You must complete the following before applying to the Nursing Program:

  • A student in Good Standing with Georgia Perimeter College
  • Complete BIOL 1611/1611L Anatomy and Physiology I and lab.
  • Application Deadline is January 31 for Generic Track and May 31 for the LPN-RN Bridge Track.
  • TEAS exam must be received by the application deadlines

Please complete all information. You may submit this form by e-mail (there is a submit button at the end of the form) or print the printer friendly form, sign it and return it to: Administrative Coordinator, Department of Nursing, Georgia Perimeter College, 555 N. Indian Creek Drive, Clarkston, GA 30021.

Part of the admission criteria will include but is no limited to, Nursing Biology courses GPA, Nursing General Education GPA, Nursing Entrance Test, and academic and institutional history.  The academic and institutional history will include the following; repeated courses, number of withdraws, number of "D"s and "F"s in other non-related courses, and violations of the Georgia Perimeter College Student Code of Conduct.

IMPORTANT NOTE FOR ALL APPLICANTS: An arrest or conviction of any offense other than a minor traffic violation may affect placement in a clinical site during the program and/or a graduate's becoming licensed. Questions should be directed to the Georgia State Board of Nursing who is the authority in this situation.
 

Personal Information:
   
Last Name 
First Name 
Middle Name 
Georgia Perimeter College Student ID Number   (Use numbers only - no hyphens)
Street Address
City
State/Country Zip Code
Home Phone Work Phone 
E-mail Address
US Citizen   Yes             No
Native Language  
Language of Education

Please indicate the semester to which you are applying:

         Generic Track Fall Semester

         LPN-RN Bridge Track Spring Semester

 


Are you applying as a High School graduate with no college credit?

Yes    No.   If yes, year of graduation .  
 

Do you have a College Prep Diploma?  Yes  No


 Are you currently attending or have you ever attended Georgia Perimeter College (formerly DeKalb College)?     Yes     No

Have you previously applied to the Georgia Perimeter College Nursing Program?    Yes  No

If yes, when?


Please list all colleges and technical schools you have attended. Give latest first, include dates:

 
 1 Name of Institution, City and State: Major or Degree:
 
  Dates of Attendance (month/year):

From: 

To: 

2 Name of Institution, City and State: Major or Degree:
  Dates of Attendance (month/year):

From: 

To: 

3 Name of Institution, City and State: Major or Degree:
  Dates of Attendance (month/year):

From: 

To: 

4 Name of Institution, City and State: Major or Degree:
  Dates of Attendance (month/year):

From: 

To: 

 

Have you ever attended an RN nursing program?     Yes   No

If yes, when?

Have you ever failed a nursing course?                     Yes   No

If yes, when?

(Students must adhere to the Department of Nursing Policy on the number of failures permitted to enter and to progress in the nursing program.)

Have you ever written the NCLEX (license exam) for RNs?    Yes   No

If yes, when?

Have you ever written the NCLEX (license exam) for LPNs?  Yes   No

If yes, when?

(If you are an LPN, you must submit a copy of your current license with your application)

Please list all employment as an LPN. Give latest first, include dates:

 
 1 Name of Employer, City and State:  
  Dates of Attendance (month/year):

From: 

To: 

2 Name of Employer, City and State:  
  Dates of Attendance (month/year):

From: 

To: 

3 Name of Employer, City and State:  
  Dates of Attendance (month/year):

From: 

To: 

4 Name of Employer, City and State:  
  Dates of Attendance (month/year):

From: 

To: 

 

 

CERTIFICATION OF ACCURACY

I certify that information given on this application is accurate and complete to the best of my knowledge, and I understand that failure to give accurate and complete information may invalidate my admission.

Signature (type in your name to acknowledge the above statement):

Signature:  

Date:


 

 

   


Reminder: Applicants to the Nursing Program must have been accepted by the College. You may apply online at the Georgia Perimeter College Application Page