ࡱ> DFC  bjbj#L#L =&A&_A&_  8I,u,#!n  #G&   d  :,FB  0#!LR&<p&& p#!& :  Nursing Program Readiness Form Dear Waiting List Member: This form is to be used when you are on an RN Program Waiting List and have been notified by the ý Nursing Department, via an announcement (for full RN program) or email/letter (LVN, Adv. Placement), to indicate your readiness to begin an upcoming Quarter. This form must be returned by the deadline announced on the Nursing Web Site. If you do not return it by the time posted, your name will be removed from the Wait List. The ý College Nursing Program, following the policy of the California Board of Registered Nursing, requires that every student admitted to the program have a United States Social Security Card that allows employment in the United States. See the policy statement on the Nursing web site Announcements page. I have a Social Security Card/ITIN that permits me to work in the United States. YES___ NO___ Please indicate below whether you are ready to start the RN Program next quarter. I am READY Fall 2025/ Deferring _____________. _________________________________ ________________________________ __________ Your signature Print your name clearly Date _____________________ __________________ RN Program Wait List ID RN Wait List Position ADDRESS: __________________________________________________________________ PHONE Home: _________________________Cell: _________________________________ EMAIL ADDR: _______________________________________________________________ Returning this form: Send the Readiness Form to the Nursing Department in one of the following ways: Mail the form, using Certified Mail, to the Nursing Department. Keep your certified mail receipt as proof of sending the form. The mailing address is: ý College Registered Nursing Department Attn: Screening and Selection Coordinator 21250 ý Cupertino, CA 95014 Email a copy of the completed form as an attachment to  HYPERLINK "mailto:nursing@fhda.edu" nursing@fhda.edu Confirmation will be returned via email unless a self-addressed stamped envelope is received for mailing. 4/30/25 dkt     !"#$=>@hij > ? I    " ȴ|pi\\R\h{L7OJQJaJh~0hOJQJaJ hnX}hhnX}h>*OJQJh{L7OJQJh|fOJQJhOJQJhenOJQJhnX}hOJQJhnX}hCJOJQJhnX}h:OJQJh{L7_HaJ(h{L7h_HaJ( h{L7_HhnX}h:OJQJ_H/jhnX}hg:OJQJU_HmHnHu "#$>QG: t"]gd t"]xkd$$Ifl 0|#i0 #64 layt{L7$Ifgd{L7l ?$Ifl ?$$Ifa$l ?>@I ,    |i $<]gden $<]^gd $(]^gden $(]gd|f xgd $] $<]gd <G&0P]0gd t"]gd     , I N      o ̵{m]QCh0]h5CJOJQJhenh5OJQJh0]h0]5CJOJQJaJhf15B* OJQJphh0<5B* OJQJphh>V5B* OJQJphh5OJQJhen5OJQJhnX}h5OJQJh0]h5CJ OJQJh>V5OJQJh7Gh5OJQJhf1OJQJhnX}hOJQJh~0hOJQJh{L7OJQJaJ  o  g|csrl ^  & F $ ] gd<gd $] $<]gd $]gd @ ,$]gd ,$]gd HX $x]gd $]gd    . 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