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Forsyth Campus3410 Ronald Reagan Blvd.Cumming, GA 30041Admissions (Forsyth): 678-341-6610ASN Program contact:ASN-Program@laniertech.edu 678-341-6604Associate of Science in Nursing (ASN) Program ApplicationCohort Beginning FALL 2022**(NOTE: This is not an admissions application to Lanier Technical College)**Applicants must complete this ASN Program application form and submit it, along with all required supplemental documentation, to the address shown on page 4;the entire packet must be received on campus by 5 pm (EST) January 18, 2022 (no later), to be considered for selection for the fall 2022 cohort. Note: this isa fillable PDF; please type in your responses, and then, once completed, print this form out to be submitted, along with all required supplemental paperwork, asoutlined on page 5 of this document. Candidates who submit incomplete application packets will not be considered in the admissions process for theASN Program.NameLastFirstLTC Student ID Number*MiddleBirth DateSocial Security #*Note: You must be an accepted & admitted LTC student with no ‘holds’ on your account prior to submitting an ASN Program ApplicationAddressStreet/Road/PO BoxCityStatePhone (Mobile)Zip CodeCountyPhone (Other)LTC Student EmailPersonal EmailApplicants must complete the Test of Essential Academic Skills (TEAS) for Allied Health to be considered for selection. The TEAS may be taken no more than 2times in a calendar year, with at least 30 days between each attempt. No TEAS score greater than five (5) years old will be accepted. Please list the scoreand date for each time you have taken the TEAS. Note: If you have taken the TEAS at a testing site outside of Lanier Technical College, you must request yourofficial TEAS score report be sent from ATI to Lanier Technical College.1st Attempt3rd AttemptScoreDate2nd Attempt4th Attempt1 of 69/2021 lvScoreDate
ScoreDateScoreDateAttendance at an ASN Information Session within one year of the ASN application deadline is mandatory; please list the date below that youattended an ASN Information Session. This will be confirmed against ASN information session attendance records. To register for a session, go tothe ASN webpage, which may be found at on-webinar-tickets-101674240390DATE YOU ATTENDED AN ASN INFORMATION SESSIONDateCompletion of the following courses with a grade of ‘C’ or higher in each course and with a cumulative grade point average of 3.0 orhigher of these courses is required. Please list the grade(s) you have for each of the courses. List the highest grade for courses that have beenretaken; these grades will be verified alongside the applicants’ official transcript(s) on record with Lanier Technical College.GRADECOURSEENGL 1101 (Composition and Rhetoric)ENGL 1102 (Literature and CompositionBIOL 2113 (Anatomy & Physiology I)*BIOL 2113L (Anatomy & Physiology I Lab)*BIOL 2114 (Anatomy & Physiology II)*BIOL 2114L (Anatomy & Physiology II Lab)*BIOL 2117 (Introductory Microbiology)*BIOL 2117L (Introductory Microbiology Lab)*PSYC 1101 Introductory PsychologyMATH 1111 (College Algebra)Area IV: General Education Core class*Note: All courses with the “BIOL” prefix may be no more than five (5) years old on the application deadline.2 of 69/2021 lv
Associate of Science in Nursing (ASN) Program ApplicationSignature PageI hereby apply for admission to the ASN Program for fall semester 20 and certify this application and the accompanying documentation isboth correct and complete. I have read the application packet, and the ASN Program information (which may be found ursing/associate-of-science-in-nursing/), including the essential skills necessary for the ASNProgram, and the Admission Points Worksheet (all found on the ASN webpage), and I understand the application and selection processes.I further understand that any failure on my part to comply with these processes will result in the invalidation of my application. I am aware of thecompetitive nature of the application process for the ASN program and understand that meeting all minimum requirements as outlinedon the Admission Points Worksheet does not guarantee admission into the program.Signature3 of 69/2021 lvDate
Continue reading below for application submission instructions and supplemental documentation checklist.4 of 69/2021 lv
Please mail the completed application packet (pages 1 – 3) and all required documentation to the addressbelow:Lanier Technical CollegeAttn: Program Application for AdmissionAssociate of Science in Nursing – Room C209A3410 Ronald Reagan BlvdCumming, GA 30041ONLY mailed application packets received by 5PM on January 18, 2022 will be accepted. ONLY complete application packets that includethe required supplemental documentation will be processed. Hand delivered application packets will not be accepted and incompleteapplications will not be processed.Application Status: Please do not call or email to inquire about the status of an application. Once your application packet has been received, youwill receive a confirmation email; confirmation may be delayed if the College is closed for any reason. If you desire a secondary confirmation thatyour application packet was received, please mail the application as certified mail, or with a tracking number, via the US Post Office. Mailing theadmission packet this way allows you to receive delivery confirmation from the postal service. If you wish to know if your application is complete,please read all directions and utilize the checklist below.5 of 69/2021 lv
Checklist for required documentation for completed ASN Application Packet:ATI TEAS Score Report [NOT the ATI TEAS V (five) test] Include an unofficial copy of your TEAS Score Report with your application; scores are automatically sent to the location where yourtest was administered (no cost). Therefore, if you take the TEAS at a Lanier Technical College campus, you will not need to havethe official TEAS test results transcript sent in with your application documents. If you took the TEAS elsewhere, you must requestthat the official ATI transcript be sent to Lanier Technical College (this includes if you took the proctored TEAS online, which isonly accepted for the fall 2022 cohort, due to the limited testing opportunities this past year, due to COVID restrictions). TEAS transcript information is found at ATI’s website: https://www.atitesting.com/Completed ASN application, must be received on campus (via mail) by Tuesday, January 18, 2022, by 5:00 PM (EST) Sent as certified mail or with a tracking number, (optional), if you want your application to be trackedLegible printout/copy of current American Heart Association BLS for the Healthcare Professional certification (course mustinclude hands-on training; must remain active throughout the entire ASN program). NO 100% online courses will be accepted.Legible printout/copy of current, ACTIVE licensure/certification from the official issuing organization (for LPN/LVN, certifiedParamedic, certified EMT-I/A-EMT, Certified Medical Assistant, Registered Medical Assistant, and Certified Nursing Assistant):ParamedicineMust have attended a state-approved and accredited Paramedicineprogram, completed a clinical practicum, and passed the NREMTCertification ExaminationEMT-I/AEMTMust have attended a state-approved and accredited Paramedicineprogram, completed a clinical practicum, and passed the NREMTCertification ExaminationMedical AssistantCMA/RMA applicant must have attended a CAAHEP or ABHES accredited program,completed a clinical practicum, and passed the CMA (AAMA) or RMA (AMT) CertificationExamination (CCMA is not accepted)Nursing AssistantCNA applicant must have completed a program that includes classroom education, a clinical practicum, and passedthe National Nurse Aide Assessment Program (NNAAP)6 of 69/2021 lv
Applicants must complete this ASN Program application form and submit it, along with all required supplemental documentation, to the address shown on page 4; . Associate of Science in Nursing (ASN) Program Application Cohort Beginning FALL 2022 **(NOTE: This is not an admissions application to Lanier Technical College)** 2 of 6
