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

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♥  Which Program are you interested in?

Choose One Trinidad - Summer ADN Alamosa - Fall ADN Trinidad - Fall ADN

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:
Address:
Street:
City:
State:	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:

Prerequisites:
ENG121-English Composition - Grade	Choose One A B C	Date Completed:
PSY235-Growth and Development - Grade	Choose One A B C	Date Completed:
BIO201-Human Anatomy & Physiology - Grade	Choose One A B C	Date Completed:
BIO202-Human Anatomy & Physiology - Grade	Choose One A B C	Date Completed:
BIO204-Microbiology - Grade	Choose One A B C	Date Completed:

Additional Courses:
Nutrition - Grade	Choose One A B C	Date Completed:
BIO216-Pathophysiology - Grade	Choose One A B C	Date Completed:
Social/Behavioral Elective - Grade	Choose One A B C	Date Completed:
Medical Terminology (Recommended) - Grade	Choose One A B C	Date Completed:

Previous Degrees:
Nurse Aid Certification:	Choose Yes No
Associate Degree:	Choose Yes No
Bachelor's Degree:	Choose Yes No
Master's Degree:	Choose Yes No