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Personal Information
| First Name: | MI: | Last Name: | ||||||
|---|---|---|---|---|---|---|---|---|
| Student ID: | Birth Date: | Phone #: | ||||||
| SSC Email: | Personal Email: | |||||||
| Street Address: | City: | |||||||
| State: | Zip Code: | Permanent Resident Ohio: | ||||||
| RN License Information | ||||||||
| Type of RN License: | RN License #: | |||||||
| Years of RN Experience: | License Expiration. Date | |||||||
| Academic Background | ||||||||
| ADN- Institution: | Graduation Date: | |||||||
| SSC Graduate: | Reapplicant: | Overall GPA: | ||||||
| Prerequisite Course Grades (Grade Required โCโ or higher) | ||||||||
| Course | Grade | Course | Grade | Course | Grade | |||
| BIO221: | MTH124: | PSY123: | ||||||
| SOC121: | ENG124: | |||||||
| RN-BSN General Curriculum Course Grades (Grade Required โCโ or higher) | ||||||||
| Course | Grade | Course | Grade | Course | Grade | |||
| PHL 122 | ENG231: | Arts & Humanities Elective (1) | ||||||
| NTR121: | HIS100: | Social Science Elective (1) | ||||||
| PSY220: | COM121 or COM122: | |||||||
| Do you have the required documents? | ||||||||
| ADN Official Transcript | RN license | |||||||
| Eligible BCI Email from SSC Security | Completed 15-30 credits from OT36 (Ohio Transfer 36) | |||||||
| C or better in all courses | Application Form | |||||||
First Name:
MI:
Last Name:
Birth Date:
Student ID:
Phone #:
SSC Email:
Personal Email:
Street Address:
City:
Permanent Resident Ohio:
State:
Zip Code:
RN License Information
RN License #:
License Expiration.
Years of RN Experience:
Graduation Date:
ADN-Institution:
Reapplicant:
SSC Graduate:
Overall GPA:
BIO221:
MTH124:
PSY123:
SOC121:
ENG124:
PHL 122
Grade
Course
Arts & Humanities Elective (1)
NTR121:
COM121 or COM122:
Social Science Elective (1)
Social Science Elective (1)
PSY220:
Do you have the required documents?
Electronic Signature: Date:
Electronic Signature:
Date: