Advanced Standing Nursing Program Application Form

Application Deadlines:
Fall - February 28

This is NOT the online nursing application!

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

Are you applying for the Online LPN-RN Program?

First Name:

Middle Initial:

Last Name:

Maiden Name:

ACM Student ID #:

Date of Birth:

E-mail Address:

Telephone Number:

Daytime Telephone:

Mailing Address:

City:

State:

Zip:

LPN or Nursing School Attended:

LPN License Number:

State LPN licensed:

Current Employer (if applicable):

Please provide a print out of your State Board of Nursing website with your name and license number visible

Have you ever failed a nursing course of failed nursing at another college or nursing school?

If Yes, name of school:

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 college transcripts?

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

Most Recent Institution Attended:

Address:

Dates of Attendance:

Degree or Credit Hours Earned:

Other Institution Attended:

Address:

Dates of Attendance:

Degree or Credit Hours Earned:

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

I certify that all statements given on this application are true and accurate to the best of my knowledge. My signature on this form indicates that I am aware of the competiveness of the Nursing Program and understand the admission process.

Applicant's Signature:

Date: