Nursing Program Application

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Nursing Program

Application

All nursing programs start in August and complete in May

• Online and on-campus ADN Program (Associate Degree in Nursing)

• Application Deadline April 1

• All prerequisite courses must be completed no later than May 15

• Transcripts from PN/Paramedic certificate granting institution by June 1

• LPN/Paramedic - License/Certificate available for verification by July 1

• TEAS test scores by May 15

• On-campus PN (Practical Nurse Program)

Located at Pratt Community College and Winfield Campus at the Cowley Community College Allied Health Center

• Application deadline April 1

• All prerequisite courses completed no later than May 15

• Transcripts from prerequisite schools by June 1

• CNA Certificate available for verification by June 1

• TEAS test scores by May 15

International Students:

F-1 Visa students must have met International Student requirements as identified on the PCC

website at: prattcc.edu/student-services/international

Non-US Citizens:

Permanent Residency status students must provide a clear and legible copy of the valid

permanent card/certificate with the application. Applications without documentation will

not be considered.

All students:

To be considered for the program, your nursing application MUST:

Be Complete

Be Legible

Be accurate

Be submitted on or prior to the deadline

For additional information:

prattcc.edu

[email protected]

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Nursing

Application Form

Personal Information - ALL information MUST be completed or won’t be processed

Last Name First Name Middle Name

Maiden Name Other Last Names (That may appear on transcripts) Date of Birth (MM/DD/YYYY)

Street Address City County State Zip Code

( ) ( )

Home phone cell phone e-mail address (required)

Alternate e-mail address

Are you a Kansas Resident? Yes No

Are you a US citizen? Yes No

Persons with F-1 or preeminent residency or a certificate of nationalization

If you have permanent residency, F-1 VISA, or have obtained US Citizenship you MUST provide

supporting documentation before you will be considered for our program.

I have provided the following:

I agree that the information I have provided is correct.

Prior to completing the nursing application form, students must complete a PCC admissions

application for the college. Please review the admission and legal requirements for LPN/RN very

carefully. A one-time $25 non-refundable fee must accompany application. Application will not be

processed until fee is received.

Permanent Residency

F-1 Visa(I-20) and TOEFL scores

US Citizenship documents

Office use only:

Program applied for __________________

Student ID __________________________

Yes

No

Program Applying for:

Only one (1) program may be chosen.

Winfield PN Program — on-campus Pratt ADN Completion Program — online Winfield ADN Program — on-campus Pratt ADN Completion Program — on-campus Pratt PN Program — on-campus

On-campus and online programs will start in August

August 2016 August 2017 August 2018

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Education

ALL official college transcripts including official high school transcripts are required for the following:

- Nursing Applicants will not be evaluated for program until ALL official transcripts have been received - Financial Aid cannot be completed until all official transcripts have been received

Where did you receive your high school diploma, GED, or home school certificate?

If received diploma, name of high school:

Year of graduation:

List all colleges and universities attended:

1. 2.

3. 4.

5. 6.

7. 8.

9. 10.

Nursing application and fee must be mailed to: Pratt Community College

Att: Nursing Admissions

348 NE SR 61

Pratt, KS 67124

Prerequisites required

All grades must be a “C” or better and must be completed prior to admissions requirement deadline date. Please note the higher pre-req GPA the better your chances are at getting selected.

Required Courses:

• English Composition I • General Psychology

• Developmental Psychology

• Microbiology with lab (BIO 165) - 5 credit hours (5 year expiration)

• Anatomy & Physiology with lab - 5 credit hours (5 year expiration) OR A&P I + A&P II OR Human Anatomy + Human Physiology

• Intermediate Algebra or higher

Recommended Courses:

Chemistry

Biology

College Algebra

Pharmacology (If received your LPN more than three years ago)

We have found that students who take and successfully complete the recommended courses are more likely to succeed in the program.

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Pre-Requisites

(Transferability to be

determined by the

PCC Registrar)

Status

(To be considered

‘complete’ must have

a C or better)

Where you

completed the

course

Date course

was or will be

completed

Anatomy & Physiology w/ Lab

(Minimum 5 hour course) Course Number _________

Completed

In Progress

PCC

Other (please list)

CPR for Healthcare Providers

Course Number _________

Completed

In Progress

Completed

In Progress

Completed

In Progress

Completed

In Progress

Completed

In Progress

Completed

In Progress

Completed

In Progress

PCC

Other (please list)

PCC

Other (please list)

PCC

Other (please list)

PCC

Other (please list)

PCC

Other (please list)

PCC

Other (please list)

PCC

Other (please list)

Completed:_____________

Will be complete:________

Completed:_____________

5 year expiration Developmental

Psychology Course Number _________

English Comp I Course Number _________

General Psychology Course Number _________

Kansas Certified Nurse Aid Certification Course Number _________

Kansas License for Practical Nursing Course Number _________

Microbiology w/ Lab (Minimum 5 hour course) Course Number _________

Prerequisites required

This section MUST be completed and turned in with application materials.

Completed:_____________

5 year expiration

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ALL information is required or application will NOT be processed

List licensure or certification:

Name as it appears on license/certificate

How many times did you take the state boards for LPN or Paramedic?

We must receive an official transcript showing program completion for LPN and Paramedic.

Pratt Community College is an equal opportunity employer and does not discriminate on the basis

of any characteristic protected by law in admission, recruitment, treatment or employment in

its programs and activities. Pratt Community College hires only U.S. citizens and aliens lawfully

authorized to work in the United States. If you have any questions, please contact the Director of

Personnel, Pratt Community College, 348 NE SR 61, Pratt, KS 67124, Title IX/Section 504 Coordinator.

Pratt Community College reserves the right to change program dates and times.

Completion of admission checklist items makes candidates eligible for consideration by the

selection committee. College Admission does not guarantee admission into the

Nursing Program.

Qualifications

Legal Qualifications

ALL information is required or application will NOT be processed

Have you been convicted of a misdemeanor or felony? Yes No

If yes, see Legal Qualifications before applying to this program to see if you are eligible. You may find the Legal Qualifications at the following website: http://www.prattcc.edu/sites/all/files/pdf/LegalQualifications_1.pdf

Terms:

I certify that the information provided is correct and complete. I understand that submission of false information and/or failure to submit supporting transcripts is grounds for denial of admissions, re-enrollment, or immediate suspension if enrolled. If accepted as a student at PCC, I agree to abide by the rules and regulations of the college regarding conduct, financial and other obligations. I have read the admission requirements, the legal qualifications for LPN/RN Licensure, and the estimated cost sheet. I affirm my intention to meet these requirements and agree to immediately report any change of status related to information on this application.

I agree with these terms: Yes No

Student Signature

Today’s Date

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Nursing

Application Fee Form

348 NE SR 61 Pratt, KS 67124 prattcc.edu (620) 672-5641

Prior to completing the nursing application form, students must complete a PCC admissions application for

the college. Please review the admission and legal requirements for LPN/RN very carefully.

A one-time $25 non-refundable fee must accompany application. Application will not be processed until

fee is received.

Personal Information

Last Name First Name Middle Name Date of Birth (MM/DD/YYYY)

Street Address City County State Zip Code

Home phone cell phone e-mail address

Check here if address listed above is permanent address

Payment Information: Check Money Order Credit/Debit

If you wish to be by credit or debit card, please call one of the phone numbers listed below to submit payment and fax application.

Completed application and fee forms must be mailed to:

Pratt Community College Nursing Admissions

348 NE SR 61 Pratt, KS 67124

Fax: (620) 450-2282

Phone: (620) 450-2134 or (620) 450-2143