Directions for Submitting a Complete Application for the
Associate Degree Nursing Program
It is very important your application is legible, complete, and received in the Nursing office prior to the
deadline. Only one submission will be accepted per applicant; multiple applications will result in
disqualification.
APPLICATION ACCEPTANCE BEGINS: February 1
DEADLINE: April 15 (or the last business day prior) – 4:00 p.m.
Enclose all documents in a large manila envelope.
Applications may be MAILED to:
Sierra College Nursing Department
5000 Rocklin Road
Rocklin, CA 95677
NOTE: If mailing, do not mail any later than 2 weeks prior to deadline. Application
may not be received in Roseville office in time to be considered.
Applications may be DROPPED
OFF at:
333 Sunrise Avenue
Room 101
Roseville, CA 95661
NOTE: This address does not accept mail delivery.
A complete application consists of the following:
Official transcripts of all colleges where prerequisite courses were completed, including
Sierra College. Pre-requisite courses cannot be “in progress.”
Official high school transcript ONLY IF meeting Math A requirement with high school
algebra. (Two semesters of high school Algebra completed with a grade “C” or higher).
Course descriptions for all prerequisite courses if taken outside of Sierra College. The course
descriptions must be from the institution/college attended and match the year the course
was taken.
Your most recent English Composition course grade which is used to calculate the
Chancellor’s Predictor of Success score. Include an official transcript verifying the most
recent English Composition grade, and a course description if taken outside of Sierra
College.
If you are using an assessment test to meet the required reading proficiency, submit a copy
of the reading assessment test result from the Sierra College Assessment Center or printed
from MySierra under Registration and Student Records/Course Placement & Eligibility. If
assessment taken elsewhere, contact the Sierra College Assessment Center or a counselor
to complete verification process.
Copy of DD 214 if you are a veteran (for statistical/reporting purposes).
Active, legible email address (this is how selected students will be notified).
TEAS Results – if achieved after June 2013.
Signature and printed name (pages 1 and 2).
PLEASE NOTE: If any item is missing, the application packet will not be processed. Application status
will be communicated by email. Notification occurs approximately 8 weeks after the submission
deadline. No telephone verification is provided by the nursing department or the counseling department. If
not selected, all submitted materials will be destroyed; transcripts of selected students only will become
property of the District and posted.
Admission into the nursing program is contingent upon a clear background check, drug screening, health
screening and completion of the TEAS test with a cumulative score of 62% or higher. TEAS results are valid
for one year and may be submitted along with the application provided they were achieved after June 2013.
If not completed prior to applying, the TEAS will be administered once an applicant has gained provisional
admission.
In accordance with Regulation 480 of the State Board of Registered Nursing, a person convicted of any offense
other than a minor traffic violation, may not qualify to be licensed as a registered nurse. If there are any questions
regarding this regulation, please contact the State Board of Registered Nursing, or visit their website at
www.rn.ca.gov.
RN Applicant F14
Sierra College Registered Nursing Program
Fall 2014 Application
Demographics (Please Print)
1. Name__________________________________________________________________________________________
Last
First
Middle
2. List maiden and all other names used ________________________________________________________________
3. Address ________________________________________________________________________________________
Number and Street
City
State
Zip
County
4.
5.
Date of Birth
Date of High School Graduation
or GED Completion
Contact Information
1. Home Telephone
Cell
2. E-Mail Address (Required)
3. All colleges attended where pre-requisites were completed, including Sierra College. (ALL TRANSCRIPTS MUST BE
ATTACHED).
College
City/State
Dates Attended
The following information is requested for compliance with Section 56110, Title V California Administrative
Code reporting procedure and will be used for statistical purposes only. Please check applicable
information.
1
2
3
4
5
6
Veteran
American Indian/Alaskan Native
Asian/Pacific Islander
Black/African
White/Caucasian
Hispanic/Latino
Other
YES, I am interested in pursuing the BSN Merger Track
I certify that all information contained on this form is true and accurate. I understand that failure to disclose or falsify any
documents will automatically and permanently disqualify my application and admission into the nursing program.
Applicant’s Signature
Date
Continue to Page 2 of the application
1
RN Applicant F14
Applicant Name _________________________________________
Sierra College Registered Nursing Program
Prerequisite Course Work Verification
ATTENTION: All prerequisites must be completed, with a grade posted to applicable
transcript, at the time application is submitted.
Prerequisite
Name of
College where
Date
Number Grade
Course
course was
Completed
of Units
completed
Semester/Yr
English 1A
Bio Sci 4 or 8A/8B
(Microbiology)
Bio Sci 5 or 7A/7B
(Anatomy)
Bio Sci 6
(Physiology)
One of the
following:
Math A, D, 12,
16A, 16B, 24, 29,
30, 31, 42, or two
semesters of HS
algebra or higher
with grade “C” or
better.
Psychology 1
(Introduction)
Human
Development 1
Nutrition 10
Co-requisite
Name of
Course
College where
course was
completed
Date
Completed
Semester/Yr
Number
of Units
Grade
Fundamentals of
Public Speaking
Intro to Sociology
OR Cultural
Anthropology
Required – Demonstrated Reading Proficiency: Select ONE of the following:
Criteria
Completion of one of the following courses with grade “C” or better:
English 1B, 1C, 11, 50, N, ESL 30R; History 35; Philosophy 4. Include transcript.
OR
Possession of either a bachelor or higher degree from a regionally accredited institution
(must match information on page 1 of application). Include transcript.
OR
Reading Assessment: Copy of reading assessment test result from the Sierra College
Assessment Center or printed from MySierra. If assessment taken elsewhere, contact
the Sierra College Assessment Center or a counselor to complete verification process.
2
Select
One
Course:
RN Applicant F14
3
RN Applicant F14