Nursing Program Application

If you see this don't fill out this input box.

Please note, that in addition to the application below, you must complete the CCC application or the SUNY application for admission. An official copy of your high school transcript is required. A GED will be accepted in lieu of a high school transcript. If you have attended other colleges or received credit from other colleges, including CAP credit, you must have official academic transcripts sent from each of those institutions.

First Name: *

Middle Initial: *

Last Name: *

Previous Name(s):Include any previous names used.

P.O. Box or Street Address: *

City: *

State: *

Zip Code: *

Phone Number: *Include a phone number where we can reach you.

Email Address: *Include an active email address where we can contact you.

Date of Birth: *Select your birth date.

Social Security Number: *

Education History: *Please list information concerning high school or other secondary schools attended. Include name of school, location of school, date of entrance and exit, and diploma/degree received.

Have you ever previously applied to Clinton Community College? *

Yes

Have you previously attended Clinton Community College? *

Yes

Have you ever been in Clinton's Nursing program before? *

Yes

If you've previously attended Clinton, were you academically dismissed in the last semester you attended? *

Yes

Are you currently attending Clinton? *

Yes

Have you ever been dismissed from Clinton or any other college for disciplinary reasons? *

Yes

Previous College History *Please list below information concerning ALL colleges, universities, or other post-secondary schools attended. Please include name of school, location of school, date of entrance and exit, and diploma/degree received.

If program was not completed, state reason:If any previous college program was not completed, indicate a reason why.

Applicants who have attended another school of Nursing, RN or LPN, and left prior to completion, must request a letter from the Nursing Program Director be sent to the Nursing Program Director of Clinton Community College indicating the circumstances under which the student withdrew.

Please list other educational, travel, and/or community service experience.Describe any additional educational, travel, and/or community service experience.

Do you have any prior health-related work experience (Nurse aid, medic, etc)? *

Yes

If yes, please describe work, including length of service:Describe any previous health-related work experience. Include dates of service.

How would you rate your own general health? *

Excellent

Good

Fair

Poor

Essay *Please respond with an account of (1) your experiences and activities since you last attended school, if more than six months have elapsed, (2) all the things you have accomplished that have given you the greatest satisfaction, (3) what you most enjoy doing in your leisure time, (4) your reasons for selecting nursing as a career, (5) any special reasons for desiring to enter this school, and (6) your plans and aspirations for the future. Include any data or facts relative to your application which you feel are important and which may not have been covered elsewhere.

Nursing Admissions

Nursing Program Application