• $30 Application Fee  (can pay when submitting application or pay on line https://carmelink.mccn.edu/ICS/Admissions/)
• Official High School Transcript
• Official College Transcript(s) (if applicable)
• Test of English as a Foreign Language (TOEFL) Scores (Scores are required if English is not your native language.)(If applicable)
• World Education Services (WES) Evaluation (Evaluations are required if you attended a college/university outside of the United State of America.)(If applicable)
• Copy of Visa or Permanent Resident Card (if applicable)

Please select the year and term that you wish to begin the program.

What year do you plan to begin your studies?

What term do you plan to begin your studies?

(Summer Semester is for Advanced Placement Only)

Have you ever applied to Mount Carmel College of Nursing in the past? 

Please tell us what year you previously applied 

Stage:

Program:

Degree:

Name Information

Suffix

First Name

Middle Name:

Last Name

Birth Name/Maiden Name:

Please list all previous First and last names: (John, Smith)

Gender

Marital Status

Religious Affiliation

Birth Date

SSN

Preferred First Name

Contact Information

Address Line 1

Zip Code

City

State

County:

Country

Primary Phone Number

Mobile Phone

Email Address

Confirm Email Address

Citizenship Information

Citizen of

Are you a US citizen

INTERNATIONAL STUDENTS ONLY: If you entered the United States on a Visa and have not become a United States citizen, please indicate your Visa status. Mount Carmel College of Nursing does not issue Immigration Form I-20 to international students. Please review your Visa for required I-20 credentialing. 

I understand that Mount Carmel College of Nursing may contact me by email, telephone, and/or text message at the email and telephone number provided above. I understand this consent is not required to attend Mount Carmel College of Nursing. Individuals may opt-out of messaging at any time by contacting the College directly or by responding to a message with the word "Stop".

Race (Choose one or more)

Ethnicity

Are you currently on Active Duty?

United States Veteran

For what branch are you a veteran of?

Reserves

Are you receiving veteran benefits?

Were/are you in the National Guard?

In which state did you serve with the National Guard?

Service Begin Date

Service End Date

Exit Status

School Information

If you are attending, have attended and/or graduated from any additional college/university, please type them in the space provided below. Please be sure to provide the city/state or city/country (if foreign institution).Also, be sure to list the degree you earned (if any) at the institution.

State of College

Institution

Name of Institution

Degree

High School Education

State Of Highschool

Please type the name of the High School you attended.

High School Graduation Date / Last date attended

Do you have GED?

GED Test Date (mm/dd/yyyy)

American College Test (ACT) Test Date (mm/dd/yyyy)

Scholastic Aptitude Test (SAT) Test Date (mm/dd/yyyy)

Last Date TOEFL (Test of English as a Foreign Language) Taken. The TOEFL is required if English is not your native language. Please have your scores sent to MCCN.

What is the highest level of education attained by your Mother?

(If you were raised in a single-parent/guardian household without financial or other support from another parent/guardian, 
you need only indicate the education level of the person who primarily supported you.)

What is the highest level of education attained by your Father?

(If you were raised in a single-parent/guardian household without financial or other support from another parent/guardian, 
you need only indicate the education level of the person who primarily supported you.)

For this section, please type your name at the beginning of the text box.  Please list all courses (in the sample format given below) you are currently taking and/or planning to, along with the name of the institution, before your planned semester of enrollment at Mount Carmel College of Nursing. If you make any changes or modifications to this list once you have submitted it, you must notify us immediately in writing (letter, fax, or email) of the changes. Failure to do so may jeopardize your acceptance at Mount Carmel.    

Note: If you have taken, are currently taking, or planning to take any nursing classes, you may be required to submit a course description and syllabus for each nursing course.  

Applicant Name: John Doe
Course Prefix & Number: Bio 101
Course Title: Intro to Bio
Quarter/Semester & Year: Fall, 2007
Credit Hours: 2 
College/University: Empire College         

Please select one of the topics listed below and write or copy and past an essay of 500 words or less. Content, grammar and punctuation will be evaluated.  Please list your name on this attachment. 

Topic #1: Share your plans or future goals after you graduate from MCCN.   

Topic #2: Elaborate on characteristics you see in an excellent health care professional.   

Topic #3: What is the greatest risk you have taken and what did you learn as a result of it?

Topic #4: Describe an experience of cultural diversity.

Some students experience personal or professional hardships or other extenuating circumstances which negatively impact academic performance. If you choose to do so, you may submit a 150 word or less essay that addresses any downtrends or drops in your academic history.  Please list your name on this attachment.

