Associate Degree Nursing Program

1 Mail to: Attn: Applications Bakersfield College Nursing Department 1801 Panorama Drive Bakersfield, CA 93305. Associate Degree Nursing Program Application Form New Applicant Prior Applicant: When? List all dates: _____. Re-entry Applicant: Last Semester/Year Attended? _____ Advanced Placement Admission to: Fall Semester Spring Semester Year_____. Nursing Semester: 1st Semester 2nd Semester 3rd Semester 4th Semester Are you registered with Bakersfield College as a Veteran or spouse/dependent eligible for military benefits? Yes No If you answered yes, attach DD214 form and, if applicable, Certificate of Eligibility. Personal Information Student ID #: @_____ BC email address: _____.

2 Full Name: _____. Last First Previous Last Name Address: _____. Street Address Apartment/Unit #. City State Zip Code Birth Date: ____/____/_____ Cell/Day Phone: (_____) _____ Alternate Phone: (_____) _____. Citizen: Yes No **Do you have a valid Social Security Number/ITIN: Yes No Have you ever enrolled in a Nursing Program ? Yes No What Program /Where?_____ When?_____. Have you ever taken the TEAS? Yes No If Yes, attach ATI transcript. Where taken?_____ Score:_____. Were you required to complete the BC remediation plan? Yes No If Yes, when was remediation completed?_____. Have you already attained a college Degree ? No AA/AS BA/BS or higher Major: _____. College Education College Name City/State Dates Attended Degree Earned *For additional college information attach a separate sheet.

3 ALL APPLICANTS must submit an unofficial Bakersfield College transcript along with this application. If you have completed any coursework at another college, you must request a transcript evaluation from the BC Admissions and Records Office. These courses must be reflected on your BC unofficial transcript at the time of application. Failure to report and/or have transcripts evaluated will result in ineligibility to the Bakersfield College ADN Program . Check the Nursing Website for complete Program information and application periods ( ). **The Board of Registered Nurses requires possession of a valid Social Security number or Individual Taxpayer Identification Number (ITIN) to apply for licensure.

4 Failure to provide a social security number will result in your application for licensure to not be processed.**. Please Complete Reverse Side Revised 08/02/2021 1. Demographic Information Data is for statistical analysis only, to be used for reporting purposes by the Board of Registered Nursing . This information will NOT affect Program consideration. We strongly encourage and appreciate your participation. (Completion is optional). Gender: Male _____ Female_____ Decline to Answer _____. Age (please mark one of the following): 17-20 years of age 21-25 years of age 26-30 years of age 31-40 years of age 41-50 years of age 51-60 years of age 61 years or older Ethnicity (mark all that apply): Black/African American Native/Hawaiian or other Non-Filipino Pacific Islander American Indian or Alaska Native White/Caucasian Asian (if not included in another Asian category) Hispanic/Latino Asian Indian Two or more races Filipino Other Race Were you ever in Foster Care or a Ward of the Court for any length of time after turning 13?

5 Yes No English Second Language (ESL): Yes No Primary Language _____. Do you meet requirements under the DACA (Deferred Action for Childhood Arrivals? Yes No Were you a part of the Umoja Community ASTEP Program ? Yes No Are you a registered DSPS student (Disabled Students programs & Services) with BC? Yes No If you are a registered DSPS student with BC, mark all accommodations you are entitled to receive: Academic Counseling/Advising Disability-Related Counseling/Referral Adaptive Equipment/Physical Space/Facilities Interpreter and Captioning services Exam Accommodations (Modified/Extended Time/Distraction Reduced Space). Assistive Technology/Alternative Format Note-Taking Services/Reader/Audio Recording/Smart Pen Priority Registration Reduced Course Load Transportation/Mobility Assistance and Services/Parking Other:_____.)

6 *It is the applicant's responsibility to keep the Nursing Office informed of any change in address or phone number. Acknowledgement Failure to sign this application will result in ineligibility. I certify that to the best of my knowledge all information provided on this document is complete and accurate. I understand that any false or omitted information, intentional or otherwise, will result in removal of consideration for the Program . Signature: _____ Date: _____. Revised 08/02/2021 2. BAKERSFIELD COLLEGE Associate Degree Nursing Program . APPENDIX A MULTI-CRITERIA POINT ALLOCATION. 1. ACADEMIC DEGREES, DIPLOMAS, OR RELEVANT CERTIFICATES HELD BY APPLICANT. MAXIMUM POINTS = 10.

7 Degree , diploma, or certificate Possible Applicant's Required Documentation Points Points 1a. Bachelor's Degree or higher 5 Official/unofficial transcript from regionally accredited colleges or universities with Degree posted. All transcripts from outside the must be evaluated by a NACES independent agency. 1b. Licensed Health Care Workers- BC programs 10 Copy of current California license with license number, date issued, (LVN's, Paramedics, Radiologic Technologists) and expiration date. No points will be awarded for out of state or expired licensure. *Include transcript from school where coursework completed. As of January 1, 2021, proof of working a minimum of 6 months in field in the last 5 years.

8 1c. Licensed Health Care Workers Non BC programs 8 Copy of current California license with license number, date issued, (LVN's, Paramedics, Radiologic Technicians, and expiration date. No points will be awarded for out of state or Psychiatric Technician) expired licensure. *Include transcript from school where coursework completed. As of January 1, 2021, proof of working a minimum of 6 months in field in the last 5 years. 1d. Certified/Licensed Health Care Worker(less than 6 Copy of current California Certificate/License with certificate 18 week Program ) BC programs number, date issued, and expiration date. No points will be awarded Nurse Assistant(NA) or Emergency Medical for out of state or expired certificates.

9 Course completion certificates Technician (EMT) or Phlebotomy (AUMT) are not accepted. As of January 1, 2021, proof of working a minimum of 6 months in field in the last 5 years. One certificate considered. 1e. Certified/Licensed Health Care Worker (less than 4 Copy of current California Certificate/License with certificate 18 week Program ) Non BC programs number, date issued, and expiration date. No points will be awarded (NA, EMT, Medical Assistant, Phlebotomist) for out of state or expired certificates. Course completion certificates are not accepted. As of January 1, 2021, proof of working a minimum of 6 months in field in the last 5 years. One certificate considered.

10 1f. Prior Military Medical Training 5 DD-214 and military transcript reflecting medical training completed 2. GRADE POINT AVERAGE(GPA) IN RELEVANT COURSEWORK. MAXIMUM POINTS = 50. GPA Possible Applicant's Required Documentation Points Points 2a. Combined Prerequisite Biological Science GPA: Combined Unofficial or official BC transcript showing all pre-requisite (Anatomy, Physiology, and Microbiology) GPA of courses posted. (All non-BC transcripts MUST be evaluated by the Minimum of combined GPA required, and no less or higher x BC Admissions & Records office. Official, sealed transcripts from than a C in any course. 10 regionally accredited colleges or universities, showing course Points are calculated by multiplying the combined GPA (Maximum completion must be received in the BC Admissions & Records office by 10.))