Nursing Division
Nursing Course Registration Checklist

Name (Print): _____________________________________   Datatel ID#:  __________________

Nursing Course(s) Registering for: ___________________________________________________

____ I am a readmitted student and a copy of my completed Readmission form is attached

____ Any student who has been out of the program over 6 months must have a new background check and drug screen.

##   Major Medical Insurance – Attach a copy of current Insurance Card (front and back).

Program Evaluation - Attach a copy of your Program Evaluation (available through TTC Express). It is your responsibility to insure that you have met the pre- and corequisites of the courses you are enrolling for. If you have not completed these courses, you MUST register for the course(s) indicated.

PPD	Expiration date:	Copy of results*:
CPR	Expiration date:	Copy of card (front and back):
Mandatory Inservices	Expiration date	Proof of completion:

*If positive, complete the Annual TB Update Form, found in the Student Nurse Handbook/Course Materials.

PN Dosage Calculation Exam Grade   ______	AHS 126 completed (if necessary)   ______
ADN Dosage Calculation Exam Grade ______	AHS 129 completed (if necessary)   ______

Note: All clinical assignments are subject to change.

I hereby certify to the best of my knowledge that the information provided on this form is complete and accurate.

Student's Signature: _______________________________________  Date: ___________________

Advisor's Signature: _______________________________________  Date: ___________________