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Application process for students beginning the nursing program by elizabethberkley


									          *Application Process for Beginning Students Fall 2007*

Please read carefully when filling out the application. Provide all information requested or if something
does not apply to you: write N/A in the space provided. Also, TYPE or PRINT your response.

To apply for the nursing program you must complete and submit a nursing packet, including:

        1. NURSING APPLICATION (Available on line on the Nursing department web page)
        2. CCC Admissions Application (if applicable)
        3. Proof of high school graduation, GED test, OR higher level degree (AA/AS/BA/BS)
        4. OFFICIAL college transcripts from ALL INSITUTIONS ATTENDED (except Diablo
            Valley College or Los Medanos College)
        5. Work in Progress/Registration Statement (obtain from college in which you are
           enrolled in in-progress courses)

           The deadline for submitting your application is February 1, 2007.
   (Applications are accepted between October 1, 2006 and February 1, 2007. Applications
                     postmarked on or before February 1 will be accepted)


Please mail/walk-in completed nursing application to Contra Costa College:
                     Admissions and Records Office H-42
                     Attn: Nursing Application
                     Contra Costa College
                     2600 Mission Bell Drive
                     San Pablo CA 94806

                 *Application Process for Advanced Placement*

LVN applicants are admitted into the 3rd semester of the program and take two
short bridge courses in the summer preceeding admission.

    Deadline for submitting applications for LVN advanced placement:
     October 1– February 1.

Psych Tech applicants are admitted into the 2nd semester of the program

    Deadline for submitting applications for Psych Tech advanced placement:
     July 1 – October 1.

Transfer applicants are admitted into the program based on the recommendation
of the Nursing Admissions Committee.

    Deadline for submitting applications for Transfer advanced placement:
     July 1 – October 1 for students entering in the Spring semester.
     November 1 – February 1 for students entering in the Fall semester.
To apply for Advanced Placement you must complete the following:

1. A nursing application to the Admissions & Records Office with OFFICIAL college transcripts

2. A letter requesting admissions into the nursing program, along with a copy of your
   unofficial transcripts with course descriptions sent to the attention of:
       Nursing Admissions Committee, HS Building, Room 103.

The nursing program bulletin may be requested from the Nursing Department:
(Health Sciences Building, Room 103), (510) 235-7800, ext 4267 or on-line @ click Departments, Nursing, Nursing Department Web Page,
Nursing Program Application Form)

    It is the student’s responsibility to request transcripts from any institution attended.

                   Please note deadline dates and requirements.

              Check List for Nursing Program Admission
Please answer the following questions in order to assure that your application is
complete and ready for submission to the Admissions & Records Office.

1.   □Yes or □No                          Completed or Work in Progress with Group A Courses:

                                                   Anatomy      - BIOSC 132
                                                   Physiology - BIOSC 134
                                                   Microbiology - BIOSC 119 OR 148
                                                   English Composition – ENGL 001A

2.   □Yes or □No                          Completed or Work in Progress with Group B Courses:

                                                   Introduction Sociology                      - SOCIO 220
                                                   Psychology                                  - PSYCH 130 or 220
                                                   Human Communication                         - SPECH 121 OR 128
                                                   Developmental Psychology                    - PSYCH 126 OR 128
                                                   Drug Dosage Calculations                    - NURS 205

3.    □Yes or □No                         Filled out a CCC Admissions application (if applicable)
                                          (Available online )

4.    □Yes or □No                         Filled out a Nursing Admissions application
                                          (Available online , click Departments,
                                          Nursing, Nursing Department Web Page, Nursing Program
                                          Application Form)

5.    □Yes or □No                         Obtained official transcripts (or proof of registration in
                                          in-progress courses)

6.    □Yes or □No                         Obtained Proof of High School graduation / GED /
                                          College degree

If you answered NO to any of the questions above, please complete the
requirements and submit your application at a later time. Also, schedule an
appointment with a counselor (510) 235-7800 ext 4255.
     Note: If course(s) are work in progress at another institution you must provided proof and follow-up with an official transcript.

            Contra Costa College Nursing Program

Please check the appropriate box for which you are applying:

First Semester Nursing Student                                    □
Advanced Placement ONLY:
       Transfer from another RN Program                           □
       L.V.N. to RN - AS Degree option                            □
       L.V.N. to RN - 30-unit option                              □
       Psychiatric Technician to RN                               □

Please fill-out

Name ____________________________________________________________________
      (LAST)           (FIRST)        (MIDDLE)           (PREVIOUS)

Address: _________________________________________________________________
               (STREET)                            (CITY)         (STATE)      (ZIP)

Student ID# or SSN # ____________________________              Birth date ____/_____/______

Day Phone: (      ) _____________      Evening (    ) _____________ Cell (   ) _____________

E-mail address: ___________________________________________________________

Contact person:       _____________________________________________________
                      (Name)           (Telephone #)          (Relationship)

Citizenship Status: ( ) U.S. Citizen ( ) Permanent Resident ( ) Temporary Resident ( ) Other
What State do you regard as your permanent home: ___________________
When did your stay begin      ____/_______/________

High School Attended              Dates of Attendance             Degree/Date Awarded

College(s) Attended               Dates of Attendance             Degree Earned/Grad. Date

Signature: ______________________________________________________

Name: ___________________________________________                       _______________
          Last                 First                                    Student ID #

1. Are you applying for Advanced Placement?                              □Yes or □No

2. Are you a Licensed Vocational Nurse?                                  □Yes or □No
       LVN # __________________________________
                             a copy is not required

4. Are you a Licensed Psychiatric Technician?                            □Yes or □No
       LPT # __________________________________
                             a copy is not required

Dear Student:

The Board of Registered Nursing is requiring all nursing programs to provide them with the
following data. Please complete as accurately as possible. The information you provide will be
confidential and not released to any source nor will it affect your application status.

Racial Background                           Check one     Gender
American Indian or Alaskan Native                              Male
Asian or Pacific Islander                                      Female
African American, Non-Hispanic
White, other than Hispanic

Age                Check one
18-25 years of age
26-35 years of age
36-45 years of age
46-55 years of age
> 56 years of age

Name______________________ ID#_________________

revised 2/15/07


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