Collin College

Nursing Program(s) Admission Application

ADN Nursing Program

______

Read the application carefully, complete, sign, and submit with required documents to:Collin College, Nursing Department,2200 W. University Drive,McKinney, TX 75071. Submitting an application is not a guarantee of acceptance into the program.

(Please Select )

Nursing –Summer Semester 20; Submit by January 15th (Starting 2018)

Traditional LVN-RN Bridge Medic/Paramedic Fast Track

Nursing – Fall Semester 20; Submit by May 31st

Traditional LVN-RN Bridge Medic/Paramedic Fast Track

Nursing - Spring Semester 20; Submit by August 31st

Traditional LVN-RN Bridge Medic/Paramedic Fast Track

HCA North Texas 2-Step -Summer Semester 20; Fall Semester 20; Spring Semester 20;

Traditional LVN-RN Bridge

I. Personal Information (Please Print or Type)

Last Name / First Name / Middle
Initial
Other Legal Names Used
Street Address / County
City / State / Zip
Home Phone / Work
Phone / Cell Phone
Email Address / Employer
CWID# / Social Security#

Have you submitted an admission application and been accepted at Collin College?

Yes No If No, please submit an application to the Admissions Office.

Have you submitted an application to the Collin College Associate Degree of Nursing program before? If yes, what year?

Yes, Spring: Summer: Fall: No

II. Academic Information

Complete Academic History (Including Collin College)

College(s) attended/attending: Dates attended/attending (most recent first)

College Attended Dates

(Write additional colleges/universities attended on back of form)

List any degree(s) or certifications you have earned and your major:

(Write additional colleges/universities attended on back of form)

III.PSB - Nursing School Aptitude Exam: Date Completed or Date to Take .

**The PSB test may only be taken once per application cycle. Testing Center personnel may end a test session if all directions and procedures are not followed.Failure to complete the test will void the application to the nursing program.

IV. Acknowledgment for LVN-RN and Medic/Paramedic Bridge Programs: HESI Mobility (second entrance exam) will be administered once nursing admission requirements have been met. Nursing Department will contact applicant regarding scheduling.

**The HESI Mobility exam is only required for the LVN-RN Bridge and Medic/Paramedic Fast Track programs and benchmark of 850 higher achieve. The exam results are valid for 12 months.

IV. Eligibility

Have you ever been arrested for anything in your life? Yes No If yesyou will not be allowed to begin the program until you have been cleared by the Texas Board of Nursing. Contact the Texas Board of Nursing to begin the Declaratory Order process.

**(Collin College student applicant ONLY)**

Collin College Authorization to Release Academic and Disciplinary Records

I hereby authorize Collin College - Dean of Students Office, to release information of my academic and disciplinary record to the Collin College Nursing Department as part of the application process for the Associate of Applied Science – Nursing program.

Student’s Signature: ______Date: ______

VI. (Initials required) Non-Collin College Students ONLY

A Disciplinary Action Disclosure Release must be completed in order to apply. Please complete and submit Exhibit A form to your current or last institution attended. Form must be sent directly from institution (application deadline dates listed on page one will be strictly enforced)

Applicant's Signature ______Date ______

Please provide official transcripts from all colleges attended, including Collin College.

Collin College does not discriminate on the basis of race, color, religion, age, sex, national origin, disability or veteran status.

Revised: February 2017

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