You must have JavaScript enabled to use this form. Required fields are marked with an asterisk '*'. Date * Student ID # * Contact Information * Name * Full legal name including first name, middle initial, and last name CravenCC Student Email Address * Phone * Address * street address City/Town * State * ZIP/Postal Code * Additional Last Names Alternate Email Address Alternate Phone Number What City/State are you currently living in? * Nurse Aide I Listing Number If you do not have your CNA at this time, you must be listed on the NC registry by May 31st, 2022. Do you understand? * Yes No Have you previously applied to any other health programs at Craven Community College? * Yes No When and which program? Completed Classes Have you met the developmental requirements to take the following classes? ENG-111 * Yes No BIO-163 * Yes No MAT-110 * Yes No Have you taken a high school or college level chemistry and made a C or better? * Yes No What year did you graduate high school or obtain your GED? * Have you sent Craven CC all of your official high school and/or GED transcripts? * Yes No If not, please do as soon as possible; this is an application requirement. Have you sent Craven CC all of your official college transcripts? * Yes No If not, please do so as soon as possible; this is an application requirement. List all post-secondary institutions attended Do you have a bachelor’s degree? * Yes No What institution did you graduate from? Are you CPR certified (American Heart Association Basic Life Support Provider)? * Yes No Have you taken the TEAS test before? * Yes No I understand that I may submit TEAS scores from the past 12 months (10.01.2020 thru 09.30.2021). * Yes No I understand that if I have not taken the TEAS within the past 12 months or wish to retake it, I will need to test during the application period (10.01.2021 thru 12.18.2021) and can only test once during this time. * Yes No I understand that it is my responsibility to send all official transcripts to the Registrar at Craven Community so that my application can be processed. * Yes No Special Comments