El Centro College LVN-RN Advanced Placement
El Centro College LVN-RN Advanced Placement
El Centro College LVN-RN Advanced Placement
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EL CENTRO COLLEGE<strong>LVN</strong> TO <strong>RN</strong> ADVANCED PLACEMENT PROGRAM APPLICATIONPLEASE PRINT:SOCIAL SECURITY NO. __________/________/__________DCCCD ID NO.NAMELast First Middle/OtherADDRESSNumber and StreetApartment NumberCity State Zip CodePHONEEMAILHomeCell/OtherHIGH SCHOOL GRADUATE? _____ Yes _____ No GED? _____ YesNAME OFYOUR VOCATIONAL NURSING PROGRAM:__________________________________________________<strong>College</strong> or Training Program____________________________________City/StateDATE OF ENTRANCE: ___________________ DATE OF COMPLETION:TEXAS <strong>LVN</strong> LICENSURE #___________________EXP. DATE ____________ VERIFIED BY _________HOAOLIST ALL PREVIOUS COLLEGES ATTENDED FOR ACADEMIC CREDIT, INCLUDING DALLASCOUNTY COMMUNITY COLLEGES. (Do not abbreviate.)I am submitting my application materials for admission to the(Fall or Spring)20______ semester.I certify that the information given on this application is complete and accurate.Applicant’s SignatureDateEducational opportunities are offered by the Dallas County Community <strong>College</strong> Districtwithout regard to race, color, age, national origin, religion, sex, disability, or sexual orientation.19- Revised 09/01/09 -