Associate Degree Nursing (ADN) Program Application
Greenfield Community College
Office of Admission, Attn: Laura Earl
One College Drive, Greenfield, MA 01301
Phone: (413) 775-1816
Fall 2017 Program Entry
Name
GCC Student ID#
Mailing Address
City/State/Zip
Report all mailing address changes to the Office of
Admission to avoid delay of important correspondence
and/or final decision letter.
Email
Email is required if you would like to
receive confirmation of receipt of your
Program Application.
Preferred phone # ______________________________
Have you previously applied to the GCC ADN Program? YES / NO
Year? ________________
Are you currently still in High School? 
NO
Please circle: YES
Did you enroll in courses during the fall 2016 semester
and/or January 2017 intersession?
YES
NO
(circle one)
at GCC
not GCC
Deadlines
 Transcript deadline: Official transcripts will only be accepted if postmarked or delivered by
February 1, 2017.
 Application deadline: Program Applications will only be accepted if postmarked or delivered
between September 1, 2016 and February 14, 2017.
Instructions
1.
2.
3.
4.
5.
6.
7.
8.
Complete requirements #1 through #9. Check the appropriate item in each section.
If you are a high school student pay special attention to the instructions at the top of page 3.
DO NOT send resumes, recommendation letters or any extra documents not required for application.
DO submit the GCC ADN Health Requirements Form to the Health Records Office, available from the
website at web.gcc.mass.edu/admission/health-careers/ or from the Office of Admission. Health records
that are not attached to the proper GCC ADN Health Requirements Form will NOT be considered
complete.
Health forms and records that are faxed will NOT be considered official or complete.
If you have ever taken classes at GCC your GPA must be 2.0 or higher to apply.
After you have completed all requirements, and completely filled out this form, sign and submit this
application to the address at the top of this application (program applications that are not complete will be
returned).
Incomplete applications will be returned to the student by mail with an explanatory letter. Returned
applications may be resubmitted upon completion, but no later than February 14, 2017.
Page 2 of 6
Application Requirements
Requirement #1: GCC Application for Admission
____ Submit a GCC online application located on the college website at web.gcc.mass.edu/admission.
Your Program Application and your transcripts (if applicable) will not be reviewed until
you have submitted a GCC application.
If you are already enrolled at GCC it is highly recommended to choose Liberal Arts/Health
Science with Nursing intent as your major to ensure proper advising as you work on your Nursing
requirements. To change your major obtain the Change of Major/Advisor Form from the
Academic Advising Center, room C118.
_______________________________________________________________________________
___
Requirement #2: High School Transcript
____ Submit official high school transcript or GED with graduation date to the Office of Admission (graduation
date required). All students must submit regardless of college experience.
_______________________________________________________________________________
___
Requirement #3: Transfer Credit Evaluation (check only one)
_____ Submit official transcripts of all previous colleges attended to the Office of Admission.
The final transcript deadline is February 1, 2017. All transcripts must be postmarked or delivered
by this date in order to be considered – no exceptions.
After your transcripts have been reviewed, transfer credit will appear in your MyGCC record, and an email
will be sent to your GCC student email address regarding placement testing requirements. If testing is
required call the Testing Center to schedule at (413) 775-1821. It is your responsibility to check to
ensure all transfer credit has been applied. If you have questions on your transfer credit, please contact
Laura Earl (413) 775-1816 or earl@gcc.mass.edu.
_____ I have not attended another college. I have only attended GCC, or I am still in high school.
DO NOT SEND IN YOUR PROGRAM APPLICATION UNTIL
YOU HAVE RECEIVED YOUR TRANSFER CREDIT EMAIL. TRANSCRIPTS
SHOULD NOT BE ATTACHED TO YOUR PROGRAM APPLICATION.
_______________________________________________________________________________
___
Requirement #4: Math (check only one) 
_____ Complete the placement assessment in math with scores of 67 or higher in arithmetic and 91 or higher in
Algebra within five years prior to entering the program, OR
_____ Complete Intermediate Algebra (MAT 096) or higher level math course at GCC, with a grade of C+ or
better within five years prior to entering the program, OR
_____ Complete an equivalent or higher level math course at a previously attended college with a grade of C+ or
better within five years prior to entering the program.
_______________________________________________________________________________
___
Requirement #5A: English (to be completed only by applicants who have graduated from high school)
_____ Complete English Composition I (ENG 101, 103 or 105) at GCC, or an equivalent course at a
previously attended college, with a grade of C or better. Note: Eligibility to take English
Composition I is determined by taking placement tests in English with a score of 88 or higher in
sentence skills and a score of 77 or higher in reading. If your scores are below those noted, you
must complete developmental level English (ENG 090 and/or ENG 094) before English Comp I.
