ASSOCIATE OF SCIENCE IN NURSING
PROGRAM APPLICATION

Application Due by Monday, April 30 end of Business


Student Last Name:
Student First Name:
Middle
Social Security Number:
Student ID#:
Date of Birth: Month/Day/Year (mmddyyyy) Enter as Ex. 01011900.
Address:
City:
State:
Zip Code:
Home Phone:
Enter Home phone number as Ex. 4042254400.
Work Phone:
Enter Work phone number as Ex. 4042254400.
Mobile Phone:
Enter Mobile phone number as Ex. 4042254400.
Email Address:
Resident of Georgia?:   Yes     No   
Are you a U.S. Citizen?:   Yes     No           If no, are you classified as an international Student, see additional requirements)
Place of Birth: City:  
State:   
County:
Are you a high school graduate?:   Yes     No           
If no, did you earn a GED?   Yes              What Year    
Name of University/College you currently attend or attended:
University/College you currently attend or attended: Which City:  
Which State:   
Declared Major:
Will you have earned a degree prior to the semester for which you are applying?   Yes              If yes, when?    
If yes, check all that apply::   Associateís     Bachelor's    Masterís  
Institution from which you earned your highest degree:
Major:
TEAS Nursing Admission Test Date:
Please enter the date as 09252013.

*Only scores from Atlanta Technical College will be accepted

Test Location     

Test Score     



***** International Student Requirements: Students who are not born in the United States are
considered international students and must present the following additional information:

  • Official scores from the Test of English as a Foreign Language (TOEFL)
  • Official evaluation of international transcripts by admission office..

Please be aware that when you apply to sit for the Georgia Board of Nursing Licensing Examination upon graduation, you will be asked to respond to a question regarding any violations of federal, state, or local law. You may be required to submit documentation to the Board explaining any such occurrence. Authority to issue a license for the Registered Professional Nurse is exclusive to the Georgia Board of Nursing as well as any other state licensing board where you may contemplate practicing.

By signing below, I hereby request consideration for acceptance into the Atlanta Technical College Associate Degree Nursing Program. I understand completion of the nursing application does not guarantee admission to the program. Admission is based on a point system, and space availability. Students with higher points will be given preference.

Student Signature:
Please type your Full name.
Date:
Please enter as Example: 02082014


Please take time to review your information before completing your application.
Application information will be immediately submitted once button is clicked.