***Please complete all fields, insert n/a in fields that do not apply

Reset
Print
Submit
**To submit this form by email, save it to your
computer and use Adobe Reader to open it **
RN to BSN Nursing Application
OUR LADY OF HOLY CROSS COLLEGE DEPARTMENT OF NURSING APPLICATION FOR ADMISSION RN to BSN PROGRAM ***Please complete all fields, insert n/a in fields that do not apply***
DIRECTIONS Fill in all applicable fields. Answer all questions. Incorrect or incomplete information will delay
processing of this application. Contents of this application are considered confidential and will be available only to
authorized person
Admission is requested for Fall 20 __ ____ Spring 20__ ____ Summer 20__ ____
Prefix _____Mr. _____Miss _____ Ms _____Mrs
First Name ________________________________________________________________
Last Name ___________________________________________________ Middle Initial ______________
Maiden Name _________________________________________
Permanent Address ___________________________________________________________________________
City ________________________________________
State __________
Zip _____
Mailing Address ______________________________________________________________________________
City ________________________________________
State __________
Zip _____
Email ______________________________ Home Phone _______________ Cell phone _________________
State of Residence
Race __________ Gender __________ Birth Date __________ Marital __________
Religion __________
Previous Education List every University or College you have ever attended. Begin with your current school first.
Include Institution Name, Dates of Attendance, Major Area of Study, Degree or Diploma.
RN to BSN Nursing Application
OUR LADY OF HOLY CROSS COLLEGE DEPARTMENT OF NURSING APPLICATION FOR ADMISSION RN to BSN PROGRAM Employment History (most recent first) Include Institution and Address, Dates of Employment, Position and Reason
for Leaving.
Do you have a current unencumbered nursing license?
_____ Yes
_____ No
Have you ever before made application to OLHCC Department of Nursing? _____ Yes
RN License State ____________
_____ No
If 'Yes', give date of previous application to the OLHCC Department of Nursing __________
Are you currently enrolled in any other school? _____ Yes
_____ No
If you are not a student at OLHCC, are you enrolled at another college? If so, where?
______ Yes ______ No
______ I am currently not attending school
List any pre-requisite courses you are currently enrolled in or will enroll in prior to entry into the RN to BSN
Program. Indicate the semester and year, then list courses.
RN to BSN Nursing Application
OUR LADY OF HOLY CROSS COLLEGE DEPARTMENT OF NURSING APPLICATION FOR ADMISSION RN to BSN PROGRAM If you are not a student at OLHCC, have you applied and been accepted to OLHCC? (If not, applicant must apply to
OLHCC before Application for Admission to the Department of Nursing can be processed.) ______ Yes _____ NO
List any Honors, Awards, Scholarships/community involvement.
DIRECTIONS In the space below, compose a personal statement explaining why you wish to pursue a BSN degree
at OLHCC.
By entering the date and my name below, I HEREBY CERTIFY THAT THE INFORMATION GIVEN IN THIS
APPLICATION IS TRUE AND COMPLETE
___________________________________
_________________________________
Print Name
________________________________
Signature
___________________________
Date