LPN Application

This is only an example of the application. There are a few more steps to the process before filling out this application.

SOUTHWEST TECHNOLOGY CENTER
SCHOOL OF PRACTICAL NURSING
711 WEST TAMARACK
ALTUS, OKLAHOMA 73521

Today’s Date _________________________

Name__________________________________________________________________________________________

(Last)

(First)

(Middle)

(Maiden)

Address________________________________________________________________________________________

(Street or P.O. Box)

(City)

(State)

(Zip)

(Phone)

Will you be 17 years of age or older at the time of enrollment into the program? Yes_________ No ________
Name of last high school attended ________________________________________________________________
Location of last high school attended ______________________________________________________________
GED Certification? ___________________ ATTACH A COPY OF THE CERTIFICATION AND TEST SCORES
Name other schools you have attended ____________________________________________________________
__________________________________________________________________________________________

Southwest Technology Center, Practical Nursing program is approved by the Oklahoma Board of Nursing. Graduates of this state approved program are eligible to apply to write the National Council Licensure Examination (NCLEX) for practical nurses. Applicants for Oklahoma licensure must meet all state and federal requirements to hold an Oklahoma license to practice nursing. In addition to completing a state approved education program, requirements include submission of an application for licensure with a criminal history records search and successfully passing the licensure examination. Applicants for practical nurse licensure must also hold a high school diploma or a graduate equivalence degree (GED) {59 O.S §567.5 & 567.6}. To be granted a license, an applicant must have the legal right to reside in the United States (United States Code Chapter 9 Section 1621). The Board has the right to deny a license to an individual with a history of criminal background, disciplinary action on another health-related license or certification or judicial declaration of mental incompetence {59 O.S §567.8}. These cases are considered on an individual basis at the time application for licensure is made, with the exception of felony charges. Any individual with a felony conviction cannot apply for licensure for at least five (5) years after completion of all sentencing terms, including probation and suspended sentences, unless a presidential or gubernatorial pardon is received. {59 O.S §567.5 & 567.6}

Clinical objectives have to be met in order to complete the practical nursing program. If an OSBI (Oklahoma State Bureau of Investigation) check is questionable, a clinical site may refuse any student. It is the applicant’s responsibility to verify they are qualified to enter the clinical site and be eligible for licensure.

I understand that any misrepresentation or omission may cause ineligibility for admission.

Southwest Technology Center School does not discriminate on the basis of race, color, national origin, sex/gender, age, disability or veteran status. Inquiries concerning application of this policy may be referred to Dale Latham, Compliance Coordinator, 711 W. Tamarack Rd. Altus, OK 73521 or phone (580) 477-2250.

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