LPN to RN Application

Please don't fill out this input box.

Please note, that in addition to the application below, you must complete the CCC application or the SUNY application for admission. An official copy of your high school transcript is required. A GED will be accepted in lieu of a high school transcript. If you have attended other colleges or received credit from other colleges, including CAP credit, you must have official academic transcripts sent from each of those institutions.

Application period has been extended.

First Name:*

Middle Initial:*

Last Name:*

Previous Name(s):

P.O. Box or Street Address:*

City:*

State:*

Zip Code:*

Phone Number: *

Email Address:*

Social Security Number:*

LPN License Number (if pending, list date exam taken)*

High School Education History:*

Have you ever previously applied to Clinton Community College?*

Yes

Have you previously attended Clinton Community College?*

Yes

If you've previously attended Clinton, were you academically dismissed in the last semester you attended?*

Yes

Are you currently attending Clinton?*

Yes

Have you ever been dismissed from Clinton or any other college for disciplinary reasons?*

Yes

Previous College History*

If program was not completed, state reason:

Applicants who have attended another school of Nursing, RN or LPN, and left prior to completion, must request a letter from the Nursing Program Director be sent to the Nursing Program Director of Clinton Community College indicating the circumstances under which the student withdrew.

Please list other educational, travel, and/or community service experience.

Do you have any prior health-related work experience (Nurse aid, medic, etc)?*

Yes

If yes, please describe work, including length of service:*

How would you rate your own general health?*

Excellent

Good

Fair

Poor

Essay*Please describe (1) your experiences and activities since you last attended school, if more than six months elapsed; (2) all the things you have accomplished that have given you the greatest satisfaction; (3) your reasons for desiring to become an RN and to enter this school; (4) your plans to be successful in the RN program; and (5) your aspirations for the future.