You must complete the following before applying to the Nursing Program: A Pre-Nursing student in Good Standing with Georgia Perimeter College Complete BIOL 1611/1611L Anatomy and Physiology I and lab. Application Deadline is January 31. TEAS exam must be received by the application deadline 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 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:          Clarkston Campus, Fall 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)     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