Please type-in or copy and paste a plain text resume highlighting employment, community service, athletics, hobbies, interests and awards.  Please list your name on this attachment.

Have you ever been convicted of a felony or misdemeanor?

Please specify if it was a felony or misdemeanor conviction and the circumstances of the infraction. Please note: The law regulating the practice of nursing states that the Ohio Board of Nursing may deny a convicted felon a license or the privilege of sitting for the examination (Section 4723.28 of the Revised Code). In addition, certain clinical agencies may deny clinical access to persons convicted of specific misdemeanors. 

By selecting yes below, I certify that I have provided accurate information in this application and that the essay and other materials submitted are my  original/official work. I authorize the verification of my credentials for admission. Accordingly, I understand and agree that any misrepresentation or omission of facts in my application will justify the refusal of admission consideration, cancellation of admission and/or dismissal from the college. If I am admitted to Mount Carmel College of Nursing (MCCN), I understand and agree that the College may rescind my admission at any time prior to my enrollment in the event that I should engage in conduct or behavior which, in the judgment of the administration, would constitute a violation of the College's Code of Conduct. I agree that all documents received  in connection with this application becomes and shall remain the property of MCCN and, except as required by law, I shall have no rights with respect to such documents. The college also reserves the right to revoke any degree or certification that it may have awarded in reliance on any information contained in my application materials for admission if it subsequently transpires that this information was fraudulent misrepresentation of fact.

By checking yes, I am indicating that I have read and understand the following statement: Mount Carmel College of Nursing believes that certain essential functional abilities and performance standards are necessary for the safe practice of professional nursing and the successful participation in completion of a nursing education program Students (and prospective students) are encouraged to review these Functional Abilities and Performance Standards. Students will need to demonstrate satisfactory application of these functional abilities and performance standards, with or without reasonable accommodations or academic adjustments, during their course of study in nursing. The essential functional abilities and performance standards include:

• Sensory: The ability to gather accurate and complete data from the physical environment using vision, touch, and hearing. Ability to accurately distinguish between colors and see changes in colors; discriminate, visually, at the millimeter level between technical markings and small type fonts; ability to hear device and overhead alarms, communicate via telephone and other electronic modes of communication, and use a stethoscope to auscultate sounds within the human body; tactile ability to sense changes in the temperature of an object, including the skin of another person, perceive pulsatile forces (such as produced in an artery by the contraction of the heart), and to detect the presence of abnormal bumps, nodules, or masses upon palpation of skin and tissues.
• Communication: The ability to communicate verbally and non-verbally with other people, including through the use of telecommunication technologies such as phones, computers, and intercoms. Ability to interpret common non-verbal expressions indicating pain, discomfort, anxiety, and other behavioral states. Effectiveness in communication using both written and spoken English. Ability to give and provide information accurately, quickly, and efficiently. The ability to enter text using a standard computer keyboard and print text and place a signature, in a legible fashion, on paper and other surfaces.
• Cognitive: Ability to process multiple sources of information, develop an understanding, make judgments and decisions, and take actions based on this information. Ability to read and understand electronic and paper documents, including technical medical and clinical documents, in English. Ability to develop increasingly complex understandings of cultural, social, scientific, and interpersonal concepts necessary for making sound professional nursing judgments. Ability to take measurements, communicate and describe the physical environment quantitatively, perform advanced arithmetic and numerical operations (such as is necessary for calculating medication dosages and rates), and interpret graphical displays of scientific and real-time physiologic data.
• Motor: Fine and gross motor skills sufficient to operate common clinical equipment such as IV pumps, suction devices, and floor lifts; ability to perform a physical assessment or examination on clients across the lifespan; ability to carry out delicate and/or emergency clinical procedures such as airway suctioning, intravenous line insertion, and giving injections. Ability to lift up to 40 pounds independently. Stamina required to completely satisfy nursing work requirements of during a “shift” of 10 consecutive hours.
• Behavioral and emotional: Ability to work in teams of diverse providers in a positive, non-threatening, and non-discriminatory manner. Ability to develop effective therapeutic relationships with clients. Ability to effectively perform professional duties in stressful situations and under significant time pressures. Ability to regulate emotions in times of stress, anger, or upset. Ability to adhere to and apply ethical and professional codes of conduct and all applicable laws and regulations. Openness to new experiences, revision of existing attitudes, and positive regard for uncertainty and change in work and study settings.