DALTON STATE COLLEGE DEPARTMENT OF BACHELOR'S DEGREE NURSING RN-BSN APPLICATION

The online application will be open between January 1 - April 1, 2015. Returning students who have not attended Dalton State College for three or more consecutive semesters must fill out a Readmit Form (found on the A-Z Index, R - Registrar, Current & Former Students Applications & Forms) to be considered for admission.

A. Personal Data:
 
Name:
(Last, First, Middle,and Maiden)


         Last                              First                              Middle                               Maiden

Street Address:
City, State and Zip:
         City                               State                             Zip
Current Dalton State ID Number:
Telephone Number (Permanent):
Dalton State Email Address:
 
A. Educational Information:
 
List all colleges and universities you have attended (most recent first).
1 - School name
City/State/Zip
Dates Attended
Graduated Yes     No
 
2 - School name
City/State/Zip
Dates Attended
Graduated Yes     No
 
3 - School name
City/State/Zip
Dates Attended
Graduated Yes     No
 
4 - School name
City/State/Zip
Dates Attended
Graduated Yes     No
 

School from which you received your Associate Degree in Nursing (or Diploma)


Any official transcripts from other colleges should be mailed to Enrollment Services, Dalton State College, 650 College Drive, Dalton, GA 30720.

Enrollment Services
Dalton State College
650 College Drive
Dalton, GA 30720

 
C. Employment/Licensure Information:
 
Are you currently employed? Yes     No
If so, where are you employed?
How many years have you been employed there?

A Verification of Employment form must be submitted as part of the application process if applicant graduated from an ASN or Diploma program more than four years ago with documentation of 1000 hours of practice within the past 3 years. This form is located on the Bachelor's Degree Nursing web page and must be filled out by current and/or previous employers. The form should be mailed to the Health Professions Office.
 
D. RN License Information:
 
RN License Number and State:
Is this a multistate license? Yes     No
License expiration date:
*A copy of your license(s) or documentation of licensure application must be included with your packet.
 
A COMPLETED APPLICATION PACKET WILL INCLUDE:
 
  1. Submission of Online Application Form
  2. Employment Verification Form (if applicable)
  3. Current, unencumbered nursing license or documentation of licensure application
  4. Current resume
  5. Current evidence of Basic Life Support (BLS) certification
  6. Unofficial college transcripts from all colleges attended (this is the responsibility of the student to provide those).

Application packets should be submitted to Cheryl Nuckolls, Administrative Assistant, School of Health Professions, in Sequoya Hall, Room 153. Packets can also be mailed to Cheryl Nuckolls, Dalton State College, School of Health Professions - Sequoya Hall, 650 College Drive, Dalton, GA 30720.

 
INCOMPLETE PACKETS WILL NOT BE CONSIDERED!!
 
Please fill out the application form only once.
You will receive a response from the Department of Nursing within one week of submission.