Practical Nursing Selection Request Form Murphy

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.

YesNo

Proof of attendance at a mandatory healthcare information session is required before submitting this competitive selection application. Please contact the Advising Center for details about upcoming session dates and times, or to schedule a one-on-one meeting with an advising coach.

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.Format: (000) 000-0000.

WGTC Email*

example@student.westgatech.edu

YesNo

CPR Certification Expiration Date*

Date

Attach a copy of the front and back of your certification card*

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*

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

YesNo

Where was your credential earned?*

Please Upload Proof of Bonus Points*

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*

Date

Signature*

I confirm that I have completed all the requirements to compete for the selected healthcare program(s). I have reviewed the General Competitive Selection Procedures and Competitive Selection Program Statistics available at https://www.westgatech.edu/admissions/getting-started/competitive-selection-process/. I understand that if I am not selected for a program above, it is my responsibility to complete another Competitive Selection Form for the next selection term. If I am accepted to more than one program, I must notify each program with my decision by their indicated deadline. If I do not respond by the deadline, I forfeit my acceptance.

Once I accept a competitive selection program, the program’s admissions counselor will change my major to the accepted program.

As set forth in its student catalog, West Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, sex, age, religion, disability, political affiliation or belief, genetic information, disabled veteran, a veteran of the Vietnam Era, or citizenship status (except in those special circumstances permitted or mandated by law). The following persons have been designated to handle inquiries regarding the non-discrimination policies: Equity (Title IX) Coordinator: Melinda Hofius, AVP of Student Affairs 770.537.5722, 176 Murphy Campus Blvd., Waco, GA 30182; ADA (Section 504) Coordinators: Students: Zelma Jones, Career and Student Support Services Director, 770.824.5245, 176 Murphy Campus Blvd., Waco, GA 30182, Student504@westgatech.edu, Employees: Teresa Jiles, Assistant Director of Human Resources, 770.537.6056, 176 Murphy Campus Blvd., Waco, GA 30182, wgtcHR@westgatech.edu.

Murphy Campus Practical Nursing Selection Request Form

Bonus Points