Applicant Information:


Palomar College Nursing Education – LVN to RN Application 2018 - 2019

First Name, Middle Name, Last Name
Previous Name(s)
Address
Cell Phone Number
Home Phone Number
Birthdate
Palomar College Student ID Number
Personal Email
Ethnicity (Circle One) / American Indian, Alaskan Native, African-American, Asian, Pacific Islander, Hispanic, Filipino, White or Other

Applicant Coursework:

Course Name
(Science Prerequisites and GE Required Courses) / Course Number / Number of Units / Lab Course
Yes/No? / Repeated Course
Yes/No? / Year Completed / Letter Grade
Received / Name of College
Anatomy or
Anatomy & Physiology I
Physiology or
Anatomy & Physiology II
Microbiology
Intermediate Algebra or Higher
English Composition
Communications/Speech
Psychology
Sociology
Humanities

Applicant LVN Information:
Palomar College Nursing Education

LVN to RN Application

LVN School Name / Year Completed / Accredited Yes/No / LVN License Number / Expiration Date of License / ATI TEAS Score
LVN to RN Transition Course / Course Number / Lab
Course Yes/No / Repeated
Course Yes/No / Year Completed / Letter grade Received / Name of College
LVN Work Experience / Date
Started / Date
Left / Employer Name / Employer Address / Employer Phone
Six months minimum
experience is required within the past 2 years

Applicant Detailed Information (Circle Below):

DRC Student / Yes / No
Veteran / Yes / No
Applied before / Yes / No

Required Application Documents to Apply:

ü  All unofficial transcripts of coursework must be included

ü  A copy of high school, GED, CHSPE or highest level of U.S. degree awarded

ü  A copy of LVN license and LVN school unofficial transcripts

ü  Proof of LVN employment

ü  A copy of all unofficial TEAS attempts

Please Note: All courses used in this application are subject to evaluation and approval by the College for completion of the AA or AS degree. Minimum Science GPA of 2.5 is required to apply. Physiology and Microbiology must be completed within 7 years prior to the application date, 10 years for Anatomy. Only one (1) repeat of one (1) science prerequisite course is allowed. Online science coursework is not accepted. In addition, a 62% or better on the ATI TEAS exam is required to apply. All documents must be submitted with the application at the time of submission to be considered.

Applicant Signature and Date: ______