ASSOCIATE DEGREE RN PROGRAM APPLICATION
Applications must be submitted online September 1 - 30, 2026, by 4 p.m.
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The information noted with this symbol will in no way affect your ability to enter the Nursing and Allied Health Programs; it is obtained for statistical purposes ONLY. It will be kept confidential and used to gather data needed to receive state and federal funding.
APPLICANT INFORMATION
Cuesta Student ID Number
*
Last Name
*
First Name
*
Middle Name
Previous Name(s)
First Name
Last Name
MyCuesta E-mail Address
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Confirmation Email
This MUST be your @my.cuesta.edu address. Example: Example: cougie_cougar@my.cuesta.edu
Personal E-mail Address
*
Confirmation Email
Primary Phone Number
*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Current Mailing Address
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Street Address
City
*
City
Zip Code
*
Zip Code
Is your current address the same as your permanent?
*
Please Select
Yes
No
Permanent Address
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Street Address
City
*
City
State
*
State
Zip Code
*
Zip Code
Date of Birth^
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/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age at time of application^
*
Gender^
*
Please Select
Female
Male
Transgender
Non-binary
Other
Decline to State
California Residency^
*
Please Select
Yes
No
If yes, how many years?
Race/Ethnicity^
*
Please Select
American Indian (All persons descended from the original peoples of North America)
Asian (Persons having origins in the Far East, Southeast Asia, the Indian Subcontinent, including for example: Cambodia, China, Indonesia, Japan, Korea, Laos, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam)
Other Asian (Asian, other than Chinese, Filipino, Japanese, Korean, Malaysian, Pakistani, Asian Indian, or Thai)
Black (All persons having origins in any of the black racial groups of Africa and not Hispanic in origin)
Hispanic (All persons of Chicano, Mexican, Puerto Rican, Cuban, Central/South American, or other Spanish culture origin regardless of race)
Native Hawaiian or Other Pacific Islander
White (All persons having origins in Europe, North Africa or the Middle East and not of Hispanic origin)
Other not listed
Primary language spoken at home^
*
Please Select
American Sign Language
Arabic
Chinese
English
Farsi
Languages of Indian Subcontinent and Southeast Asia
Russian
Spanish
Tagalog
Other
Are you a veteran?^
*
Please Select
Yes
No
Are you the spouse of a veteran?^
*
Please Select
Yes
No
Have you applied to the Cuesta RN Program before?^
*
Please Select
Yes
No
If yes, what year(s) did you apply?
Have you ever been admitted to an RN Program before?^
*
Please Select
Yes
No
If yes, please enter the names of the programs you have attended
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1. ACADEMIC DEGREE OR RELEVANT LICENSE OR RELEVANT CERTIFICATE
Education
Please Select
Master's Degree or Higher
Bachelor’s Degree
Associate’s Degree
Licensed Health Care Worker (LVN, Psych Tech, Paramedic)
Certified Nurse Assistant Certification plus CNA work experience (500 hours in past 2 years)
Certificated Health Care Worker (Nurse Assistant, Medical Assistant, Phlebotomist, EMT)
No Degree, License, or Certificate
Indicate your highest level of education obtained by the application deadline.
Copy of Health Care Worker License/Certificate
*
Upload a File
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CNA Work Experience Verification Form (500 hours or more)
*
Upload a File
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College/University Attended - Other than Cuesta College
Rows
School
City
State
Dates Attended
1.
2.
3.
4.
5.
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2a. PREREQUISITE SCIENCE COURSEWORK
*Online and Distance Education labs are not accepted. Exception: Spring 2020 through Spring 2022 online science labs will be accepted due to the COVID pandemic
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Rows
School
Course #
Term/Yr
Credits
Grade
Microbiology with lab* (Bio 204)
Human Anatomy with lab* (Bio 205)
Human Physiology with lab* (Bio 206)
Enter Prerequisite Science GPA:
*
Prerequisite Science GPA must be 2.5 and higher to be eligible.
A combined GPA of 2.5 or higher is required in the prerequisite science courses.
2b. PREREQUISITE ENGLISH AND MATH COMPETENCY
English and Math Competency
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Rows
School
Course #
Term/Yr
Credits
Grade
English Composition (Eng 201A)
Math Competency (Math 127 or Higher)
Enter English and Math GPA:
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If you did not complete an associate degree level math, enter “0” in this box.
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2c.
