LPN to RN Nursing Program

Waitlist Application

All SVC RN prerequisites must be completed in order to place your name on the Part-time LPN to RN waitlist. Please indicate the classes you have completed with a grade C or better.  It is very important to include completion dates and school of completion for evaluation purposes.  Attach a copy of an active LPN license to this form. 

  (Based on 2012-2013 Catalog)                 Quarter Completed       **School of Completion

 *May require prerequisites before taking

I have completed my prerequisites and request to be considered for entry into the LPN to RN Nursing Program.

SIGNATURE:_____________________________________     DATE:_______________________

PRINT NAME:____________________________________     SID#:________________________

EMAIL:__________________________________________    PHONE #:____________________

RETURN TO:

GENIE ABBOTT

WHIDBEY ISLAND CAMPUS

1900 SE PIONEER WAY

OAK HARBOR, WA 98277