Coastal Alabama Community College March 2020
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COASTAL ALABAMA COMMUNITY COLLEGE
NURSING TRANSFER APPLICATION
Application Deadline: Transfer applications must be received before the last three weeks of the semester prior
to the requested transfer semester.
I. PERSONAL DATA Date: _____________
Last Name: _______________________ First: ____________________ MI: ___ Maiden: ___________
Social Security Number: _______________________________ Student Number: __________________
Mailing Address: ______________________________________________________________________
City: _____________________ State: ___ Zip Code: ___________ Telephone: (___)________________
Home e-mail address: _________________________ College e-mail address: ______________________
Emergency Contact: ___________________________________ Telephone: ( )__________________
II. EDUCATION
List all colleges attended including current college. (Add separate page as necessary)
Name of College (DO NOT ABBREVIATE)
A letter from the program Dean/Director of the nursing program from which you wish to transfer must be
sent to the appropriate nursing department. The letter must document that you have not been dismissed
for disciplinary or unsafe practice and are eligible to continue in the program.
_____________________________________________________________________________________
_____________________________________________________________________________________
A COPY OF YOUR ACT RESULTS MUST BE ATTACHED TO THIS APPLICATION. (There is no date
limitation). Your name, as listed when tested: ______________________________________
I understand that completion of this application is a component of the student profile and does not in itself
grant transfer to the Nursing Program. I certify that the information given in this application is true and
correct. I understand that providing false information may be deemed sufficient reason to dismiss the
student and/or to refuse transfer. All application materials become the property of Coastal Alabama
Community College. It is the sole responsibility of the applicant to ensure that the Nursing Department has
received all of the requested documentation.
All information must be submitted by the appropriate deadline or the application will be considered
incomplete. It is recommended that applicants check with the Admissions Office, at (251) 580-2111, to
confirm ACTIVE STATUS and confirm ALL TRANSCRIPTS are on file and up to date.
___________________________________ ________________________________
Applicant’s Signature Date
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