REPEATS IN SCIENCE AND ENGLISH PREREQUISITE COURSES
SUBSTANDARD GRADES ARE: C-, D+, D, D-, F, FW, NP, OR NC.
PLEASE NOTE: " W " & " I " ARE NOT CONSIDERED SUBSTANDARD GRADES.
Repeat includes the following grades of C-, D+, D, D-, F, FW, NP, or NC. Please indicate the number of course repeat(s):
*
Rows
Number of Repeats
Human Anatomy with Lab
0
1
2
3
Human Physiology with Lab
0
1
2
3
Microbiology with Lab
0
1
2
3
English Composition
0
1
2
3
Will you be submitting an appeal to waive point deductions or an ineligible status due to repeats?
*
Please Select
Yes
No
SUPPORTING DOCUMENTATION REQUIRED
Have you requested an appeal in a previous application cycle that has already been approved?
*
Yes
No
SUPPORTING DOCUMENTATION REQUIRED
Copy of Approved Appeal Notification
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If you received an appeal approval letter in an earlier application cycle, upload it here.
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I am submitting an appeal form in this application cycle for the following reason:
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Program ineligibility due to three or more repeats in prerequisite coursework with a grade of C- or lower.
Point deduction for repeats in a Science or English prerequisite course with a grade of C- or lower.
Ineligibility for Excessive Repeat Appeal Form
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Point Deduction Appeal Form
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Additional Supporting Documentation
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3. WORK OR VOLUNTEER EXPERIENCE
3a. 200 hours or more working in healthcare, within the last 2 years (September 1, 2024 through September 30, 2026). Must complete and submit the Work Experience Verification form included in the September 2026 Application Instructions.
Please Select
EMT
LVN
Medical Assistant
Paramedic
Psychiatric Technician
Nurse Assistant
Other Licensed/Certificated Healthcare Worker
Relevant Worker Experience
None
SUPPORTING DOCUMENTATION REQUIRED
3b. 200 hours or more volunteering in healthcare, within the last 2 years (September 1, 2024 through September 30, 2026) Must complete and submit the Volunteer Experience Verification form included in the September 2026 Application Instructions.
YES
NO
SUPPORTING DOCUMENTATION REQUIRED
Work Experience in Healthcare Verification Form
Upload a File
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Volunteering Experience in Healthcare Verification Form
Upload a File
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Additional Documentation
Upload a File
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4. LIFE EXPERIENCE OR SPECIAL CIRCUMSTANCES
While more than one of the following criteria may apply to you, only 2.5 points can be awarded in this category. Select only one item for Criteria 4. Refer to the September 2026 Application Instruction Packet for details on documentation required.
Please Select
Disability
Disadvantaged social or educational environment
Difficult personal or family situation/circumstances
Family income
First generation of family to attend college/university
Need to work
Refugee
Veteran status (a copy of DD214 must be submitted with application)
Living in a medically underserved area
None
SUPPORTING DOCUMENTATION REQUIRED
Documentation of Life Experiences/Special Circumstances
*
Upload a File
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Additional Documentation
Upload a File
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5. PROFICIENCY IN A LANGUAGE OTHER THAN ENGLISH
Applicant may be proficient in more than one additional language, but only 2.5 points can be awarded in this category. Must upload one form of verification. For examples of allowable verification, see the September 2026 Application Instruction Packet
Please Select
American Sign Language
Arabic
Chinese
Farsi
Languages of Indian Subcontinent and Southeast Asia
Russian
Spanish
Tagalog
Other
None
SUPPORTING DOCUMENTATION REQUIRED
Verification of Foreign Language Proficiency Form
*
Upload a File
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Additional Documentation
Upload a File
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6. ADDITIONAL POINTS FOR PREVIOUS ELIGIBLE APPLICANTS
I have submitted 3 or more applications to the Cuesta College RN Program in the past 5 years (2021, 2022, 2023, 2024, 2025). In at least 3 of those years, I received notification that I was an eligible candidate, but I was not selected for admission.
Please Select
Yes
No
Check below THREE years you applied and were eligible but not offered admission.
Rows
2021
2022
2023
2024
2025
3 years applied:
Must Submit THREE Eligibility Without Admission Letters from dates above for points. DO NOT SUBMIT LESS THAN THREE LETTERS
*
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APPLICANT ACKNOWLEDGMENT AND AGREEMENT
Signature - Use your mouse to enter signature
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Submit Application
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