OFFICIAL APPLICATION FOR EXTERNAL CCMA TO PN NURSING PROGRAM

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Prior to submitting an application to the Accelerated Certified Medical Assistant to Practical Nursing Program, you must first complete the admissions application for Northshore Technical Community College. To complete the application, please visit

ADMISSIONS APPLY NOW

After completing the application, please locate your NTCC student ID# (LoLA#) and list it in the box below.
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Date of Birth Date of Birth / MM / DD YYYY
Last four digits of Social Security Number
Primary Email
Northshore or Alt. Email

Your Northshore student email or alternate email if we cannot reach you at your primary email.
Primary Phone Number Primary Phone Number - ### - ### ####
Alt. Phone Number Alt. Phone Number - ### - ### ####
Have you completed the NTCC Admissions Application?

Have you completed the NTCC Admissions Application? YES NO

You MUST first complete the admissions for NTCC prior to submitting this Practical Nursing Application.
What is your NTCC Student ID number (LOLA)?

This number can be found in your LoLA account under the Student home tab. https://my.lctcs.edu/
Which Campus are you applying to?

Which Campus are you applying to? Hammond Campus Lacombe Campus
Have you ever been enrolled in any Practical Nursing Program prior to this?

Have you ever been enrolled in any Practical Nursing Program prior to this? YES NO
If YES, at which School?
Did you attend the Practical Nursing Program through NTCC?

Did you attend the Practical Nursing Program through NTCC? YES NO
If previously attended the Practical Nursing Program through NTCC, at which campus were you enrolled?

If previously attended the Practical Nursing Program through NTCC, at which campus were you enrolled? Lacombe Hammond Sullivan (Bogalusa) Livingston (Walker) Florida Parishes (Greensburg)
Last Semester Attended?

Last Semester Attended? Fall Summer Spring
Year Attended?
Number of semesters in the Practical Nursing program completed with an 80%?

Number of semesters in the Practical Nursing program completed with an 80%? Semester 1 Semester 2 Semester 3 Semester 4
Reason for leaving?

Reason for leaving? Academic Failure Absences Exceeding Required Attendance Residence Relocation Code of Conduct Dismissal Personal Issue Medical / Health Issues Financial Issues Military Deployment LSBPNE Dismissal Other Other