RN-to-BSN-Application-Form-artifacted.pdf — PaddleOCR-VL (Baidu)

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 “C” or higher)
Course	Grade		Course	Grade		Course	Grade
BIO221:			MTH124:			PSY123:
SOC121:			ENG124:
RN-BSN General Curriculum Course Grades (Grade Required “C” 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)

PSY220:

Do you have the required documents?

Electronic Signature: Date:

Electronic Signature:

Date: