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2014 Practical Nursing
(LPN)
Application
Cover Sheet
Campus (check one): Faribault __ North Mankato __
Directions: Students must print and submit a complete nursing application by June 27, 2014 at 4:00 p.m.
In order to be considered for January 2015 admission, this deadline must be met.
See page 11 for further directions on submitting your application.
Please print clearly. All information provided must be legible.
Read through the entire application carefully.
Print Applicant First Name: ___________________________
Print Applicant Last Name: ___________________________
Notice: There are 12 pages to this application. Applicants MUST turn in all 12 pages for their
application to be processed. Incomplete applications will not be considered.
Be sure you initial, sign and date in all required areas before submitting this application.
Date Rec’d:
For
Office
Use
Only
NURS GPA:
Check here when
initial data entered
into database: ___
Check here when entire
application entered into
database: ___
HESI Score:
Follow up:
Reviewed by:
1.
2.
Outcome:
Qualified:
___
Not Qualified: ___
Page 2 of 12
Before completing this core-Practical Nursing application, initial to signify
you meet the following minimum qualifications:
These requirements must be met:
Initial in this column if you
meet this requirement:
Admission: Applicant must be fully admitted to South Central College by June 27, 2014.
Accuplacer: Applicant must be college ready based on their Accuplacer scores (or have completed the
required college readiness courses if applicable).
Nursing Assistant: Provide evidence of current Nursing Assistant registry in the state of Minnesota (NA,R)
(See page 5 for more details).
HESI Entrance Score: Provide proof of passing SCC’s HESI Entrance Exam with a score of 700 or higher
(See page 5 for more details).
Chemistry: Provide evidence of Chemistry 108 (or equivalent) within 5 years or meet the high school
exception rule (See page 4 and 8 for more details).
GPA: Demonstrate a college “nursing” GPA of 2.7 or higher (See page 7 for more details).
Good Academic Standing: Demonstrate being in good academic standing at the college.
Info Session: Provide original certificate of attendance from an up-to-date Info Session (marked “2014”)
(See page 4 for more details).
If applicant/student cannot demonstrate all of the above items, the
applicant/student has not met the qualifications to apply to the corePractical Nursing program at this time.
Page 3 of 12
Practical Nursing (LPN) Application
___________________________________________________________________
This application is for the Practical Nursing (LPN) Program. If your intent is to apply to the Associate in Science (RN) program, please
note, the Associate in Science (RN) Application window will open in January 2015.
Students may only apply to ONE program or the other—NOT both.
Applicants must provide all requested information at time of application for successful submission of their
nursing application. Incomplete
applications will not be considered.
Applicant Data
Print Clearly!
Name:
(Last)
(First)
(Street)
(City)
(Middle Initial)
Address:
(State)
(Zip)
Phone:
(Primary Phone)
(Secondary Phone)
(SCC Student Email)
(Alternative Email)
Email:
Previous
Names:
(Print any previous names; such as: maiden name, etc.)
Gender:
____ Female
____ Male
Please check one. Certain clinical sites request gender information. This has no bearing on the application process.
8-digit South Central College student ID#: ___ ___ ___ ___ ___ ___ ___ ___
Check here if the only college you have attended is South Central College: ___
Page 4 of 12
Notice: The grey shaded area below includes preparatory classes (minimum
qualifications) to making application to the core-nursing program. If you are
unable to submit evidence of meeting these criteria, you are not qualified to make
application to the core nursing program.
Attention: Students may only apply to one campus (not both). Select the campus to which you are applying
North Mankato _____ Faribault ______ Check only one
Notice: Applicants must have all college admission items into SCC Admissions by June 27, 2014. No exceptions.
Applications to the college received after this point will not be considered for the 2014 core-nursing application.
Enter your 8-digit South Central College student ID#: ___ ___ ___ ___ ___ ___ ___ ___
Note: If you do not have an 8-digit SCC student ID, you must first apply to the college and contact the admissions
department to find out what your ID# is.
