Restricted Allied Health Admission Application

YOU MUST HAVE A JALC STUDENT ID NUMBER BEFORE APPLYING TO THE PROGRAM AND REGISTERING FOR THE PRE-ENTRANCE EXAM.

Which Program Are You Applying For? *

Admission Deadline: March 1, 2022

Admission Deadline: February 11, 2022

Admission Deadline: March 31, 2022

Admission Deadline: APPLICATIONS WILL BE ACCEPTED UNTIL THE START OF THE PROGRAM OR UNTIL ALL AVAILABLE POSITIONS ARE FILLED, WHICHEVER OCCURS FIRST.

Student Information

JALC Student ID *

Which Massage Therapy program are you applying to *

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number with Area Code *

Date of Birth *

Personal Email *

Email

Confirm Email

Additional Information

Preference is given to in-district applicants. Will you be a legal resident of JALC College District #530 by the admission deadline? *

Preference is given to in-district and CAREER Agreement applicants. Will you be a legal resident of JALC College District #530 or have an approved CAREER Agreement from your community college on file by the admission deadline? *

Each college does give preference to its in-district students. Will you be a legal resident of JALC College District #530 by the admission deadline? *

If NO, in which college district are you a legal resident?

High School attended or currently attending. If GED received, enter GED *

Date of actual or anticipated high school graduation, or when GED received *

Are you transferring courses taken at another college for consideration within the ADN program guide? *

Are you transferring courses taken at another college for consideration within the ADN hybrid online program guide? *

Are you transferring courses taken at another college for consideration within the DNA program guide? *

Are you transferring courses taken at another college for consideration within the DMS program guide? *

Are you transferring courses taken at another college for consideration within the MAS program guide? *

Are you transferring courses taken at another college for consideration within the MDA program guide? *

Are you transferring courses taken at another college for consideration within the MLT program guide? *

Are you transferring courses taken at another college for consideration within the OTA program guide? *

Are you transferring courses taken at another college for consideration within the PNE program guide? *

Are you transferring courses taken at another college for consideration within the STP program guide? *

If YES, list all colleges from which you have requested official transcripts

Will transcripts be submitted under any other name(s)? *

If so, list names

Will you have all prerequisite course requirements completed by the start of the program? *

Will you have prerequisite courses BUS 115 and NAD 101 completed by the start of the program? *

Will you have prerequisite course requirement BIO 205 completed by the start of the program? *

Have you graduated from or currently attending an accredited Practical Nursing Program? *

If YES, proceed to next question.
If NO, please stop and apply to the Practical Nursing Program.

Are you currently enrolled in a Nursing Assistant Training course? *

Where did you attend or currently attending accredited Practical Nursing Program as well as the date of your actual or anticipated graduation (MM/YY) *

If NO, when (MM/YY) and where did you graduate from a Nursing Assistant Training course?

Name of accredited Practical Nursing Program from which you graduated *

Date of actual or anticipated graduation from accredited Practical Nursing Program *

Do you hold a current unencumbered Illinois LPN License? *

Do you have Licensed Practical Nurse work experience (or equivalent work experience)? *

Agreement *

I certify that the information contained herein is true, complete, and correct. It also certifies that I have read the admission packet online, and agree to all application procedures.

The ADN, ADN Hybrid Online, DNA, DMS, MAS, MDA, SICCM MLT, SICCM OTA, PNE, and SICCM STP programs admission process does not discriminate on the basis of race, creed, color, national origin, gender, age or the presence of a non-job related condition or disability.

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Restricted Allied Health Admission Application

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