CCCTC Practical Nursing Admissions Application

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

25% of survey complete.

We are currently accepting applications for the Part-time 2025-2027 Evening/Weekend class and the Part-Time 2025-2027 Daytime class that will begin in March 2025 as well as the Full-Time 2025-2026 that will begin in July 2025. 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 2025 (applications received after June 15, 2025 may be considered for the full-time class beginning in July 2026).

Part-Time (Evening/Weekend-2 year) - The next class will begin in March 2025 (applications received after February 1, 2025 may be considered for the part-time evening/weekend class beginning in March 2027)

Part-Time (Daytime-2 year) - The next class will begin in March 2025 (applications received after February 1, 2025 may be considered for the part-time class beginning in March 2027).

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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

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

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

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* 3. Telephone #'s:

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* 4. Last 4 Digits of Social Security #

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* 5. Birthdate

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* 6. EMERGENCY CONTACT:

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* 7. Relationship to Emergency Contact