It is an application requirement to attend an updated Nursing Info Session. Applicants must submit their original certificate
of attendance with this application. Does your certificate of attendance say “required component of the 2014 nursing
application” and have a label that states “This Certificate expires January 30, 2015”? Yes ____ No _____ Must check one
Introduction to Chemistry—Chemistry 108:
Have you completed Chemistry 108 (or equivalent), are you currently registered for the course, or do you meet the high
school “exception” rule? (See page 8 for further details). Must check one:
_____ Yes, I am currently enrolled in Chemistry 108 (or equivalent)
_____ Yes, I have already completed Chemistry 108 (or equivalent) within the last 5 years
_____ No, I meet the high school exception rule
Have you previously applied to either core-Nursing Program at SCC? Must check one:
_____ Yes, I have previously applied to the Associate in Science (RN) program at SCC (Month_______ Year________)
_____ Yes, I have previously applied to the Practical Nursing (LPN) program at SCC (Month_______ Year________)
_____ No, I have not previously applied to either the RN or LPN programs at SCC
Minimum Qualifications continued:
Page 5 of 12
Nursing Assistant Registry:
Note: Applicants must provide proof of being current on the Minnesota Registry as a Certified Nursing Assistant. Submit
this documentation along with your nursing application. Enter your Nursing Assistant Registry certificate number issued
from the State of MN:
___ ___ ___ ___ ___ ___ ___ ___ ___
There are two ways to provide proof of being current on the Minnesota Nursing Assistant Registry:
—Provide the “Letter of Verification” received from the state of MN. To receive this form, applicants may contact the state at: 1-800-397-6124 or at
this website: http://www.health.state.mn.us/divs/fpc/profinfo/narinfo/contactnar.html
—Provide a copy of your up-to-date registry card. Note: these cards are good for 24 months from the date of issue.
If your card date is older than 24 months, you must request a “Letter of Verification” as stated above.
HESI Entrance Exam Score:
Prior to applying to the core-Practical Nursing program, applicants are required to take SCC’s HESI Entrance Exam.
Applicants are required to test prior to making application. A HESI score of 700 or higher is required in order to apply to
the core-Practical Nursing program. For more information, go to this website: http://southcentral.edu/nursing/entranceexam.html
HESI Entrance Exam scores are available immediately after completing the testing. In order to qualify for admission into the
nursing program at South Central College, the student must provide a copy of their HESI Entrance Exam scores with the
application documents. A copy of the results is given to the student at the time of the exam. In order to obtain an
additional copy, the student must log into their Evolve account, click on Student Access, and print a copy of their HESI
Entrance Exam score. https://evolve.elsevier.com Choose purple box “HESI Exams” then “Log in” with account
information created at exam.
Please refer to the nursing handbook to determine if an appeal to the course repeat policy is needed.
http://southcentral.edu/nursing/nursing-handbook.html
Have you previously made an appeal to the SCC nursing program for a course repeat violation?
Yes_____ Not yet, but I am in the process _____ No, I am not in violation_____
Students meeting entrance criteria will be ranked to determine placement into the nursing program. Information regarding the criteria
used for ranking is available in the nursing handbook at: http://southcentral.edu/nursing/nursing-handbook.html.
I have read the criteria for admission to the nursing program found in the SCC handbook. I understand that in addition to completing
the required courses, I need to demonstrate a “nursing” GPA of 2.7 or above to be considered for admission into the nursing program. I
understand that application to the program does not guarantee placement into the nursing program. I understand it is my
responsibility to notify the Student Affairs Center and the Nursing Office of any change in my address or phone number.
_____________________________________
Student Signature
____________________________
Date
Page 6 of 12
Transcripts:
If you are a fully admitted South Central College student, the nursing program will access your transcripts
through the Student Affairs Center. Applicants should not submit additional copies to the core-nursing program
itself as long as the Student Affairs Center has them on file.
