Practical Nursing Certificate Application "*" indicates required fields Name* First Last Preferred name Email* Enter Email Confirm Email Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code GCC Student ID #* Check all that apply I am a US military veteran I am currently enrolled at GCC I was previously enrolled in the GCC Practical Nursing Program Requirement #1 • College Application*Program application and transcripts (if applicable) will not be reviewed until you have submitted a GCC application. If you are already enrolled at GCC it is highly recommended to choose Pre-Nursing with Practical Nursing Intent for your major to ensure proper advising as you work on your requirements. To change your major, complete and submit a Change of Major/Advisor Form to the Registrar. I have completed a GCC Application for Admission Requirement #2 • High School Transcript*Submit official high school transcript or GED/HiSet transcript with graduation date (required) to the Office of Admission. All students must submit regardless of college experience. Official high school transcripts must come directly to GCC from the high school. I have submitted or requested that my official transcripts be sent to the Office of Admission Requirement #3 • Transfer Credit Evaluation*Submit official transcripts of all previous colleges attended to the Office of Admission. After your transcripts have been reviewed, transfer credit will appear in your MyGCC record and email will be sent to your GCC student email address regarding placement testing requirements. It is your responsibility to check to ensure that all transfer credit has been applied. I have submitted or requested that my official transcripts be sent to the Office of Admission I have not attended another college besides GCC I have never attended college Requirement #3a • Transfer Credit Evaluation Email* I have received my transfer credit evaluation email Requirement #4 • Math*Check only one. I have ... Completed Math 095 or HUD 138 or higher level math course at GCC with a grade of C+ or better within five years prior to entering the PNC Program Received placement assessment scores placing out of MAT 095 within 5 years prior to entering the PNC program Completed equivalent math course(s) at a previously attended college. Requirement #5 • English*Important information about the English requirement: Eligibility to take English Composition I is determined by taking placement assessments and receiving scores that place you into ENG 101. If your scores are below those noted, you must complete developmental level English (ENG 090 and/or ENG 094) before you can take English Comp I.Check only one. I have ... Completed English Composition I (ENG 101, 103, or 105) at GCC with a C or better Completed an equivalent English course at a previously attended college Requirement #6 • Science*Indicate one GCC course from the list below that you have completed within five years prior to entering the PNC Program with a grade of C or better, or the equivalent course at a previously attended college. Comprehensive Anatomy and Physiology (BIO 194) Human Anatomy and Physiology I (BIO 215 or 195) Human Anatomy and Physiology II (BIO 216 or 196) Requirement #7 • Test for Essential Academic Skills (TEAS)*Log on to the ATI testing website to learn about the exam, purchase study materials, create an account and register for a testing date. There is a testing fee required when you register for the exam. It is highly recommended to schedule your testing appointment after you have completed steps 1 through 5. Test results from other testing sites are accepted, but the testing fee may be higher at other locations. A copy of your TEAS scores (complete with all subject scores) must be attached to your program application. The College will not download scores from ATI. I have completed the TEAS within two years of entering the PNC Program, with a composite score of 50%, including a reading score of 50% and a math score of 55% Upload your TEAS scores* Drop files here or Select files Accepted file types: pdf, Max. file size: 8 MB. Note about course currency: You must maintain currency of your math and science courses so that they are current within five years of the date you enter the program. Academic advisors are available to help you determine when your currency will expire, and how to maintain your currency if it will expire prior to program entry. Final acceptance and enrollment in the program is conditional upon the following additional requirements that must be submitted after you receive an acceptance letter to the program. The deadlines posted in your acceptance letter are strictly enforced. Students who do not have these items completed by the posted dates WILL BE REPLACED by students on the waiting list! Massachusetts Department of Public Health currently required immunizations for post-secondary students A completed Health History and Physical Exam Form. Compliance of date frames specified on all sections of the health forms are strictly enforced. A completed Tuberculin Testing Form A completed CORI (Criminal Offenders Record Information) Request Form American Heart Association Basic Life Support (BLS-Instructor-led or Heart Code BLS) CPR/AED course (cover adult, child and infant) Cumulative GPA (grade point average) at GCC of 2.0 Drug testing, flu vaccination and fingerprinting may be required once in the program Mandatory attendance at summer orientation (date announced in late spring) Successful completion of this program requires proficiency in the performance of a variety of skills. Technical standards, meant to clarify minimal standards for essential affective and psychomotor functions, require students to Be ambulatory Be able to lift a minimum of 50 lbs Possess fine motor coordination required to perform such technical skills as preparation and administration of medications Have visual acuity to perform technical skills such as physical assessment, preparation of proper dosage of medications Have auditory perception allowing effective use of stethoscope and communication Have emotional stability required to exercise sound judgment and intervention activities Have emotional maturity to develop appropriate therapeutic relationships By signing this application, you are indicating that you have read and understand these requirements. Agree to Terms of Acceptance & Enrollment* I understand that by submitting this application, I indicate that I have read and understand the acceptance and enrollment requirements