Directions for Submitting a Complete Application for the

Associate Degree Nursing Program

It is very important your application is legible, complete, and received in the Nursing office prior to the deadline. Only one submission will be accepted per applicant; multiple applications will result in disqualification.

APPLICATION ACCEPTANCE BEGINS: February 1

DEADLINE: April 15 (or the last business day prior) – 4:00 p.m.

Enclose all documents in a large manila envelope.

Applications may be MAILED to: Sierra College Nursing Department

5000 Rocklin Road

Rocklin, CA 95677

NOTE: If mailing, do not mail any later than 2 weeks prior to deadline. Application

may not be received in Roseville office in time to be considered.

Applications may be DROPPED OFF at: 333 Sunrise Avenue

Room 101

Roseville, CA 95661

NOTE: This address does not accept mail delivery.

A complete application consists of the following:

Official transcripts of all colleges where prerequisite courses were completed, including Sierra College. Pre-requisite courses cannot be “in progress.”
Official high school transcript ONLY IF meeting Math A requirement with high school algebra. (Two semesters of high school Algebra completed with a grade “C” or higher).
Course descriptions for all prerequisite courses if taken outside of Sierra College. The course descriptions must be from the institution/college attended and match the year the course was taken.
Your most recent English Composition course grade which is used to calculate the Chancellor’s Predictor of Success score. Include an official transcript verifying the most recent English Composition grade, and a course description if taken outside of Sierra College.
If you are using an assessment test to meet the required reading proficiency, submit a copy of the reading assessment test result from the Sierra College Assessment Center or printed from MySierra under Registration and Student Records/Course Placement & Eligibility. If assessment taken elsewhere, contact the Sierra College Assessment Center or a counselor to complete verification process.
Copy of DD 214 if you are a veteran (for statistical/reporting purposes).
Active, legible email address (this is how selected students will be notified).
TEAS Results – if achieved after June 2013.
Signature and printed name (pages 1 and 2).

PLEASE NOTE: If any item is missing, the application packet will not be processed. Application status will be communicated by email. Notification occurs approximately 8 weeks after the submission deadline. No telephone verification is provided by the nursing department or the counseling department. If not selected, all submitted materials will be destroyed; transcripts of selected students only will become property of the District and posted.

Admission into the nursing program is contingent upon a clear background check, drug screening, health screening and completion of the TEAS test with a cumulative score of 62% or higher. TEAS results are valid for one year and may be submitted along with the application provided they were achieved after June 2013. If not completed prior to applying, the TEAS will be administered once an applicant has gained provisional admission.

In accordance with Regulation 480 of the State Board of Registered Nursing, a person convicted of any offense other than a minor traffic violation, may not qualify to be licensed as a registered nurse. If there are any questions regarding this regulation, please contact the State Board of Registered Nursing, or visit their website at www.rn.ca.gov.

RN Applicant F14

Sierra College Registered Nursing Program

Fall 2014 Application

Demographics (Please Print)

1. Name______

Last First Middle

2. List maiden and all other names used ______

3. Address ______

Number and Street City State Zip

County

4.  Date of Birth

5.  Date of High School Graduation or GED Completion

Contact Information

1. Home Telephone

Cell

2. E-Mail Address (Required)

3. All colleges attended where pre-requisites were completed, including Sierra College. (ALL TRANSCRIPTS MUST BE ATTACHED).

College / City/State / Dates Attended

The following information is requested for compliance with Section 56110, Title V California Administrative Code reporting procedure and will be used for statistical purposes only. Please check applicable information.

Veteran
1 / American Indian/Alaskan Native
2 / Asian/Pacific Islander
3 / Black/African
4 / White/Caucasian
5 / Hispanic/Latino
6 / Other

YES, I am interested in pursuing the BSN Merger Track

I certify that all information contained on this form is true and accurate. I understand that failure to disclose or falsify any documents will automatically and permanently disqualify my application and admission into the nursing program.

Applicant’s Signature Date

Continue to Page 2 of the application

Applicant Name ______

Sierra College Registered Nursing Program

Prerequisite Course Work Verification

ATTENTION: All prerequisites must be completed, with a grade posted to applicable transcript, at the time application is submitted.

Prerequisite / Name of Course / College where course was completed / Date Completed
Semester/Yr / Number of Units / Grade
English 1A
Bio Sci 4 or 8A/8B (Microbiology)
Bio Sci 5 or 7A/7B
(Anatomy)
Bio Sci 6 (Physiology)
One of the following:
Math A, D, 12, 16A, 16B, 24, 29, 30, 31, 42, or two semesters of HS algebra or higher with grade “C” or better.
Psychology 1 (Introduction)
Human Development 1
Nutrition 10
Co-requisite / Name of Course / College where course was completed / Date Completed
Semester/Yr / Number of Units / Grade
Fundamentals of Public Speaking
Intro to Sociology OR Cultural Anthropology

Required – Demonstrated Reading Proficiency: Select ONE of the following:

Criteria / Select One
Completion of one of the following courses with grade “C” or better:
English 1B, 1C, 11, 50, N, ESL 30R; History 35; Philosophy 4. Include transcript.
OR / Course:
Possession of either a bachelor or higher degree from a regionally accredited institution (must match information on page 1 of application). Include transcript.
OR
Reading Assessment: Copy of reading assessment test result from the Sierra College
Assessment Center or printed from MySierra. If assessment taken elsewhere, contact
the Sierra College Assessment Center or a counselor to complete verification process.

3 RN Applicant F14