Bachelor's of Nursing Application

To be eligible for admission to the BSNCCC, applicants must meet the following criteria:

Completed an Associate of Applied Science (AAS) or Associate of Science (AS) in Nursing by the upcoming Fall Term.
Hold a current unencumbered RN license by the end of the first BSNCCC term Fall of the upcoming year.

Names & Demographics

*Demographic information is collected for analytics purposes and are not required.

First Name

Middle Name

Last Name

Previous Last Name

Preferred First Name

Birthdate

Marital Status

Social Security Number

Gender

Ethnicity

Race

American Indian or Alaska NativeBlack or African AmericanWhiteAsianNative Hawaiian or Other Pacific Islander

Communication Opt-In

Please confirm below if you would like to receive text or email communication from Klamath Community College. Klamath Community College does not share or sell your information for the purpose of email or SMS communication.

I Would like to receive SMS or email communications from Klamath Community College in the future

Country Code

Phone Number

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Personal Email Address

Address

Country

Street

City

State or Territory

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Educational Background

Please select your College/University

College Id

My College/University is not listed

College/University Name

College/University City

College/University State/Territory

Degree earned

Please Select Your Anticipated Start Term

Verification of Licensure

Please submit verification of licensure (RN Licensure). You can submit either: your Nursing License number, or a pdf copy of your licensure.

I will be submitting

My Licensure number	A PDF Copy of my Nursing Licensure
I will receive my Licensure before the upcoming Fall Term

I will submit a copy of my license before the Upcoming Fall Term

PDF of Licensure

RN License Number

Contact Information