Requirement #5B: English (to be completed only by applicants who are still in high school)
_____ Complete the placement assessment in English with scores of 88 or higher in sentence skills and 77 or
higher in reading. If your scores are below those noted, you must complete developmental level
English (ENG 090 and/or ENG 094) to fulfill this requirement.
Page 3 of 6
Requirement #6: Meeting with the Health Occupations Admission Office (for current high school students only)
Call (413) 775-1816 to schedule a meeting with Laura Earl.
Enter meeting date here: _____________________
Admission signature: ___________________________
2017 High School Graduates only - You may be eligible to waive Requirements #7 below if:
1. you will be graduating from high school in 2017, AND
2. you have an average of B (80%) or higher, AND
3. you rank in the upper third of your graduating class.
High school students whose native language is not English and those who have not completed grades K-12 in the
United States must demonstrate English proficiency by having completed English Comp I with a grade of C+ or
better or complete one of the following tests. 
TOEFL- Paper administration-560; Computer based- 220; Internet based- 83 with a speaking
score of 22 OR
IELTS-Overall band score of 6.5 with a minimum of 6.0 in all modules
Submit your ADN Program Application and an official high school transcript at the end of the fall 2016 semester,
but no later than February 14, 2017. Final acceptance will be contingent upon maintaining your GPA and class
ranking upon graduation. You will be required to submit a final high school transcript indicating the above
three requirements at the end of your high school year.
_______________________________________________________________________________
___
Requirement #7: General Education Courses: (Check all courses that you have completed.)
You must complete at least ten (10) credits from the list below, including at least one of the BIO classes, before
submitting this application. Additional courses taken in fall 2016 will be added to your profile after grades are
reported. Be sure to circle the correct items on page 1 if you are enrolled in fall courses to ensure review.
_____
_____
_____
_____
_____
_____
_____
_____
+
BIO 215+
Anatomy & Physiology I
BIO 216+
Anatomy & Physiology II
BIO 205
Microbiology
ENG 112,
English Composition II
114, or 116
SOC 101
Principles of Sociology
PSY 101
Principles of Psychology
PSY 217
Human Growth & Development
Humanities elective See course codes below **
(4 cr)
(4 cr)
(4 cr)
(3 cr)
C+ required within 5 years*
C+ required within 5 years*
C+ required within 5 years*
C required
(3 cr)
(3 cr)
(3 cr)
(3 cr)
C required
C required
C required within 7 years*
C required
Formerly BIO 195 and BIO 196.
* Currency exams are available for courses that were successfully completed more than five years prior to the beginning of
the program. Call (413) 775-1816 to check on your eligibility for these exams.
** Humanities elective may be any course with one of the following course codes: AHS, ART, ASL, DAN, ENG (excluding
ENG 090, 094, and English Comp I or II), FLK, FRE, GGY, HIS, HUM, LAT, MUS, PHI, PCS, SPA, or THE.
Page 4 of 6
Requirement #8: Test for Essential Academic Skills (TEAS)
_____ Complete the TEAS test with a composite score (reading, math, science and English) of 65%, including a
math score of 70%; English score of 65%; reading score of 71% and science score of 54%, within two
years prior to entering the ADN program, and attach a copy of your complete test scores to this
application. Log on to the testing website (www.atitesting.com) for information about the exam, to
purchase study materials, to create an account and to register for a testing date. There is a testing fee
required when you register for the exam. Test results from other testing sites are accepted, but the testing
fee may be higher at other locations.
_______________________________________________________________________________
___
Requirement #9: Submit your completed ADN Health Requirements Form to the Health Records Office –
Read the information below carefully before completing this requirement.
 You must download the GCC ADN Health Requirements Form from the college website at
web.gcc.mass.edu/admission/health-careers/ or request one from the Office of Admission. Health records
not attached to the GCC Health Requirements Form will not be considered complete.
 The date of your Physical Exam must be on or after September 30, 2016. Exams completed before
this date will not fulfill the application requirement. Remember to bring your Health Requirements Form
to your appointment.
 You must receive at least two doses of the Hepatitis B vaccine before submitting your Health
Requirements Form. You must provide documentation of your third dose upon completion of the series.
All other immunizations must be fully completed as listed on the immunization page.
 You, not your doctor, are responsible for submitting your health records on time. Health forms and
records that are FAXED will NOT be considered official or complete.
 If your records are submitted early you may request a preliminary review by the Health Records Office to
ensure that your health documents are properly reported. This courtesy will be provided only as time
allows. Preliminary reviews will NOT be provided during the last two weeks before the deadline.
 Applications with incomplete health records will be returned, and may be resubmitted upon
completion, but no later than February 14, 2017.
