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Coconino Community CollegeAssociate of Applied Science in NursingFALL 2020 APPLICATION FOR ADMISSIONDeadline: Tuesday, March 3, 2020, by 12:00 pm Nursing Department, Fourth StreetOnly completed applications will be acceptedApplication ChecklistOFFICE USE ONLY 1. Demographics completed2. Pre-requisite courses listed (grade, date completed, college)3. GPA 3.0 or higher?4. Co-requisite courses listed (if completed)5. AZ LNA license copy provided6. DPS Fingerprint card (copy)7. Total TEAS test results provided with score 66.1% or higher8. Attended an Application Information Session9. Copy of all official transcripts including CCC10. Application complete, including this checklist11. Application in a sealed envelope (do not bend)Number of CCC CreditsNumber of Gen EdCreditsOFFICE USE ONLY, DO NO WRITE BELOW THIS LINECurrently Work inHealthcarePrior ApplicantCEPReviewed by:Applications must be turned into the Nursing Department: 3000 N. Fourth Street, Flagstaff, Arizona 86004Administrative Assistant’s Office, by Tuesday March 3, 2020 by 12:00 pm
Coconino Community CollegeAssociate of Applied Science in NursingFall 2020 APPLICATION FOR ADMISSIONDeadline: Tuesday, March 3, 2020, by 12:00 pm Nursing Department, Fourth StreetOnly completed applications will be acceptedPlease Type or Print:Name: CCC ID:Mailing Address:City: State: Zip Code:Phone: CCC Email:1. Pre-Requisite CoursesCourseBIO 201GradeDate CompletedBIO 202BIO 205BIO 218Can be in progress ifcompleted by 8-1-20CHEM 130/138ENG 101MAT 142 (or higher)NTR 135BIO 181 (optional)PSY 101 (optional)*** Please provide a copy of all official transcripts including CCCCollege
2. Co-Requisite CoursesCourseENG 102Grade/IPDate CompletedCollegePSY 240Arts & HumanitiesGeneral EducationOption (course nameand number)**Please provide a copy of all official transcripts3. AZ LNA License Number: Exp. Date:**Please provide a copy4. TEAS Preadmission Score (total score):**Please provide a copy5. Have you previously applied to the CCC Nursing Program (circle one)?YESNOIf yes, date:6. Date you attended the Nursing Application Information Session:7. Are you interested in the Concurrent Enrollment Program throughGCU or NAU (circle one)? YES NO If yes, please fill in last page completely.8. Do you currently work in healthcare (circle one)? YESSignatureNODateI certify that all the information provided by me is true, complete, and accurate. Falsification or omission of pertinentdata on the application will forfeit admission to the Associate in Applied Science Degree. I acknowledge that admissionto the program is conditional until I have successfully completed all pre-requisites. I understand that if accepted I will berequired to meet the health requirements of the nursing program. Failure to complete this application will result ininvalidation of the application, and it will not be reviewed for admission.
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CONCURRENT ENROLLMENT PROGRAM (CEP)I am interested in applying to (circle one):NAUGCUName:Email: Phone:Address: City/State/Zip:I consent to my information being shared with NAU (Northern Arizona University) or GCU (Grand Canyon University)solely for the purpose of applying for the CEP. The Director of Nursing at CCC will be providing information within thisapplication to the appropriate personnel at the college I have chosen. I understand I may have to provide additionalcopies of official transcripts and other information as requested to the college I have chosen.SignatureDate
I consent to my information being shared with NAU (Northern Arizona University) or GCU (Grand Canyon University) solely for the purpose of applying for the CEP. The Director of Nursing at CCC will be providing information within this application to the appropriate personnel at the college I h
