Associate Degree Nursing Application

ASSOCIATE DEGREE NURSING APPLICATION (ADN)
Prospective students must have on file, official high school transcripts and, if applicable, evaluated college transcripts. Students must also be in the process of completing their final admission requirements prior to submitting this application.

Please print this application and visit our College and Career Success Center to have it verified before return the signed form to: Department of Nursing, South Suburban College, 15800 S. State Street Room 4120 South Holland, IL 60473.
Application Term 202X*
Email Address*
example@example.com
Last Name*
First*
M.I
College ID #*
Daytime Phone*
Address*
City*
State*
Zip*
Are you a Certified Nurse Assistant?*

YesNo
If yes, in which state?*
Verification of State Certification must be attached to your printed application.
Are you a Licensed Practical Nurse?*

YesNo
License #*
Verification of State Certification must be attached to your printed application.
State*
Contact Person Other Than Self
Name*
Phone Number*
Email Address*
example@example.com
Relationship*
Applicant must submi this to the academic counselor to be completed and signed. After that the application can be returned to the Nursing office before May 15th. Student must attach a copy of current class schedule for verification of course enrollment along with a copy of any State certification or license to their printed application form.
RESPONSIBILITIES AS A NURSING STUDENT
I understand that, if enrolled in the Department of Nursing at South Suburban College, I will be accountable for the following: A. Transportation to and from the College and various clinical sites B. Payment of tuition, student, laboratory and malpractice fees, uniforms, books and equipment C. Proof of health insurance coverage D. Submission of a completed physical examination form provided by the SSC Department of Nursing (including TITERS and TB test) and/or clinical affiliates. E. Flu Vaccine is required/Covid vaccination is required. F. Current CPR card (Must be American Heart Association) BLS for Healthcare Provider (CPR and AED)

G. Drug Screening and Criminal Background Check.

All expenses are the responsibility of the student.

IMPORTANT Information RELATED TO STATE LICENSURE

Upon successful completion of the program, Illinois Department of Financial & Professional Regulation (IDFPR) and not South Suburban College, grants licensure to nurses through an application and examination process. Applicant may visit

I declare that I have examined the application and all required documents submitted by me are to the best of my knowledge, true, complete, and correct. Submission of this completed application to the Nursing Department does not guarantee admission to the program.
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ASSOCIATE DEGREE NURSING APPLICATION (ADN)

Contact Person Other Than Self

RESPONSIBILITIES AS A NURSING STUDENT