John Tyler Community College
VCCS Student ID_____________
Traditional Track Nursing Program Application
Semester_______ Year_________
Did you apply to both tracks? Y N
If yes, is the traditional program your 1st choice?
Y
N
READ CAREFULLY: Per VCCS Policy 6.0.5, admission consideration is given to qualified applicants who are
residents of the political subdivisions supporting the college and residents of those localities. Since enrollments are
restricted for the Nursing Program, admission consideration will be given to permanent US residents of the JTCC
service area first. Contact your nursing advisor for questions.
APPLICANT INFORMATION
Last Name
First Name
MI
Street Address
City
Primary Phone #
Date
Apt #
State
Zip
County/ City of Residence
Phone #2
Other Phone #
VCCS Email address
Alternate Email Address
Have you ever applied to this program before? No______ Yes______
If yes, when?
Date attended mandatory Information Session: ________/_________
Month
year
CHECKLIST FOR COMPLETE APPLICATION
INITIALS
I am enrolled as a student at John Tyler Community College.
I have been curriculum placed by JTCC Counseling.
My official HS transcripts or GED documents have been supplied to Admissions and Records.
All official transcripts from each college I have attended have been hand delivered by me to JTCC
Counseling or mailed directly by my college to Admission and Records.
I have completed the TEAS test and scored in the 45th composite national percentile in the overall
score and in all content areas. A copy of the test results is included with this application.
I have a cumulative GPA of 2.0 or better in all coursework.
I have completed or currently enrolled in all 1st semester courses listed on the next page with a
grade of “C” or higher.
I have independently written a personal statement. This statement is included with this application
ACADEMIC HISTORY
High School
GED
College
College
List any certificates or degrees you have been awarded
Continue to the next page
FROM
TO
LAST YR
ATTENDED
GRADUATED?
(Y/N)
PAGE 2
TRADITIONAL TRACK
READ these Directions:






List all courses and all attempts.
If you had only one attempt at a course, use the first attempt line.
If you had more than one attempt, use both attempt lines. (Do not include course
withdrawals where the grade earned is “W”.)
If you had two attempts at a course, but one of them is over 5 years old, use only the most
current attempt.
If a course was taken at another college, write in the course prefix and number in the
Prefix & Course Number column.
If you have taken a CLEP examination for any course, write CLEP under Grade Earned and
put the date of the examination in the last column.
COMPLETE THE FOLLOWING GRID OF 1ST SEMESTER COURSES
Course
BIO 141
ENG 111
MTH 158
PSY 230
SDV 100/101
# of
attempts
Credit
Grade
Hours
Earned
1st
4
2
nd
4
1st
3
2
nd
3
1st
3
2nd
3
1st
3
2nd
3
1st
1
2
1
nd
College where course
was taken if not JTCC
Prefix &
Course
Number
Completed
or enrolled?
Beginning in fall 2015, students may be currently enrolled in 1st semester courses at the time of
application. However, if enrolled in these courses, the grades earned at the end of the semester
must be a C or better and your curricular GPA must be at least 2.5 at the end of the semester.
Any students who are enrolled in a 1ST semester course will only be eligible for conditional
acceptance, and must supply earned grades for committee review by sending an unofficial
transcript to the Admissions Committee at the end of the semester. Failure to send the
transcript showing satisfactory completion of the above courses before the established
deadline will cause the student to be ineligible, even if given prior conditional acceptance.
Initial___________
Continue to the next page
PAGE 3 TRADITIONAL TRACK
The following are requirements for students in the Traditional Track. Please acknowledge that you
understand these requirements.
Requirement
1.
2.
3.
4.
5.
6.
7.
8.
Initials
The theory portion of most courses is delivered in the classroom environment facilitated by faculty.
There are additional online, asynchronous content selections and assignments to augment learning. I
will be required have access to a computer with reliable internet.
I understand that all tests in all courses are proctored in the Nursing Education Center and I am
expected to be present at the date and time scheduled by course faculty.
Knowledge of technology is expected. I understand I am required to have an IPAD or comparable
tablet device and/ or working laptop computer with at least a high speed processor and dependable
internet access.
The clinical component of each course is face-to-face and students are expected to attend all clinical
sessions in the labs and/or in community healthcare agencies.
Clinical experiences may be held during day, evening or weekend hours and no student is guaranteed
any clinical hours or clinical facility placement.
I understand that working over 20 hours per week is not conducive to success in the Nursing Program.
I understand that employment commitments are not excuses to miss clinical days or fail to complete
assignments in a timely manner. Per course syllabi, I am held accountable for all work for class or
clinicals.
I understand that the Nursing Program will not make any special arrangements under any
circumstances with individual students for missed assignments or clinicals other than what is
described in course syllabi.
READ and Initial: Criminal Background Check Statement--A criminal background check and drug screening are required
for admission to the Nursing Program as required by our clinical affiliates. If you have a criminal conviction you should
contact www.certifiedbackgound.com to determine if your conviction will prevent you from enrolling in this program.
Initial__________
READ and INITIAL: Student Accommodations Statement--The Nursing Program is committed to the policies set forth by
JTCC regarding disabilities and reasonable accommodations. If you require special services or accommodations, you should
contact the JTCC disability support services counselor on either campus for an appointment at least 2 weeks prior to the
beginning of classes if you are accepted into the Nursing Program. Your success is contingent upon your ability to fulfill the
core competencies of the program. You are responsible for compliance with the functional abilities policy in the Nursing
Student Handbook.
Initial___________
Complete a Separate Personal Statement—All students are required to submit a 1-2 page document on one of the
following topics:
Why have you chosen to pursue nursing as a career?
What qualities do you believe you possess that will enable you to perform effectively as a student and later as a practicing
nurse?
Your personal statement should be double-spaced and typed using a size 12 font and submitted as a separate document with
your application. Please be sure that your statement includes your name and student ID#.
Instructions for Submitting Your Application—Students should submit all application documents via email to
nursingapplications@jtcc.edu. All documents must be received within the posted dates, no later than midnight on the last day
of the application period. Required documents include a completed application, a copy of TEAS test results, and a personal
statement. Students with missing or incomplete documents will be considered ineligible.
I certify under penalty of disciplinary action up to and including automatic withdrawal from the Nursing Program,
that all of the information is complete and accurate. I agree to supply the Nursing Program with supporting
documentation related to my application, if I am requested to do so.
Signature
(Electronic)
Date