Transfer Transcripts:
A complete application requires any and all transcripts from any and all college institutions to be on file in our
Student Affairs Center. If you were registered for a course at any point at another institution OR are currently
registered for courses, the SCC Student Affairs Center must have that official transcript on file by
June 27, 2014. Regardless of the grades received, applicants must supply those official transcripts. SCC must also
have received the most up-to-date transcript from that college institution. Attendance at any college, without
exception, requires a transcript, either “E-Transcripts” with MnSCU colleges or an official transcript outside of
MnSCU schools.
Applicants may contact the Student Affairs Center on either campus to verify transcript receipt. If you have
specific transfer evaluation questions you may contact the Transfer Specialist, Tony Boehler, at 507-389-7394.
MnSCU vs. Non-MnSCU college transcripts:
If you attended a MnSCU institution, SCC will be able to view your transcripts through “E-Transcript” and,
therefore, you will not be required to provide an official paper copy. Holds at transfer institutions could result in
SCC not being able to view your “E-Transcript”. If this is the case, your application will be considered incomplete
and you will not be eligible to make application to the core program. It is the applicant’s responsibility to ensure
we have access to their “E-Transcripts.”
If you attended a non-MnSCU college, you MUST provide official transcripts to the admissions office when
applying to the college. These transcripts will then become available for viewing by the Nursing office.
By signing below, you acknowledge you are aware applicants must disclose all previous college coursework,
regardless of the grades received. Furthermore, you acknowledge failure to disclose and provide this
information results in an incomplete nursing application which will automatically be denied. You also
acknowledge SCC will be accessing further information to process your application such as transcripts from
other colleges.
_____________________________________
Student Signature
____________________________
Date
Notice: Please make copies of any application documents you wish to keep. The Nursing office/College will
not make copies of the application or supporting materials on behalf of applicants.
It is the applicant’s responsibility to make any wanted copies.
Page 7 of 12
Educational Coursework
Name of college(s)
List all colleges attended, regardless if you transferred in applicable general education courses from
those colleges or not. Also include colleges where you are currently taking courses
(currently registered, “in progress” courses, etc.)
It is the applicant’s responsibility to ensure that official transcripts are on file by June 27, 2014 in
SCC’s Student Affairs Center to verify all course completions.
List ALL colleges attended or in attendance in this column
(Check here if
you attempted a
core-nursing
program at this
college (either
LPN or RN)
Estimate date of
attendance at
the the college
Example: Dakota County Technical College
2005-07
Nursing GPA:
Applicants must demonstrate a nursing GPA of 2.7 or above in order to be qualified for application into the core-nursing
program. To utilize our unofficial “nursing” GPA calculator, applicants may go to this website:
http://southcentral.edu/nursing/nursing-gpa.html
By signing below, you acknowledge you demonstrate a Nursing GPA of 2.7 or higher in order to be qualified to
make application to the core-nursing application.
_____________________________________
Student Signature
____________________________
Date
Page 8 of 12
Program-Related Coursework Checklist:
Course/Requirement
# of
credits
course
was
worth
List the
earned
grade
for this
course
List the year the
course was
completed (or
write “currently
registered” if you
are currently
registered for
that course)
List the college the listed
course was
completed at:
Intro to Chemistry CHEM 108*
(see * below for more details)
Lifespan Psychology PSYC 110
English Composition ENGL 100
Anatomy & Physiology I BIOL 225
Anatomy & Physiology II BIOL 235
Note: The shaded area above designates minimum qualifications for the program.
Applicants must provide the designated registry/licensure along with their application. They must also
have completed Chemistry 108, be currently registered for it, or meet the high school exception rule*.
If there is no proof of completion OR current registration for this item, applicants will not be qualified to
apply to the program.
*Chemistry “high school exception” rule:
Applicants who have successfully completed high school chemistry with a “C” or higher may utilize their
high school chemistry as an exception to college-level Into to Chemistry if their high school graduation is
within three years of applying to the core-nursing program.
