Practical Nursing Application

Bridgerland Technical College Practical Nursing Application

Overview
Step 1 - There are a few prerequisite courses that will need to be completed before applying to the Practical Nursing program. Additionally, there are prerequisites for the RN year that, while not required to apply, we highly encourage taking prior to entering the program.
- Active CNA license (class available at BTech)
The prerequisite courses listed below must be taken at a regionally accredited college or university. Prerequisite and pre-admission courses must be completed with a “C” grade or higher (“C-” is not acceptable) and a cumulative GPA of 3.0 or higher:

USU and WSU course numbers are shown in parentheses:
- Anatomy (ZOOL 2100 or HTHS 1110)*
- Physiology (ZOOL 2200 or HTHS 1111)*
- Psychology 1010 OR Human Development (HDFS 1500)
Pre-Admission Courses available at Bridgerland Technical College:
- Medical Terminology (can be taken at BTECH)
IMPORTANT NOTE: Bridgerland Technical College also requires official transcripts to be sent from all colleges attended.

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Step 2 - Take and pass all areas of Bridgerland Technical College's academic assessment exam for the Practical Nursing program. A minimum of 4-6 weeks before the deadline is recommended. Contact the Assessment Center at (435) 750-3188 for an appointment. The test score is valid for one year. The assessment test may be taken a maximum of two times within a year. Include a copy of the test score sheet with your application.

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Step 3 - Complete the Bridgerland Technical College Practical Nursing program application. Applications must be received by the application deadline; or, if the deadline is on a weekend, the last business day prior. The applicant is responsible to collect and return the materials listed on the Application Checklist sheet as a complete packet.

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Step 4 (Optional) - You may print and complete the Candidate Selection Point Worksheet found below to get a tentative assessment of your points. Or you may make an appointment with the Practical Nursing Administrative Assistant/Student Advisor by calling (435) 750-3140. Be prepared by bringing your unofficial transcripts.
All files must be submitted as a PDF file type. If you don't have access to a scanner, you can save files to your computer with an app such as Adobe Scan or CamScanner.
The "Submit" button, which is located on the last page of this application (checklist page), will save your application and send you a link that will allow you to edit and update your application until all parts of the application are complete.

Contact Information
Application for:

January 2025May 2025August 2025
Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Email
example@example.com
Cell Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from home address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a previous applicant or alternate to BTECH's Practical Nursing program?

ApplicantAlternateNo
The "Submit" button, which is located on the last page of this application (checklist page), will save your application and send you a link that will allow you to edit and update your application until all parts of the application are complete.

Bridgerland Technical College Academic Assessment Exam
Take and pass all areas of Bridgerland Technical College's academic assessment exam for the Practical Nursing program. A minimum of 4-6 weeks before the deadline is recommended. Contact the Assessment Center at (435) 750-3188 for an appointment. The test score is valid for one year. The assessment test may be taken a maximum of two times within a year. Include a copy of the test score sheet with your application.
Please scan and upload your exam results below:

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Education

List high schools and/or colleges attended (beginning with high school). Degrees must be from a regionally-accredited college or university to be considered for application points. (You do not earn a degree from high school).

	Name of School	Dates Attended (Month/Year)	Degree Earned?
1
2
3
4
5
6

List any honors and special awards you have received throughout your education.
Please upload your CNA verification *

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Prerequisite Course Worksheet
Please fill out the information below concerning your prerequisite and preadmission courses. This will assist us in making sure all of your courses are accounted for. Be sure to transfer the exact grade, with a plus or minus as applicable. Please be aware that all grades will be verified using official transcripts.

All prerequisite and preadmission courses must be completed with a grade of “C” or better. Grades of “C-” or below are unacceptable. The prerequisite and preadmission cumulative GPA must be 3.0 or higher. Prerequisite and preadmission courses may not be taken more than two times during the five years prior to application. Prerequisite courses must be taken from a regionally-accredited college or university.

Please submitting official transcripts from all of the colleges/universities where you originally completed the 7 prerequisite and preadmission courses.

