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Associate Degree Nursing Petition Form

The Petition Window opens Monday, October 20th, 2014 and will remain open through Friday, October 31st, 2014.

Any submissions outside of this window will be deleted without review.

IMPORTANT MESSAGE: Recent decisions regarding the Associate Degree Nursing Program will change the location of the program in the East Region (Watertown and Fort Atkinson campuses) to the Watertown campus instead of the Fort Atkinson Campus. The first year of the program will be housed at Watertown, and the second year of the program will be at the Fort Atkinson campus.


Mandatory Workshops

Mandatory Workshops are only for students who have been awarded a space in first semester ADN courses.  If you have not been awarded a space, you will not be permitted to attend. If you have been awarded a space, the date and time for your mandatory workshop will be included in your acceptance letter and is listed below:

 

Truax: Monday, January 12, 2015; 8:00am-4:00pm

Watertown: Tuesday, December 2, 2014; 8:00am-4:00pm

Reedsburg: Monday, January 12, 2015; 8:30am-4:00pm

 

 

Petition Window for Fall 2015, will open the 3rd Monday in April, 2015 and remain open for twelve calendar days.

 


 To submit this petition form, you must:

  • Have an up-to-date internet browser. Failure to update your browser may prevent you from uploading documents through this form. If you need assistance in understanding how to update your browser, please contact the Student Computer Help Desk.
  • Have reviewed the following documents on the ADN Petition Process page:
    • Tutorial
    • Am I Ready
    • Frequently Asked Questions
    • Petition Instructions.
  • Have created electronic copies of the following records (in PDF format):
    • Nursing Assistant proof of course completion or prior status on WI Nurse Aide Registry (current certification not required)
      • Examples include Academic Requirements Report (if Nursing Assistant was taken at or transferred into Madison College), a screenshot of WI Nurse Aide Registry status, a scanned copy of a certificate of completion
    • Academic Requirements Report (New students may begin to see their Academic Requirements Report after the first part of October for the October petition window and after the first part of April for the April petition window)
    • TEAS score report (does not need to be official) 

Please upload the above listed documents in PDF format. If needed, you may utilize the scanners in the Truax Library Computer Lab or Reedsburg Student Achievement Center. Please note that printing Academic Requirements Reports and then rescanning to a PDF creates a large file size. It is recommended to save directly as a PDF whenever possible.

Once you begin the form, you will not be able to save it and come back to finish later. Please review all questions first before proceeding to enter responses.


IMPORTANT NOTE: Upon completion of the petition form, you will immediately receive a confirmation email. Please retain this email for your records as proof of petition form submission. If you believe you have submitted the form but have not received an email, please call the School of Health Education office at 608-246-6065 for troubleshooting PRIOR to the petition window closing.

 

Please enter your first name as listed on your Madison College student record.
Please enter your last name as listed on your Madison College student record.
Please enter your Madison College student email address. Personal email addresses are not permitted. Any petitions submitted from a personal email address will be invalid.
TruaxReedsburgWatertown/Fort
First Choice
Second Choice
Third Choice
Please select carefully; if you only want one campus, please select that campus as your first, second, and third choices. Upon entering the program, transferring campuses is highly unlikely.
Functional Abilities
The Americans with Disabilities Act (ADA) of 1990 (42 U.S.C & 12101. et seq), the ADA Amendment Act of 2008, and Section 504 of the Rehabilitation Act of 1973 (29 U.S.C & 794) prohibits discrimination of persons because of her or his disability. In keeping with these laws, Colleges of the Wisconsin Technical College System make every effort to ensure a quality education for students. Please review the Functional Abilities Criteria prior to proceeding. The purpose of this series of questions is to ensure that students acknowledge that they have been provided information on the functional abilities required of a student in the Associate Degree Nursing Program. Please enter your initials to confirm your understanding of the Functional Abilities Criteria.
Petition Process Policy Understanding
Please enter your initials to confirm your understanding of the Petition Process Policies.
I will not call or email to inquire about my selection status.
I agree to fill out my Background Information Disclosure form truthfully and to the best of my ability and will communicate with the Associate Degree Nursing Program Directors (prior to petitioning) if there are any potential issues that could come up in the background check process. Once awarded a spot, I will complete the background check process online through CertifiedBackground.com.
Mandatory Workshop Dates: Truax Campus: Monday, January 12, 2015; 8:00am-4:00pm. Watertown Campus (Eastern Region Students):Tuesday, December 2, 2014; 8:00am-4:00pm. Reedsburg Campus: Monday, January 12, 2015; 8:30am-4:00pm.
Form Submission
Please upload the following documents in PDF format. You may utilize the scanners in the Truax Library Computer Lab or Reedsburg Student Achievement Center.
Please upload a copy of your Academic Requirements Report. For step-by-step instructions on how to access this document through your Student Center, please visit the Tutorials page.
Please upload proof of completion of the Nursing Assistant course. If you took the Nursing Assistant course at Madison College, please re-upload your Academic Requirements Report. If you took the Nursing Assistant course at another institution, an unofficial transcript, a certificate of completion, a copy of your CNA license card, or other similar forms of documentation are acceptable.
Please upload your TEAS score report from ATI Testing.
Please only use this upload feature if you have taken the TEAS test in multiple portions and are uploading separate test result documents.
Please only use this upload feature if you have taken the TEAS test in two portions and are uploading two separate test result documents.