 Tuberculin Testing may be withheld until you are accepted to the ADN Program.
NOTE: The Massachusetts Board of Registration in Nursing’s regulation 244 CMR 6.04(3) stipulates
that all candidates for admission to a nursing program are required to provide satisfactory evidence of
compliance with the immunization requirements as specified by the Massachusetts Department of Public
Health. Candidates are also required to meet the standards set by the student nursing practice facilities.
_____ All sections of my Health Requirements Form are complete, and all documentation has been
submitted to the Health Records Office.
Page 5 of 6
ADDITIONAL INFORMATION - Previous Education or Training: It is not required to complete a degree or
special training prior to applying to the ADN Program. However, such experience will enhance your overall
application profile. If you have previously completed any college degrees and/or health-related
certificates/licensures, please list them below. (Do not send copies of your diplomas or certificates.)
College
Degree
Major
Year of Graduation
_______________________________________________________________________________
___
_______________________________________________________________________________
___
Certificates/Licensures
Completion Date
_______________________________________________________________________________
___
_______________________________________________________________________________
___
DO NOT SEND ANY ADDITIONAL DOCUMENTS WITH YOUR PROGRAM APPLICATION SUCH
AS RESUMES, RECOMMENDATION LETTERS, CPR CARDS, CORI FORMS, OR
CERTIFICATIONS.
ADDITIONAL REQUIREMENTS for ENROLLMENT
For students accepted to the ADN Program for fall 2017
Enrollment in the ADN Program is conditional upon completion of the following items. Detailed information
about completing these requirements will be sent to students with their program acceptance packet. The
information below will help you to plan ahead for the timely completion of requirements in the event you are
accepted. The deadlines posted in the students’ acceptance packet are strictly enforced. Students who do
not have these items completed by the posted dates WILL BE REPLACED by students on the waiting list!
1. Criminal Offender Record Information (CORI) Request Form.
2. Proof of CPR certification (Health Care Provider level).
3. Mandatory attendance at orientation. In summer, date announced in April after acceptance letters are
sent.
4. Completion of Tuberculin Testing.
5. GCC grade point average (GPA) of 2.0. Only applies to students who have completed coursework at
GCC.
6. Drug testing, flu vaccination and fingerprinting may be required once in the program.
*******************************************************************************************
Page 6 of 6
Required Signature: All of my application requirements for the ADN program are complete.
Student’s signature_________________________________________ Date _____
__________
Students selected for the ADN Program will be mailed letters of acceptance by the end of April 2017.
A waiting list of qualified applicants will be established for fall 2017 entry only. Students who are not selected for
fall 2017 must reapply if interested in entering in a subsequent year.
If you have any questions about the completion of the attached requirements, please contact Laura Earl in Student
and Academic Affairs at (413) 775-1816 or earl@gcc.mass.edu.
Please note that the requirements and procedures for application to health occupation programs are subject to revision. It is
the responsibility of the student to maintain contact with the Office of Admission, or visit the GCC website, for the most up to
date application form and information regarding changes to requirements and procedures.

Extra Resources for Students:
 High School Students – For students who are applying directly from high school, you can begin taking
support courses the semester or year before entering. This will lighten your course load during the Nursing
Program.
 Math Studio – This service is intended to help students who have difficulty in math related to, math,
science, information technology and business courses to succeed. Services include peer tutoring and Math
Studio drop-in hours. The Math Studio coordinator is available to meet with individual students to discuss
tutoring and math advising.
 Non-Native English Speakers - Students who feel as though they would like to strengthen and/or improve
English-language speaking skills may contact Kit Carpenter (carpenter@gcc.mass.edu or 413-775-1826) in
the ESOL program for more information about language support options.
For Office Use Only:
_________________________________
Date received by the Office of Admission
_______________________________
Signature/ Admission Staff
_________________________________
Second submission date, if applicable
_______________________________
Signature/ Admission Staff
Greenfield Community College is an affirmative action/equal opportunity employer and does not discriminate on the basis of
race, color, national origin, sex, disability, religion, age, veteran status, genetic information, gender identity or sexual
orientation in its programs and activities as required by Title IX of the Educational Amendments of 1972, the Americans with
Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, Title VII of the Civil Rights Act of 1964, and other
applicable statutes and college policies. The College prohibits sexual harassment, including sexual violence. Inquiries or
complaints concerning discrimination, harassment, retaliation or sexual violence shall be referred to the College’s
Affirmative Action and/or Title IX Officer, Peter H. Sennett, at 413-775-1312 or sennettp@gcc.mass.edu, the Massachusetts
Commission Against Discrimination, the Equal Employment Opportunities Commission, or the United States Department of
Education’s Office for Civil Rights.