Nursing ​​Application Form​

Nursing Application Form - Page 1

1. Know which Rout​e to choose

• Generic – two-year nursing program—the most common and likely choice
• LVN-RN – enter Generic program with advanced placement, pending space availability; must be enrolled in required transition courses at time of application
• Semester and year –​ indicate target admission semester

2. Provide your basic info​rmation

• Your LACCD Student ID # and LACCD Email Address are required. Only the LACCD Email Address will be used for any and all communication regarding your nursing application—make sure the email address is spelled correctly. The Nursing department will not attempt to correct a misspelled email address and will simply mark the application as ineligible.
• Age should be automatically calculated from Date of Birth

3. ATI TEAS, RN Program, Veter​an Status

• Indicate Yes/No for each area
• ATI TEAS – if you have taken the ATI TEAS previously, report your score. However, do not send or attach your scores to your application.
• If you have previously attended another RN program, you must obtain and complete the Transfer Recommendation Form from the nursing website. This must be completed by you, as well as by the Program Director of your previous program. The previous program will need to mail the form back to LAHC Nursing on your behalf.
• Veteran Status – include proof of veteran status (e.g. DD 214)

4. Education and School Atte​nded

• Indicate Highest Education Completed
• List schools in order of most recently attended
• Trade schools are not required to include

5. Pre/Co-Re​quisites

• For separate Lecture and Lab science courses, provide the individual information for each course. If you took a combined course, you may leave the Lab information blank.
• For any Co-Requisites in-progress, provide the necessary information and type the Grade as "IP."
• If you repeated any sciences courses (Anatomy, Physiology, or Microbiology) to replace a substandard grade e.g. ("D," "F") or to improve a passing grade, go to "Repeated?" and select "Yes." Under Grade, please provide the repeated grade (not the substandard grade).
• If you repeated any sciences courses (Anatomy, Physiology, or Microbiology) for recency, go to "Repeated?" and select "Yes, for Recency." However, please provide the first grade received (not the grade from recency).

6. Signature and De​mographics

• Sign and date your application form. Applications without signature will be denied.
• Please complete the Demographics portion, as it is required. However, the information you provide does not affect your eligibility for admission into the program.