*Science 5-year rule:
Courses such as Chem 108 must be taken within five years of making application to the core-nursing
program in order for those specific courses to count for our nursing program. Refer to the nursing
handbook for more specific information regarding the 5-year science rule.
Nursing Assistant Registry:
You must demonstrate you are on the registry in the state of Minnesota as a Certified Nursing Assistant
(CNA). (Provide a copy of this with your nursing application). See page 5 for the two methods to
demonstrate proof of current registry. Due to clinical requirements, all students will need to remain on
the registry throughout their core-nursing program.
Page 9 of 12
Nursing Informational Sessions—Required Component of application!!
One of the minimum qualifications to making application to the core-nursing program includes providing proof of
attendance from a monthly Nursing Info Session for the 2014 application. At each monthly meeting, “2014” certificates of
attendance are handed out to each participant. Applicants must include their certificate of attendance with their nursing
application in order to be qualified to make application for this application period. If you have not attended a session or do
not have your certificate of attendance, you are not qualified to apply to the core nursing program at this time.
Make-up/Final Information Session Dates:
Faribault Campus:
Tues. June 17
9:00 – 11:00 a.m.
Room: B-110
N. Mankato Campus:
Wed. June 18
1:00 – 3:00 p.m.
Room: Conference Ctr “B”
_____________________________________________________________
Results of application:
The nursing program will ensure every effort to notify applicants of their results
via letter/mail by September 1, 2014.
Results will not be provided by telephone.
If your contact information changes, you must contact the nursing department to ensure we have your updated address. To
update your address with nursing, contact Heather Milton at: 507-389-7231.
Please read your results letter very carefully.

If you are notified of acceptance, you will be required to participate in a “Mandatory Nursing” meeting at a later date prior to
the start of the semester you begin “core” classes. Failure to participate in that session may forfeit your spot in the corenursing program.

If notified of acceptance, you will be required to participate and pass a state of Minnesota background study. Acceptance to
the nursing program is contingent upon passing a Minnesota Department of Health background study without
disqualifications. Failure to pass the background study results in an applicant forfeiting their reserved spot for the core-nursing
program.

If notified of acceptance, you will be required to travel between the two campuses for some courses, some labs, some exams,
and some clinicals. Failure to recognize and participate in this travel may cause you to forfeit your spot in the core-nursing
program.
By signing below, you acknowledge you must participate in the “Mandatory Nursing” meeting listed above,
you understand travel will be required of you, and acceptance to the core-nursing program is provisional based
on your successful completion the state background study.
_____________________________________
Student Signature
____________________________
Date
Page 10 of 12
Application Preview Workshops—Optional Sessions
These sessions are OPTIONAL and attendance is NOT required!
Applicants may have a staff member preview their nursing application. These sessions are NOT mandatory—they are
strictly available for students who would like to have someone preview their application. In order to serve all students,
applications will only be previewed on the outlined dates listed below. Again, these sessions are NOT mandatory, are NOT
required, and applicants do NOT need to attend these workshops. No pre-registration is required to attend.
Previewing occurs on a first-come, first-serve basis.
Faribault Campus Preview Workshop
N. Mankato Campus Preview Workshop
Date
Time
Room:
Date
Time
Room:
Tues. June 17
1:00 - 2:00 p.m.
B-110
Thurs. June19
10:00 - 11:00 a.m.
E-114
NOTE: The college/university is asking you to provide information that includes private and/or confidential information under state
and federal law. The college/university is asking for this information in order to process your application. You are not legally required to
provide the information the college/university is requesting; however, the college/university may not be able to effectively process your
application if you do not provide sufficient information. With some exceptions, unless you consent to further release of private
information, access to this information will be limited to school officials, including faculty who have legitimate educational interests in
the information. Under certain circumstances, federal and state laws authorize release of private information without your consent:
- to other schools in which you seek or intend to enroll, or are enrolled;
- to federal, state or local officials for purposes of program compliance, audit or evaluation;
-as appropriate in connection with your application for, or receipt of, financial aid;
-to your parents, if your parents claim you as a dependent student for tax purposes;
-if the information is sought with a subpoena, court order, or otherwise permitted by other state or federal law, and
-to an organization engaged in educational research or an accrediting agency.
