate category.
                                            Unable to                                Above                            Below
                                            Evaluate             Outstanding         Average        Average           Average   Unsatisfactory
Character (Integrity, Forthrightness)
Personality (Ability to get along)
Academic Achievement
Persistence and Drive
Leadership Potential
Self-Confidence & Self-Control
Ability to Express Self
Alertness (Decision Making Ability)


Please indicate below your knowledge of this candidate:
_____Acquainted personally outside of class _____Has been in my employ               _____Have been his/her advisor

_____Have known him/her well as a student               _____Limited classroom knowledge       _____Do not remember him/her

_____Other (Please explain)

Please write below a brief personal estimate of the candidate that may be available to the Admissions
Committee. Include any information which you think might be useful in evaluating this candidate. (Please
print in ink or type). Use additional sheets if necessary.




DATE:__________________________________NAME:_____________________________________

PLACE OF EMPLOYMENT_________________________________SIGNATURE_____________________

POSITION:________________________________________________

NOTE: When you have completed this form, please return it directly to the Director of Admissions, Clinton
Community College, 136 Clinton Point Drive, Route 9 South, Plattsburgh, New York 12901.

                                        DEADLINE FOR SUBMISSION: FEBRUARY 15, 2012.

				
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