| 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 |
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