Student ID: ____________________________________
Last Name: ____________________________________ First Name: __________________________ Middle Initial: ______
Former last name(s) if any: _____________________________________
Mailing Address:
_______________________________________________________________________________________________________
Street City State Zip Code
E-mail address: ______________________________________________________________________________________
Primary phone number: ________________________ Alternate phone number: ________________________
Birthdate (MM/DD/YYYY): ________________
CCSNH Institution where ADN was or will be completed:
Anticipated Completion of ADN (Month/Year): __________________
Entry term for 3
rd
year at CCSNH: __________________________ Anticipated start term at GSC: _____________________
(Example: Fall 2017) (Example: Fall 2017)
In order to be fully admitted to the BSN degree program
at Granite State College, students must successfully graduate with the
Associate Degree in Nursing (ADN) with a CGPA of 2.00 or higher and pass the NCLEX-RN Licensing examination. Conditionally
admitted students who have not yet submitted proof of conferred ADN and passed the NCLEX-RN may only take non-NUR
courses and NUR 602 and may not proceed with other NUR courses until they have an active R.N. license.
Students who have completed a CCSNH ADN program, satisfy the admission requirements described above, and are eligible for
New Hampshire residency for tuition purposes will receive the discounted tuition through this partnership as long as they
remain in good academic standing and retain that residency status.
Students who have previously completed a Bachelor’s or Master’s degree in another field will not need to take the third year
courses; those students will be required to only take the 30 credits of NUR courses and CRIT 502: Conducting Critical Inquiry at
GSC and MATH 504: Statistics (if not satisfied in transfer).
In addition to submitting this form to the CCSNH institution, you must also complete an application to Granite State College
to become dually enrolled; this application is available online at:
https://www.granite.edu/become-a-student/apply-
now/undergraduate-apply-now/. If you completed college courses at a location other than the CCSNH institution listed
above, it is your responsibility to request official transcripts from each previously attended college for your GSC application.
RN to BSN Nursing Public Pathway
Granite State College (GSC) has partnered with the Community College System of New Hampshire
(CCSNH) to build an affordable pathway to a Bachelor of Science in Nursing (BSN).
Students with an Associate Degree in Nursing (ADN) from a CCSNH institution are eligible for this
pathway. This affordable option allows students to remain at or return to a CCSNH institution to
take third year courses toward the BSN degree program and conclude their fourth year studies,
including all NUR courses and CRIT 502, at Granite State at a reduced tuition rate for in-state
residents.
Begin by completing this form and submitting it to the Admissions Office at the CCSNH institution.
Review the Specific coursework you will need to complete at
https://www.granite.edu/degree-
programs/bachelors-degrees/cssnh-nursing-partnership/.
In addition to submitting this form to the CCSNH institution, you must also complete an
application to Granite State College; this application is available online at:
https://www.granite.edu/become-a-student/apply-now/undergraduate-apply-now/.
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