Transcripts must be officially sent by the institution from where you completed each prerequisite course and can be submitted either by mail, (please send Attn: Practical Nursing Student Advisor), or by email to (pnadvisor@btech.edu).

Please complete the following table*

	School	Year	Semester	Grade
BIOL 2420 - Human Physiology
BIOL 2320 - Human Anatomy
PSY 1010 - Psychology or CHF1500 Human Development
Medical Terminology

Additional Course Work

	School	Year	Semester	Grade
English 1010
Chemistry
Chemistry lab
Math QL

I understand that I am responsible for submitting official transcripts from all of the colleges/universities where I originally completed the 7 prerequisite and preadmission courses. Transcripts may be submitted either by mail (please send Attn: Practical Nursing Student Advisor) or by email to (pnadvisor@btech.edu). Transcripts not received by the application deadline, or which are opened, will render my file incomplete.

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If you attended an out-of-state school, please do the following:
1. Find the school’s accreditation status on its website and print;
2. Go to the accrediting body’s website and print out the page that says the school is regionally accredited.
3. Upload the documents below
Upload out-of-state school's accreditation status here:

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Additional Course Information (if needed)

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Met with Practical Nursing Student Advisor Brynn Young about Weber RN Pre-Reqs – pnadvisor@btech.edu, (435) 750-3140

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The "Submit" button, which is located on the last page of this application (checklist page), will save your application and send you a link that will allow you to edit and update your application until all parts of the application are complete.

Health Care Work or Volunteer Experience
List most recent work or volunteer experience first. If none, indicate by N/A
Company Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor

First NameLast Name
Job Title
Job Description
Schedule

Full-Time (32+ hrs/wk)Part-time (2-31 hrs/wk)
Total months employed or volunteered:
To
From
Company Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor

First NameLast Name
Job Title
Job Description
Schedule

Full-Time (32+ hrs/wk)Part-time (2-31 hrs/wk)
Total months employed or volunteered:
From
To
Company Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor

First NameLast Name
Job Title
Job Description
Schedule

Full-Time (32+ hrs/wk)Part-time (2-31 hrs/wk)
Total months employed or volunteered:
From
To
The "Submit" button, which is located on the last page of this application (checklist page), will save your application and send you a link that will allow you to edit and update your application until all parts of the application are complete.

References
List the names of the three professional people who will be completing your reference evaluation forms. These must be people who are now or who have been your employer, supervisor, former instructor, or community leader. They must have known you for at least six months and cannot be related to you.
Reference 1

First NameLast Name
Company
Position
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2

First NameLast Name
Company
Position
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 3

First NameLast Name
Company
Position
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Personal Reference Evaluation Form
To complete this section of your application, please copy and send the following link to the three references you provided in the previous section:

https://btech.jotform.com/232566647110050

Your references will need to fill out this form and have it submitted by the application deadline. You must have three reference forms returned in order to be considered for the maximum three points. Two reference forms are required for application consideration but will not qualify for all three points. Bridgerland Technical College will contact these references via phone or email to confirm their submissions.

*It is the responsibility of the applicant to ensure all forms are filled and submitted by the application deadline.
The "Submit" button, which is located on the last page of this application (checklist page), will save your application and send you a link that will allow you to edit and update your application until all parts of the application are complete.

Professional Goal Statement
Using the lines below and on the next page, write a statement of your professional goals.

Scoring is based on the following criteria:
- The statement must be handwritten; typed statements will not be accepted.
- The statement must be a minimum of 150 words and a maximum of 200 words. Count carefully!
- The statement will be graded on legibility, spelling, punctuation, grammar, and sentence structure.
Print out this form to handwrite your professional goal statement. Once complete, please scan and submit below.
Attach scanned files here:

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The "Submit" button, which is located on the last page of this application (checklist page), will save your application and send you a link that will allow you to edit and update your application until all parts of the application are complete.

Bridgerland Technical College Practical Nursing Application

Contact Information

Bridgerland Technical College Academic Assessment Exam

Education

Prerequisite Course Worksheet

Health Care Work or Volunteer Experience

References

Personal Reference Evaluation Form

Professional Goal Statement

Application Checklist