Nursing Program Application

This form is not an application to the College. It is part of your application to the program.

*All fields are required

First Name:

Middle Initial:

Last Name:

Student ID:

Street:

City:

State:

Zip Code:

Phone:
--
Email:

(Note: all further correspondence will be via Lake Land College email)

Select program to which you are applying and fill in the year you want to begin:
(Students may only apply to ONE program within the same year)

Practical Nursing
Fall semester of: (year)

Associate Degree Nursing
Fall semester of: (year)

LPN to Associate Degree Nursing
Fall semester of: (year) - OR -
Spring semester (Kluthe ONLY) of: (year)

Review the appropriate Nursing Program Application Checklist. The checklist contains information needed to ensure your application is complete. This includes testing information, admission requirements, pre- and co-requisites, tuition and fees.

Practical Nursing:
Checklist for traditional students

Associate Degree Nursing:
Checklist for traditional students

LPN to Associate Degree Nursing:
Checklist for Licensed Practical Nurses

INITIAL: I have reviewed the information in the Application Checklist.

Students applying to the nursing programs at Lake Land College must be able to meet the technical requirements of the program and not pose a risk to the well-being of patients, other students, staff or themselves. Students applying to the program will need, at a minimum, to be capable of performing all Essential Functions required of the nurse. The student will need to maintain and demonstrate these abilities through the duration of the program.

Review the requirements for Essential Functions.
Essential Functions

INITIAL: I have reviewed the list of Essential Functions and understand that I need to be able to perform these functions to complete the nursing program.

INITIAL: Upon acceptance, I understand that I will be required to comply with all requirements of the program and of the clinical facility to which I am assigned. This may include Covid-19 vaccination.

Upon submission of this document, notification of your next steps will be sent via Laker email.

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