Trinidad State Junior College

Nursing Program Admission Application


Please complete the form and click submit to send it to the TSJC Nursing Department
Fields marked with a   ♥  are required

♥  Which Program are you interested in?
Enter Full Name - ♥  First: ♥  Last:
Student S#
(this is not a Social Security Number
It is a number that continuing students have
New students will not have this number)
General Information:
♥  Phone (Cell or Home):
♥  Email Address:
♥  Confirm Email Address:
ENG121-English Composition - Grade Date Completed:
PSY235-Growth and Development - Grade Date Completed:
BIO201-Human Anatomy & Physiology - Grade Date Completed:
Additional Courses:
Nutrition - Grade Date Completed:
BIO216-Pathophysiology - Grade Date Completed:
BIO202-Human Anatomy & Physiology - Grade Date Completed:
Social/Behavioral Elective - Grade Date Completed:
Previous Degrees:
Nurse Aid Certification:
LPN Certification:
Associate Degree:
Bachelor's Degree:
Master's Degree: