FOR OFFICE USE ONLY New Applicant YES NO TEAS V SCORE ELIGIBLE Applicant YES NO APPLICATION DATES: JANUARY 15 TO FEBRUARY 18, 2015 INSTRUCTIONS Complete all blank spaces. 1. Application form Submit the Nursing Program application after all prerequisite course work for admission has been completed. The Nursing Department is located in the Center for the Sciences Building 9000. You can mail application to: 6201 Winnetka Avenue, Woodland Hills, CA 91371 Attn. Nursing Department – Mailbox 258 or submit in person during office hours. Office Hours: Monday to Thursday 8:30am to 12:30pm and 1:30pm to 3:30pm. Friday – CLOSED 2. Official Transcripts Submit one set of official transcripts of required academic course work from all colleges attended, including LAPC. These must be submitted to the Nursing Department along with your application. Withholding college transcripts is grounds for denial to the LAPC Nursing Program. a. If you have completed required prerequisites within LACCD’s nine colleges, you still need to submit one set of official transcripts from each college attended to the Nursing Department. For a complete list of LACCD colleges, please go to www.lacolleges.net. 3. Course Equivalencies Prerequisite courses taken outside of the Los Angeles Community College District will be evaluated by the Counseling Department. Submit catalog course descriptions from the catalog year the course was taken along with your application for all courses completed outside the Los Angeles Community College District. The Nursing Department will forward the information to the Counseling Department. 4. TEAS V Test – Paper and pencil TEAS test will be offered two days only: Friday, March 6, 2015 from 9:00am to 1:00pm and Saturday, March 7, 2015 from 9:00am to 1:00pm. TEAS V will be offered to eligible students only. 5. Submit copy of LVN license Please Check all that apply: LVN to RN – ADN ___________________________________ Last Name 88 - ___ ___ ___ - ___ ___ ___ ___ Student ID # (if applicable) __ __ - __ __ - __ __ __ __ Date of Birth ____________________________ First Name ____________________________________ Valid Email Address (write legibly) (__ __ __ ) __ __ __ - __ __ __ __ Home Phone Number _______________________________________________ Street Address Letter of Reference: Work Experience: LVN – 30 units option Yes LVN TO RN Admissions Application FALL 2015 No LVN License #: Expiration date: ________________ _______________ ____ M.I. Female Male __________________________________ LAPC Email Address (if applicable) (__ __ __ ) __ __ __ - __ __ __ __ Cell Phone Number ___________ Apt. No ________________________ City ___________ Zip Code ____________________________ _________________________ 88 - __ __ __ - __ __ __ __ ________________ Last Name First Name Student ID # Date REGISTERED NURSING PROGRAM: The following semester courses must be completed with a grade of “C” or better prior to acceptance of this application. Complete the following; names of Colleges can be abbreviated. General Education Requirements Course Units Course name/number OFFICE USE ONLY College Semester/yr Units Grade COURSEWORK REVIEW Anatomy 1 or Physiology 8 4 Repetition Yes No Physiology 1 or 9 4 Repetition Yes No 4/5 Repetition Yes No Microbiology 1 or 20 GPA Anatomy, Physiology, Microbiology GPA 2.5 minimum Please leave blank Reviewers initial: Psychology 1 or 6 3 Yes No Psychology 41 (Life Span) 3 Yes No English 101 3 Yes No 3 Yes No 4/5 Yes No GPA Overall GPA (all prerequisites) GPA 2.5 minimum Math 115 or higher* or Math Competency Exam Chemistry 51 or equivalent or *1 yr HS Chem/lab Please leave blank Reviewers initial: Additional Requirements for Graduation (complete if applicable) Speech 101, 102, 104 or 121 History/Political Science 3 Yes No 3 Yes No Humanities 3 Yes No Math (125 or higher) 5 Yes No PE 1 Yes No Anthropology 102 or Sociology 1 or 2 3 Yes No Note: Refer to LAPC Catalog, Nursing Brochure and website www.piercecollege.edu/departments/nursing for additional information on eligibility requirements for the lottery and the TEAS Exam. Additional courses are required to complete the nursing major and graduate. *Math 125 required for graduation. *High school transcript must be submitted for Chemistry. Print name _______________________________________ Date: ___ ___ / ___ ___ / ___ ___ ___ ___ LVN TO RN Admissions Application FALL 2015 Signature ___________________________________________