EICC Nursing Program Application

• Choose which campus/program you would like:
  
  ADN - SCC - Day
  LPN - SCC - Day
  
  
  
• Final high school transcript, GED, or high school equivalency has been submitted to Clinton, Muscatine, or Scott Community College.
  
  Yes No
  
  
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• Have you completed your CNA:
  
  Yes No
  
  
• If your CNA is not completed but you are currently registered for a CNA class complete the following questions with when and where it is scheduled.
• CNA completion date:
  
  
• CNA completed at:
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• First Name
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• Last Name
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• Student ID #
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• Use your EICC live email account - This is the only way we can assure you will receive a confirmation and how the nursing department will contact you regarding any questions about your application.
• Email address
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• Address
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• City
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• State AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
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• Zip/Postal Code
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• Phone Number
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• Date of Birth
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  Other names your records may be under:
  
  
  
  

All Applicants

Please identify where and when you completed the course and the grade you received or enter 'Currently Enrolled' in the Grade column if you are currently in the class:

* Note: must have been taken within 5 years of enrolling in Intro to Health Concepts

ADN Applicants ONLY

Please identify where and when you completed the course and the grade you received or enter 'Currently Enrolled' in the Grade column if you are currently in the class:

• How did you take AP I & II:
  
  Online In classroom
  
  
• TEAS Test
• If you have not taken the TEAS Test yet, please enter 'NA' for score and select the anticipated date you will take the test. The TEAS test must be completed before October 15.
• TEAS Score
• Date Taken
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• 
  Remediation Completed:
  
  Yes No
  
  

It is the policy of Eastern Iowa Community College District not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential family, parental or marital status, as required by the Iowa Code §§216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681-1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact EICC’s Equal Employment Opportunity Officer/Equity Coordinator, Eastern Iowa Community College District, 101 West Third Street, Davenport, Iowa 52801, 563-336-5222, equity@eicc.edu or the Director of the Office for Civil Rights U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, Telephone: (312) 730-1560 Facsimile: (312) 730- 1576, TDD (800) 877-8339 OCR.Chicago@ed.gov.