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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.\nDate
Academic Background
ADN- Institution:Graduation Date:
SSC Graduate:Reapplicant:Overall GPA:
Prerequisite Course Grades (Grade Required “C” or higher)
CourseGradeCourseGradeCourseGrade
BIO221:MTH124:PSY123:
SOC121:ENG124:
RN-BSN General Curriculum Course Grades (Grade Required “C” or higher)
CourseGradeCourseGradeCourseGrade
PHL 122ENG231:Arts & Humanities Elective (1)
NTR121:HIS100:Social Science Elective (1)
PSY220:COM121 or COM122:
Do you have the required documents?
ADN Official TranscriptRN license
Eligible BCI Email from SSC SecurityCompleted 15-30 credits from OT36 (Ohio Transfer 36)
C or better in all coursesApplication Form
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