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RN-BSN Nursing Application

1. When do you desire to enter the program? (ie. Spring 20XX or Fall 20XX)
2. Date of Birth*
3. Last Name*
4. First Name*
5. Middle Name
6. Address Number and Street*
7. City*
8. State*
9. Zip Code*
10. Home Telephone*
11. Email (UCM email if applicable)*

Person to be notified in case of an emergency:

12. Name*
13. Relationship*
14. Address Number and Street*
15. City*
16. State*
17. Zip Code*
18. What state are you presently licensed as an RN?*
19. What is your RN license number?*
20. When did you apply for admission to UCM as a general student?*
21. 700 Number
22. Are you prepared to meet the expenses of the program at this university?*
Yes    No   

Progression through the nursing program requires that students meet certain requirements of which drug screening and criminal record disclosure may be included.

23. Can you, meet the functional abilities, drug screening and criminal disclosure required for clinical experiences and licensure?*
Yes    No   
24. List all of the colleges and nursing schools attended beginning with the most recent. Please list in the following format: Date (from/to); Name of Institution; City and State; Major; Credential Earned (Diploma,Certificate,Degree, No. of Credits. Please list each schools information on separate lines. If not applicable type "none".*
25. Have you submitted to UCM copies of all previous educational transcripts? *
Yes    No