CCCTC Practical Nursing Admissions Application

PLEASE ALLOW 5-7 BUSINESS DAYS FOR REVIEW OF YOUR APPLICATION

25% of survey complete.

We are currently accepting applications for the Full-Time 2027-2028 that will begin in July 2027, however, applications received after June 1, 2027 may be considered for the Full-Time class that will begin in July 2028 as well as the Part-time 2027-2029 class that will begin in March 2027, applications received after February 1, 2027 may be considered for the part-time class that will begin in March 2029.. Upon receiving your application we will contact you by email with information regarding the admissions test. Please include an email address when completing this application for further information on the admission test.

PLEASE ALLOW 7-10 BUSINESS DAYS FOR REVIEW OF YOUR APPLICATION.

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1. Please specify which Practical Nursing program you are interested in.

Full-Time (1 year) - The next class will begin in July 2027 (Applications received after June 1, 2027 may be considered for the Full-time class beginning in July 2028).

Part-Time (Daytime-2 year) - The next class will begin in March 2027 (applications received after February 1, 2027 may be considered for the part-time class beginning in March 2029).

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Thank you for your interest in the CCCTC Licensed Practical Nursing Program. All information will be kept confidential and will not be released to any other institutions.
The application consists of 4 pages and should only take a few minutes to complete. Incomplete Applications may not be considered.
Once you have completed your application you can expect a response at the email address you provided on your application within 5-10 business days (Monday-Friday).

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2. Personal Information (Required.)

First *

Middle

Last *

Address

City/Town *

State *

Zip *

Maiden Name

Email Address

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3. Telephone #'s:

Home:

Cell:

Work:

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4. Last 4 Digits of Social Security #

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5. Birthdate (Required.)

Birthdate

Date

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6. EMERGENCY CONTACT:

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Phone Number:

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* 1. Please specify which Practical Nursing program you are interested in.

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* 2. Personal Information (Required.)

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* 3. Telephone #'s:

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* 4. Last 4 Digits of Social Security #

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* 5. Birthdate (Required.)

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* 6. EMERGENCY CONTACT:

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* 7. Relationship to Emergency Contact

1. Please specify which Practical Nursing program you are interested in.

2. Personal Information (Required.)

3. Telephone #'s:

4. Last 4 Digits of Social Security #

5. Birthdate (Required.)

6. EMERGENCY CONTACT:

7. Relationship to Emergency Contact