Health Sciences application

Section I

Please indicate the health sciences program for which you are applying. Be sure to apply to only one program at a time.

Associate Degree Nursing (AASRN) application deadline April 1 of the application year for a fall semester start
Licensed Practical Nursing (CERLP) application deadline September 1 of the application year for a winter semester start
Radiologic Technology (AASRD) application deadline February 15 of the application year for a summer semester start
Respiratory Therapy (AASRP) application deadline June 30 of the application year for a fall semester start
Transition Nursing (AASNT) application deadline October 1 of the application year for a winter semester start

If you are interested in applying for the allied health degree program or the therapeutic massage program, you do not need to fill out this health sciences application. Please proceed to sc4.edu/apply to fill out the general application.

I prefer *

On-campus
Online program

Please attach a copy of your LPN or Paramedic licensure to this application.

Click or drag files to this area to upload. You can upload up to 2 files.

Section II

I have attended SC4 within the last two years.

Yes
No

(If you have never attended SC4, or if it has been more than two years since you last attended you need to stop and apply online at sc4.edu/apply.)

Section III

Name *

First

Middle

Last

If you have no middle name, use “n/a”

Suffix

Jr., Sr., III, etc.

Former name

if applicable

Chosen first name

if applicable

Chosen middle name

if applicable

A chosen name cannot:

misrepresent a person’s identity and/or misappropriate the identity of another person or organization;
be used in attempt to avoid a legal obligation;
be used if its appearance on college records would be harmful to the reputation or interests of the College;
be derogatory, obscene, convey an offensive message, or be otherwise inappropriate.

Preferred pronoun

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary phone *

Alternate phone

Student number or Social Security number *

Email *

Date of birth *

Electronic signature: Type your full legal name in the box provided as an electronic signature for this Application for Admission *

I certify that all answers I have given are complete and accurate. I understand that the official policies and procedures of SC4 are published in the College Catalog at sc4.edu/catalog.

Have you ever applied to any SC4 health sciences program in the past?

Yes
No

If yes, when

What program? *

Please note

Your health sciences program application will not be processed if: You don’t have a current general application for admission on file, or if you don’t pay your $25 application fee (per application) via the The Pier at sc4.edu/HealthSciencesFee.

For students wishing to pay for more than one application and for third-party payers wanting to pay for multiple applicants’ applications please use this link, sc4.edu/HealthScienceFeeMultiple.