Minnesota State Colleges and Universities abide by the provisions of Title IX and other federal and state laws forbidding discrimination
on the basis of sex, race, color, national origin or handicap and all other state and federal laws regarding equal opportunity. This
document can be made available in alternate formats, such as large print or cassette tape, upon request by calling one of the numbers
below.
If you have been arrested, charged or convicted of any criminal offense, you should investigate the impact that the arrest, charge or
conviction may have on your chances of employment in the field you intend to study or on your chances to obtain federal, state, and other
higher education financial aid.
This information can be made available in alternative formats such as Braille, large print or cassette tape, upon
request. For further information, contact us at 507-332-5847 (Faribault) or 507-389-7222 (North Mankato).
Page 11 of 12
Notice:

Online Technology: Students interested in the nursing program should expect to utilize online technology
in their studies. SmarterMeasure is a tool to help students decide if online learning is a good fit for them.
To access this tool, go to: http://southcentral.smartermeasure.com
Username: southcentral

Password: student
Communication: Students must have the ability to speak and be understood in English as well as
understand the English language. The Nursing Program recommends that students pursuing nursing, if
needed, take English for Academic Purposes as developmental courses to strengthen English skills in
preparation for the health care environment. These “EAP” courses can be found in the SCC e-catalog.
Submitting your application:
Applications must be received on the North Mankato campus or
postmarked by 4:00 p.m. on June 27, 2014!
Application materials should be mailed or dropped off to E-116 on the
North Mankato campus. Faxed applications are not accepted.
Heather Milton
E-116
South Central College
1920 Lee Blvd
North Mankato, MN 56003
Page 12 of 12
Application Checklist
Checklist ( Check the item if you meet the requirement)
____Be fully admitted to South Central College and provide all required college admission items by June 27, 2014.
____Attend one monthly Info Session and include 2014 certificate of attendance with this application. Failure to provide
original proof of attendance (certificate of attendance) results in an incomplete application.
____Completely fill out the nursing application. Incomplete applications will not be considered.
____Provide evidence of current nursing assistant registry in the State of Minnesota (NA,R). Attach a copy of your card
from the MN Department of Health verifying you are currently on the MN Nursing Assistant Registry. See page 5 to
view acceptable methods to provide proof of current registry.
____Provide verification of your completion of the SCC PN HESI Entrance Exam and proof of scoring 700 or higher.
See page 5 for more details.
____Request official transcripts from ALL other colleges are mailed to SCC Student Affairs Center (to demonstrate
completion of general education and pre-requisites if taken at another college).
See page 6 for the note on MnSCU transcripts.
____Submit ALL nursing application items between June 1 and June 27, 2014 to the North Mankato campus.
Single staple your application and supporting documents together before submitting them.
Please sign:
I fully understand the policies set forth by the Nursing Program at South Central College in regard to admission to the
nursing program. Furthermore, I hereby state everything listed in this application is correct. I understand that incomplete
applications will not be accepted. By submitting my application to the core-nursing program, I agree to follow the policies
and procedures set forth by the nursing program.
_____________________________________
Student Signature
____________________________
Date
There are 12 pages to this application. Is your
application complete? Do you have all pages
secured together?
ONE FINAL CHECK: Did you included these items with your application?
___ A completed application
___ A copy of valid proof of Nursing Assistant Registry status
___ The original certificate from Nursing Information Session
___ A copy of HESI exam results
Remember to keep copies for your records. SCC will not provide copies of any submitted materials to applicants.