Reset Print Submit **To submit this form by email, save it to your computer and use Adobe Reader to open it ** RN to BSN Nursing Application OUR LADY OF HOLY CROSS COLLEGE DEPARTMENT OF NURSING APPLICATION FOR ADMISSION RN to BSN PROGRAM ***Please complete all fields, insert n/a in fields that do not apply*** DIRECTIONS Fill in all applicable fields. Answer all questions. Incorrect or incomplete information will delay processing of this application. Contents of this application are considered confidential and will be available only to authorized person Admission is requested for Fall 20 __ ____ Spring 20__ ____ Summer 20__ ____ Prefix _____Mr. _____Miss _____ Ms _____Mrs First Name ________________________________________________________________ Last Name ___________________________________________________ Middle Initial ______________ Maiden Name _________________________________________ Permanent Address ___________________________________________________________________________ City ________________________________________ State __________ Zip _____ Mailing Address ______________________________________________________________________________ City ________________________________________ State __________ Zip _____ Email ______________________________ Home Phone _______________ Cell phone _________________ State of Residence Race __________ Gender __________ Birth Date __________ Marital __________ Religion __________ Previous Education List every University or College you have ever attended. Begin with your current school first. Include Institution Name, Dates of Attendance, Major Area of Study, Degree or Diploma. RN to BSN Nursing Application OUR LADY OF HOLY CROSS COLLEGE DEPARTMENT OF NURSING APPLICATION FOR ADMISSION RN to BSN PROGRAM Employment History (most recent first) Include Institution and Address, Dates of Employment, Position and Reason for Leaving. Do you have a current unencumbered nursing license? _____ Yes _____ No Have you ever before made application to OLHCC Department of Nursing? _____ Yes RN License State ____________ _____ No If 'Yes', give date of previous application to the OLHCC Department of Nursing __________ Are you currently enrolled in any other school? _____ Yes _____ No If you are not a student at OLHCC, are you enrolled at another college? If so, where? ______ Yes ______ No ______ I am currently not attending school List any pre-requisite courses you are currently enrolled in or will enroll in prior to entry into the RN to BSN Program. Indicate the semester and year, then list courses. RN to BSN Nursing Application OUR LADY OF HOLY CROSS COLLEGE DEPARTMENT OF NURSING APPLICATION FOR ADMISSION RN to BSN PROGRAM If you are not a student at OLHCC, have you applied and been accepted to OLHCC? (If not, applicant must apply to OLHCC before Application for Admission to the Department of Nursing can be processed.) ______ Yes _____ NO List any Honors, Awards, Scholarships/community involvement. DIRECTIONS In the space below, compose a personal statement explaining why you wish to pursue a BSN degree at OLHCC. By entering the date and my name below, I HEREBY CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS TRUE AND COMPLETE ___________________________________ _________________________________ Print Name ________________________________ Signature ___________________________ Date
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