Nursing Program Application

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Applicant Information Klamath Community College Nursing Program Icon

First Name

Preferred Name(if different than first name)

Middle Name (If Applicable)

Last Name

Date of Birth

Social Security Number

Marital Status

Home Address

City

State

Zip Code

Military Status

Are you a United States Veteran?

YesNo

Are you on Active Duty in the U.S. Military or in Reserves?

YesNo

Are you the Spouse of an Active Duty Servicemen?

YesNo

Please submit a PDF copy of Military ID

Communication Opt-In Klamath Community College Nursing Program Icon

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

Personal Email Address

Demographic Information Klamath Community College Nursing Program Icon

Gender

Ethnicity

Race

American Indian or Alaska Native	Asian
Black or African American	Native Hawaiian or Other Pacific Islander
White

College Educational Background Nursing Logo

Have you previously attended any other College/Universities(Including Dual Credit)?

YesNo

Most Recent College Attended:

Highest Degree Earned

My College/University was not listed.

College/University Name

College/University State

College/University City

Graduation Date

*Date is less important than year/month

Program Selection Klamath Community College Nursing Program

Please Select The Program You Would Like to Apply To NOTE: If you are applying to both programs, select the first choice here

Are you a currently practicing LPN

YesNo

LPN Verification

Please Upload a PDF Copy of your Licensure to Practice

OR Enter your LPN Here:

Select Term for Program Start:

Select Term for Degree Start:

Which Location are you intending to apply for in the Nursing Program?

LakeviewKlamath FallsBoth

I am applying to both the RN and LPN Programs

**Students placed in the AAS-RN or PN certificate program in the Lakeview cohort will have most skills labs and clinical rotations in Lakeview, will be allowed to attend class remotely via Zoom from the LDH classroom at the same time lecture is conducted at the Klamath Falls campus, and will be required to travel to Klamath Falls on occasion. Current residents of Lakeview will be given preference for the Lakeview cohort(s).

Documents for Download Klamath Community College Nursing Program

The documents provided in this section are available for you to download. Make sure that they are completed and submitted to the upload location of the same name.

Language Proficiency

Are you fluent in more than one language?

YesNo

Upload the results of your language exams here OR confirm that your transcripts reflect language proficiency in a studied language. Language tests can be found by following this link.

Upload Proof of Residency here:

Upload Proof of Work Experience Form here:

Upload Volunteer Verification Form here:

Please make sure to order your transcripts through Parchment, here. For the receiving address, make sure to use nursing@klamathcc.edu

Additional Questions or Information Nursing Logo

If you have additional items for consideration or if you have any notes that you would like reviewed with your application, please add them here.

Application Checklist and Agreement Klamath Community College Nursing Program

Applicant: You must complete the following checklist as part of your applications. Please mark each checkbox below, indicating that you have read, understand, and agree to the application requirements for the Klamath Community College Nursing Program.

LPN TO RN Bridge Check Items

I have requested all previous college and university official transcripts to Klamath Community College by the March 31st deadline. ALL 45 pre-requisite classes MUST be completed by March 31, 2026.

I am still completing my last prerequisite course A&P III with lab. I Will be done by end of Spring 2026 I am submitting coursework now from ALL previously attended, regionally accredited, colleges or universities, for purpose of prerequisite verification and I will request update when the 45-credit hours are completed by June 20th.

I understand that Anatomy and Physiology as well as Math MUST have been completed within the last 7 years prior to application. I must have achieved at least a “C” in Anatomy and physiology, Math and Writing 121. Overall GPA of the 45 credits of the Prerequisite courses is 3.0 or greater.

I will complete the Kaplan PN Predictor Exam @ the KCC testing center prior to March 31, 2026. I have set up appointment to take Kaplan PN predictor test at the KCC test Center

Scheduled Kaplan Test Date

I MUST achieve a grade of 69.5% on this exam to be considered for admission for 2026.

I have provided a secure email address on my application and give permission to Klamath Community College to contact me through this email address.

I have uploaded a copy of my LPN/LVN licensure to the drop box provided on the admission form. I have also stated the number of years I have been an LPN/LVN.

I have been employed as an LPN/LVN for over 400 hours in the last 2 years. I have provided the name, email address and phone number for verification of employment in the online application. I am giving KCC permission to send a verification letter to that individual to validate work experience.

I understand that students will be informed of their acceptance status by April 30, 2026.

I understand that if there is a financial hold on my KCC account, my application will be disqualified if the hold is not removed by March 31, 2026

I have uploaded proof of residency.

I understand that reading and following directions is critical to success in nursing. Incomplete applications will result in disqualification.

