Navarro College - Associate Degree Nursing Date Received in Office _________________3200 West 7
AvenueCorsicana, TX 75110 Signature of A D N faculty/staff ___________________Attn: Betty Shumate, RN, MS
ASSOCIATE DEGREE NURSING PROGRAM APPLICATIONFor Summer 2013 LVN-RN Bridge EntryApplication Deadline: February 1, 2013 (Postmark Date)Please include with completed application form
College Transcripts for all colleges attended plus a Navarro College Transcript or Academic Evaluation.
letter of good standing from Director or Dean or previous RN program, if applicable.
Transcript must document completion of a PN/VN Program. Name as it appears on your Texas Vocational Nursing License and license expiration date. A copy of your TEAS results Declaratory Order(DO) from BON (if applicable) (If DO not available, attach proof of a request.)
Directions: Please type or print legibly in ink.
Name _______________________________________________________________________Last Name First Middle
Other names which may appear on academic recordsSocial Security Number ___________ - ______ - _____________Mailing Address _______________________________________________________________________________________________________________________________City State Zip CodeCounty _________________________Current Telephone Numbers & E-Mail AddressHome ( )_________ - ______________ Cellular ( )___________ - _______________Please List Another Telephone # Where You Could Be Reached ( )_______-____________E-Mail Address _______________________________________________________________Are you currently enrolled in college classes? Yes _______ No ________If yes, name of college(s) __________________________________________________
Previous nursing program(s) attended
including your PN/VN Program and any RN programs
.Name of School/College Type of Program Dates of Attendance Date of Graduation________________________________________________________________________________________________________________________________________________________If you have attended RN nursing programs in addition to your VN program, are you eligible for re-admission? Yes ___ No ___ Explain____________________________________________andattach letter from previous Director or Dean stating eligibility for re-entry to the previous program.
(Or a statement regarding leaving the program “in good standing” if program does not allow re
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