Practical Nursing Selection Request Form

Practical Nursing Selection Request Form
Attach all required documents for the Competitive Selection File Review Request.

The file review will not be processed if it is incomplete or missing the required documents. If you forget to attach the proper documentation, you must submit an updated Competitive Selection File Review Request by the posted deadline.

In addition to the submission of the competitive selection form, students must be regularly admitted to WGTC in good academic standing.
Name*

First NameLast Name
Student ID*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
WGTC Email*
example@student.westgatech.edu
Review your Self-Service Web student information and indicate your current residency status:*

In-StateReciprocityOut-of-StateInternationalOther
Are you in good academic standing with WGTC? (Required)*

YesNo
Have you submitted an official transcript from each college previously attended?*

YesNo
Do you hold a current CPR Certification from the American Heart Association for Healthcare Providers? (Required)*

YesNo
CPR Certification Expiration Date*

MonthDayYear
Date
Upload a front and back copy of your CPR card.*

Cancelof
Select Campus*

LaGrange - February 1 application deadlineMurphy - June 1 application DeadlineCoweta - September 1 application deadline
Have you completed the Test of Essential Academic Skills (TEAS) exam with at minimum 65% Adjusted Individual Total Score? ( Required)

YesNo
Have you completed the Test of Essential Academic Skills (TEAS) exam with at minimum 75% Adjusted Individual Total Score? ( Required)*

YesNo
Students must meet the minimum selection criteria requirements to apply to the selection process.

For information on the requirements for the LPN program, please review the Program Completion Checklist or contact admissions at admissions@westgatech.edu.
A maximum of three attempts are allowed per calendar year, with a minimum of 14 days between attempts. An official exam score report taken within the past two years reflecting the highest score earned must be attached to your application.

Upload a copy of the score you wish to use for selection below.
File Upload*

Cancelof
Bonus Points

The Bonus Points section is designed to award additional points to your overall TEAS score. These points are based on ONE of the following credentials or certifications described below. (Please note that points will not be awarded for having multiple licensures/certifications or educational credentials. Submit official transcripts or certifications documenting the earned credential on or before the application deadline.)
- 3 Bonus Points: A current Allied Health license or certification, such as certified nursing assistant (CNA), certified medical assistant (CMA), EMT, Paramedic, Phlebotomy, Medical Coding, etc., or College certificate or Diploma.
- 4 Bonuc Points: Associate Degree
- 5 Bonus Points: Bachelor Degree or Higher
Do you have one of the credentials listed above to submit for additional points?*

YesNo
Please choose from the following:

3 Bonus Points: A current Allied Health license or certification, such as certified nursing assistant (CNA), certified medical assistant (CMA), EMT, Paramedic, Phlebotomy, Medical Coding, etc., or College certificate or Diploma.4 Bonus Points: Associate Degree5 Bonus Points: Bachelor Degree or Higher
Where was your credential earned?*
Please Upload Proof of Bonus Points*

Cancelof
I understand that this request, along with supporting transcripts, test results, licenses, and a copy of my current CPR card, must be received by the application deadline. I also understand that meeting the minimum requirements does not guarantee selection as there are a limited number of seats available.
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Practical Nursing Selection Request Form

Bonus Points