Nursing Program Application Form (RN)

Dear Nursing Program Applicant:

Thank you for your interest in the HCCC Nursing Program. Qualified applicants are accepted on a “rolling admission” basis, every fall. We are now accepting applications to begin Nursing courses - Fall 2024. The Nursing Program will continue to accept qualified applicants until the class has become filled to maximum capacity.

Please complete the attached Nursing Program Information Sheet and the HCCC application (If you are not currently enrolled at HCCC) and submit all other required documents as soon as possible.

Thank you for your interest in the HCCC Nursing Program and we look forward to you becoming a part of our Nursing Program in the near future.

Sincerely,
HCCC Nursing Program

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Student ID*

Today's Date*

Last Name*

First Name*

Middle Initial

Home Address*

City*

State*

Zip Code*

Home Phone*

Work Phone

HCCC Email*

Alternate Email*

Emergency Contact Name*

Emergency Contact Number*

Have you previously applied for admission to the Nursing Program?*

Yes

If yes, date:

Have you ever taken the ATI TEAS Exam?

Yes

If yes, where and when?

Are you currently a Licensed Practical Nurse?*

Yes

If yes, give your license number:

Have you ever been convicted of a felony or misdemeanor?

Yes

If yes, please explain:Pull lower right corner to expand text box

I certify to the best of my knowledge that the information is correct and that falsification of information may subject me to dismissal.