CCC&TI Associate Degree Nursing Information Session Confirmation

* I am interested in the following Nursing program:

Associate Degree Nursing

Practical Nursing

LPN to ADN Bridge

Please check the appropriate boxes:

I certify that I have viewed and understand the online presentation of information for the Associate Degree Nursing program at Caldwell Community College & Technical Institute.

I still have questions that were not answered in the presentation. I will contact Student Services or the Program Director for assistance.

I understand that in order to complete the Information Session admission requirement that I must submit this form to Student Services immediately. The date that this form is received by CCC&TI will be used to meet this requirement in my admission folder.

I have made a copy of this confirmation for my personal records.

Please read the Technical Standards document before completing this section.

Declaration:
I have read and understand the technical standards required for Associate Degree Nursing, I hereby declare that:

I am/the student is able to meet the above listed essential technical standards

I am/the student is unable to meet the above listed essential technical standards based on the following:
(please list standard that cannot be met and give rationale:)