I understand that if accepted I will be required by a specified deadline to order a criminal background check with the Klamath Community College Nursing Department’s contracted agency, which performs criminal background checks and must also self-disclose any disciplinary action taken by a Board of Nursing, even if the disclosures are outside a five- or 10-year window, and must disclose any warrant, arrest, citation, charge or conviction if such occurs after acceptance. Prior criminal history will be considered on a case-by-case basis and is not an automatic disqualification. Information can be obtained by following this link

I understand that the Oregon State Board of Nursing (OSBN) has limits on eligibility. Ultimately, a license can be denied by the OSBN to students with a criminal offense and those with a major physical or mental condition that could affect their ability to practice nursing safely. A predetermination of eligibility can be requested from the OSBN via the following site

RN and LPN Check Items

I would also consider placement in the RN or PN Program should 1st choice not be available.

I am providing now official college transcripts (either through file upload to this document or mailing to the educational institution) from ALL previously attended, regionally accredited, colleges or universities, including coursework completed for purpose of prerequisite verification of 45 credit hours and earned degree (Klamath Community College transcripts do not need to be official).

I am still completing my pre-reqs. I will be done by end of Spring 2026. I am submitting coursework now from ALL previously attended, regionally accredited, colleges or universities, for purpose of prerequisite verification and I will request an update when the 45 credit hours by June 20th.

I am still completing my pre-reqs. I will be done by end of Spring 2026 with the exception of A&PIII with lab which I will complete by the end of Summer 2026. I am submitting coursework now from ALL previously attended, regionally accredited, colleges or universities, for purpose of prerequisite verification and I will request an update when the 45 credit hours by June 20th.

I have set up appointment to take Kaplan Nursing Entrance Exam at the KCC Testing center

Test Date

I have set up an appointment to write my admission essay

Essay Appointment Date

I have provided a secure email address on my application and give my permission for Klamath Community College to contact me through this email address. I understand that a receipt verifying my application packet was submitted to Klamath Community College will be emailed to me and that I will also receive notification of my degree audit result by email once it has been completed.

I understand that each applicant will be notified by email of his or her status regarding acceptance by June 30, 2026. I also understand that I am not to call the Nursing Program or Student Services regarding my acceptance status unless directed to do so.

I understand that if I have a financial hold on my Klamath Community College account, my application will be disqualified unless the financial holds are removed before 5 P.M., June 30, 2026

I have uploaded the completed residency form and supporting documentation, if applicable.

I have uploaded official documentation to demonstrate second language proficiency, if applicable

I have uploaded a name, phone and email for person(s) to verify volunteer hours and give KCC nursing the permission to contact this (these) individual(s)

I have included documentation indicating active-duty military/spouse, retired military or veteran with honorable discharge status, if applicable.

I have included current/active unencumbered state or national certification/license such as CNA, LPN, EMT, MA, RT, paramedic, armed forces medic/corpsman, or other approved work experience, if applicable, and uploaded the required form(s) from my employer verifying hours.

I understand that reading and following directions is critical to success in any nursing program. Incomplete applications will result in disqualification and that disqualified applicant will only receive notice of such after the application deadline has passed

I have read and understand that the program information and admission criteria (including requirement for negative urine drug screening and criminal background check in order to be admitted) for the Nursing program at Klamath Community College. (Criminal backgrounds indicating prior arrests, charges, and convictions will be considered on a case-by-case basis and is not an automatic disqualification). I understand that I will be asked to consent to a urine drug screening for any signs of impairment while in the clinical setting and will be dismissed from the program if the screen is positive for any illegal substances. Program information, including selection points, prerequisites, and information sessions can be found here:

I understand that if accepted I will be required by a specified deadline to order a criminal background check with the Klamath Community College Nursing Department's contracted agency, which performs background checks and must also self-disclose any disciplinary action taken by a Board of Nursing, even if the disclosures are outside of a five- or 10-year window, and must disclose any warrant, arrest, citation, charge or conviction if such occurs after acceptance. Prior criminal history will be considered on a case-by-case basis and is not automatic disqualification

I understand that the Oregon State Board of Nursing (OSBN) has limits on eligibility, as defined in OAS 851-031-0006 (2)(a)(b) for licensure. Ultimately, a license can be denied by the OSBN to students with a criminal offence and those with a major physical or mental condition that could affect their ability to practice nursing safely.

I understand that it is my responsibility to meet all program and application criteria. Klamath Community College nursing staff are available to answer application related questions, but will not check my application for completeness prior to submission

I verify that all statements on this application are complete and true and I understand that falsification of any information may lead to disqualification or dismissal from the program.

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