Allegany College of Maryland

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ADVANCED STANDING APPLICATION FORM TO THE NURSING PROGRAM

This form is only to be completed by applicants who are CURRENT Licensed Practical Nurses OR applicants who are transferring Nursing credits from another college.

Application Deadlines: Fall = February 28th | Spring = September 30th

Personal Information

Please enter your name and address as they are listed for contacting you.

First Name:

Middle Initial:

Last Name:

Maiden Name:

Student ID:

Date of Birth:

Contact Information

Please enter your full email address, for example, name@domain.com

It is important that you provide a valid, working email address.

Please enter the best telephone number in reaching you as well as a daytime number.

Email:

Telephone Number:

Daytime Telephone:

Address:

City:

State:

Zip Code:

Educational Information

LPN or Nursing School Attended:

LPN License Number:
(if applicatble)

Current Employer:

Paramedic License Number:
(if applicatble)

Current Employer:

Which time of day do you prefer nursing clinical classes?:

Where do you prefer
to attend classes?:

When do you expect to complete general education prerequisites to enter the clinical phase of the program? All courses from the first year of the nursing program must be completed before beginning the third semester of clinical coursework.

Have you completed all of the Allegany College of Maryland Admissions requirements including college application for admission, placement test (if needed) and sent official copies of all other college transcripts?

YES NO

If you have attended another college or previously attended Allegany College of Maryland, please complete the following:

Name of Institution(s):	Address:	Dates of Attendance:	Degree or Credits Hours Earned:

Are you currently enrolled in classes at Allegany College of Maryland?

YES NO

I certify that all statements given on this application are true and accurate to the best of my knowledge.

E-Signature:

Date:

Please print copy for your records

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Allegany College of Maryland:
12401 Willowbrook Road, SE · Cumberland, MD 21502-2596 · 301-784-5005
Cumberland Campus | Bedford County Campus | Somerset County Campus

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