CCCTC Practical Nursing Admissions Application

PLEASE ALLOW 5-7 BUSINESS DAYS FOR REVIEW OF YOUR APPLICATION

25% of survey complete.

We are currently accepting applications for the Full-time 2024-2025 class that will begin in August 2024 and the Part-time 2025-2027 class that will begin in March 2025. Admission testing will begin in December 2023 for the Full-Time class and April 2024 for the Part-time class. Please include an email address when completing this application for further information on the admission test.

PLEASE ALLOW 5-7 BUSINESS DAYS FOR REVIEW OF YOUR APPLICATION.

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* 1. Please specify which Practical Nursing program you are interested in.

Full-Time (1 year) - The next class will begin in August 2024 (applications received after July 1, 2024 may be considered for the full-time class beginning in August 2025).

Part-Time (2 year) - The next class will begin in March 2025 (applications received after February 1, 2025 may be considered for the part-time class beginning in March 2027).

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Thank you for your interest in the CCCTC Licensed Practical Nursing Program. All information will be kept confidential and will not be released to any other institutions.
The application consists of 4 pages and should only take a few minutes to complete. Incomplete Applications may not be considered.
Once you have completed your application you can expect a response at the email address you provided on your application within 5-10 business days (Monday-Friday).

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* 2. Personal Information

First *

Middle

Last *

Address

City/Town *

State *

Zip *

Maiden Name

Email Address

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* 3. Telephone #'s:

Home:

Cell:

Work:

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* 4. Last 4 Digits of Social Security #

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* 5. Birthdate

Birthdate

Date

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* 6. EMERGENCY CONTACT:

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Phone Number:

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* 1. Please specify which Practical Nursing program you are interested in.

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* 2. Personal Information

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* 3. Telephone #'s:

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* 4. Last 4 Digits of Social Security #

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* 5. Birthdate

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* 6. EMERGENCY CONTACT:

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* 7. Relationship to Emergency Contact