LVN Spring 2027 Application

Vocational Nursing (LVN)
Program Application

All components and questions in this application must be complete in their entirety to be eligible for consideration for admissions into the LVN program. You may save your progress at any time and continue later. Once the application is completely filled out, you may submit the application. After submitting the application, no edits can be made. If you have any questions with the form, email us at lvn@ccsf.edu

Name

First NameLast Name
CCSF Student ID#
Date of Birth
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
CCSF Email

Confirmation Emailexample@example.com
Personal Email

Confirmation Emailexample@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your ethnicity and language/s you speak?
Did you pass the CCSF CNA Program?
Why are you interested in this program?
Not used in determining program acceptance.

If you have any of the below items within the past 5 years, are you interested in apply for transfer credit? (Please note that you must provide documentation to be eligible for the transfer credit).

Rows	I would like to apply for credit	I do not want to apply for credit
Accredited Anatomy, Physiology, Nutrition, Pharmacology, Growth and Development courses (Minimum of 3 units and 52.5 lecture hours)
Accredited Vocational or Practical Nursing courses
Accredited Registered Nursing courses
Accredited Psychiatric Technician courses
Certified Nurse Assistant courses
Armed services nursing courses
Other courses the school determines are equivalent to the courses in the program

Program Participation Acknowledgement
Admission into the LVN Program is contingent upon meeting all program requirements. Further documentation, including health clearance and clinical eligibility requirements, may be required upon conditional acceptance.

Clinical and Compliance Requirements (Upon Conditional Acceptance)

If conditionally accepted into the LVN program, students must complete the following requirements prior to participation in clinical placement:
- Physical examination by a physician verifying ability to safely participate in clinical activities.
- Immunization documentation and/or positive titers (MMR, Varicella, and Hepatitis B)
- COVID-19, Tdap, seasonal influenza vaccination documentation
- Tuberculosis screening
- Background check (Castlebranch)
- Drug screening (Castlebranch)
The student Vocational Nursing (LVN) must meet the physical examination, immunization proof, background check, and drug screen requirements.

Please submit the copy of your transcripts; if accepted, official records will be required. Do not email your transcripts. The transcripts should include the School's name, your name, and grades that are clearly viewable.

OFFICIAL TRANSCRIPT UPLOAD INSTRUCTIONS

Please upload a clear, complete copy of your transcript.

• Upload ONE PDF file only (preferred format: PDF)
• Combine all pages into a single file
• All pages must be upright (not sideways)
• The entire page must be visible (no cropped edges)
• The text must be clear and readable (not blurry)
• Do NOT submit screenshots or partial photos
• File name format: LastName_FirstName_Transcript.pdf

Incomplete or unclear uploads may delay review of your application.
U.S. Accredited High School Transcript of Completion or GED or High School Equivalent.

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Proof of Prerequisite College Level Math or higher and English 1A or higher with a "C" grade or higher completion.

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Transcripts for the required PREQUISITES within five years with a "C" grade or better in the US accredited: Anatomy & Physiology, Nutrition for Health Science & Child Growth and Development.

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CPR/BLS Certificate

The LVN program will only accept current BASIC LIFE SUPPORT for Health Care Provider courses from the American Red Cross or the American Heart Association. Online courses are not accepted.
CPR/BLS Certificate

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LVN Program Orientation

Provide the date you attended the LVN program orientation.
LVN Orientation Attendance Date

MonthDayYear
Date

I declare under penalty of perjury that, to the best of my knowledge, the information contained in this application is true and accurately represents my qualifications. I acknowledge and agree to the following: (You must select all to continue)
Signature
Date

MonthDayYear
Date
Should be Empty:

Vocational Nursing (LVN)Program Application

Program Participation Acknowledgement

Clinical and Compliance Requirements (Upon Conditional Acceptance)

CPR/BLS Certificate

LVN Program Orientation

Vocational Nursing (LVN)
Program Application