ASN Traditional Application

* These fields are required.

* Have you applied before in a previous semester for this program?

Yes

Name and Date of Birth:

* First Name

* Last Name

Middle Initial

Maiden Name

* Date of Birth

Contact Information

GHC ID (Current Students Only)

* Email

* Phone

* Street Address

* City

* State

* Zip

* County

Emergency Contact Information

* Emergency Contact Name

* Relationship to Emergency Contact

* Emergency Contact Phone

Employment Status

* Are you currently employed?

Yes

Education Background - All official transcripts must be sen to the GA Highlands Office of Admissions

List schools (post high school) or colleges attended. Identify college level degrees earned. Click the Add Row button to additional rows.

School Attended

Degree Earned

Years Attended

Attendance + License Uploads. Max size for each file is 50MB. Files extensions may be: jpeg, jpg, png, gif, pdf, or tif.

Upload proof of Nursing Information Session attendance:

*Click "Browse" and select file for upload:

Upload driver’s license or government issued ID:

*Click "Browse" and select file for upload:

Upload copy of CNA Certification (LPN submit current license):

Click "Browse" and select file for upload:

* Do you have a current health care license (other than a CNA)?

Yes

* Are you currently employed at a medical facility?

Yes

* Please type the name of the medical facility for which you work. (Indicate N/A if you are not employed at a medical facility)

*Are you an Atrium Health Floyd "Rise to Success" recipient?

Yes

I understand (check to agree with each of the following statements):

*	Criminal background checks and drug screenings are required for clinical practice by institutions used by the nursing program for the clinical experiences associated with nursing courses. A student will be required to participate in these checks upon admission and at least annually while in the program. All criminal background checks and drug screens will be at the expense of the student. Clinical experience is a component of all required nursing courses. A course cannot be satisfactorily completed without completing the clinical component of the course. Should a student be denied placement by a clinical facility related to results on a criminal background check or drug screening, the student will be dismissed from the program with no opportunity for readmission.
*	A student who has been arrested or convicted of a crime other than a minor traffic violation may be admitted into the nursing program at Georgia Highlands College, but permission to take the RN Licensure Examination rests with the Georgia Board of Nursing. If you have been arrested or convicted of a crime other than a minor traffic violation, please make an appointment with the Assistant Director of Associate Degree Nursing at swalker@highlands.edu, please copy chooper@highlands.edu on these emails to receive further instructions
*	I must be in satisfactory health to perform classroom/clinical duties. (See Nursing Program ADA Essential Functions as stated in the current Georgia Highlands College Catalog) Program accommodation(s) can be made with approval from Student Support Services.

Please Read Carefully and Sign:

I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge. I understand that if accepted, falsified statements or withheld pertinent data on this application shall be considered sufficient cause for dismissal. Georgia Highlands College is hereby authorized to make any investigation on my personal history.

Sign on the line below with mouse (PC), stylus (touch screen), or your finger (touch screen). Click the Save Signature button once you are satisfied with your signature. *

General Application for Admission Associate Degree Nursing Program

School Attended

Degree Earned

Years Attended

General Application for Admission
Associate Degree Nursing Program