John Tyler Community College Nursing Program Application
VCCS Student ID______Semester______Year______
Select only one of the following:
( ) Consideration for the Hybrid Track only
( ) Consideration for the Traditional Track only
( ) Consideration for Both Tracks: Hybrid 1st choice and Traditional 2nd choice
( ) Consideration for Both Tracks: Traditional 1st choice and Hybrid 2nd choice
READ CAREFULLY: Per VCCS Policy 6.0.5, admission consideration is given to qualified applicants who are residents of the political subdivisions supporting the college and residents of those localities. Since enrollments are restricted for the Nursing Program, admission consideration will be given to permanent US residents of the JTCC service area first. Contact your nursing advisor for questions.
APPLICANT INFORMATIONLast Name / First Name / MI / Date
Street Address / Apt #
City / State / Zip / County/ City of Residence
Primary Phone # / Phone # 2
VCCS Email address:
CHECKLIST FOR COMPLETE APPLICATION / INITIALS
I am enrolled as a student at John Tyler Community College.
Prior to submitting my application, I have verified that my official High School transcripts or GED documents are on file at the JTCC Academics and Records department.
Prior to submitting my application, I have verified that all of my official college transcripts are on file at the JTCC Academics and Records department.
I have completed the TEAS test and submitted the correct official TEAS results document (the bar graph format) with this application.
I have an overall cumulative GPA of at least 2.0 in all coursework.
I have completed or am currently enrolled in all pre-requisite courses with a grade of “C” or better.
I have independently written a personal statement and included it with this application.
I have attended the mandatory Nursing Information session or watched the online Nursing Information session located on the JTCC nursing website: ______/______(Month/Year)
ACADEMIC HISTORY / FROM / TO / LAST YR ATTENDED / GRADUATED?
(yes/no)
High School
GED
College
College
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(yes/no)
College
College
List any certificates or Degrees you have been awarded
How many academic courses have you taken online?
READ these Directions:
· If a pre-requisite course was taken at another college, write the specific course prefix and number from that particular college in the Prefix & Course Number column and include the college where taken in the designated column.
· If you have taken a CLEP examination for any pre-requisite course, write CLEP under Grade Earned column and put the date of the examination in the completed column.
· If your plan is to CLEP any pre-requisite course, write CLEP under Grade Earned column and the date the CLEP is scheduled for in the currently enrolled column.
COMPLETE THE FOLLOWING GRID
Pre-requisiteCourses / Credit
Hours / Grade
Earned / College where course taken / Prefix & Course Number / Completed?
(yes/no) / Currently enrolled?
(yes/no)
If yes - include college where enrolled
BIO 141
(must be < 10 yr)
Semes/Year taken: ______/ 4
ENG 111 / 3
MTH 157
(or a higher level math) / 3
PSY 230 / 3
SDV 100/101 / 1
Students may be currently enrolled in pre-requisite courses at the time of application. However, if enrolled in these pre-requisite courses, the grades earned must be a C or better and your pre-requisite GPA must be at least 2.5 at the end of the semester. Students who are enrolled in any of the pre-requisite courses will only be eligible for conditional acceptance, and those taking the pre-requisite courses at JTCC will be given priority in the ranking system over conditional students taking the pre-requisite courses at other colleges.
Initial______
Continue to the next page
Acknowledgements / Initials1. Hybrid Track – I acknowledge that the theory portion of each course is delivered via online format facilitated by faculty, in both synchronous and asynchronous delivery methods and that the hybrid courses also include specified on-campus requirements.
Traditional Track – I acknowledge that the theory portion of most traditional courses are delivered in the on-campus classroom environment facilitated by faculty and that there are additional online requirements.
2. I acknowledge that I will be required to have access to a computer with reliable internet and that I will be required to have specific technology devices/requirements and technology learning tools specific for each course.
3. I acknowledge that the clinical components/experiences for each course are face-to-face and are dependent on the availability of clinical faculty and the availability of clinical sites/locations. I further acknowledge that these clinical components/experiences may be held during day, evening, weekday, or weekend hours, and possibly night shifts.
4. I acknowledge that working over 20 hours per week puts me at risk for not being successful in the Nursing Program.
5. I acknowledge that a criminal background check and drug screening are required for admission to the Nursing Program as required by the clinical affiliates. If I have a criminal conviction I should contact www.certifiedbackgound.com to determine if my conviction will prevent me from enrolling in this program.
6. I acknowledge that the Nursing Program is committed to the policies set forth by JTCC regarding disabilities and reasonable accommodations. If I require special services or accommodations it is my responsibility to contact the JTCC disability support services counselor on either campus for an appointment at least 2 weeks prior to the beginning of classes if accepted into the Nursing Program.
7. I acknowledge that I must be able to meet the essential functional abilities as stipulated in the Nursing Student Handbook.
Complete a Separate Personal Statement—All students are required to submit a 1-2 page document on the following topic:
· Why have you chosen to pursue nursing as a career?
Your personal statement should be double-spaced and typed using a size 12 font and submitted as a separate document with your application. Please be sure your personal statement includes your name and student ID#.
Instructions for Submitting Your Application—Students should submit all application documents via email to . All documents must be received within the posted dates, no later than midnight on the last day of the application period. Required documents include a completed application, a copy of the appropriate TEAS results document (with the bar graph format), and a personal statement. Students with missing or incomplete application documents will be considered ineligible.
I certify under penalty of disciplinary action up to and including withdrawal from the Nursing Program, that all of the information is complete and accurate. I agree to supply the Nursing Program with supporting documentation related to my application, if I am requested to do so.
Signature Date
(Electronic)