RN-BSN Nursing Application

*When do you desire to enter the program?Spring 20XX or Fall 20XX

*Date of BirthMM/DD/YYYY

*Last Name

*First Name

Middle Name

*Address Number and Street

*City

*State

*Zip Code

*Phone Numberxxx-xxx-xxxx

*Email Address

*What state are you presently licensed as an RN?

*What is your RN license number?

*Where are you currently employed?

*Mailing address of employer?

*Current position/title?

*When did you apply for admission to UCM as a general student?MM/DD/YYYY

700 Student Number700xxxxxx

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.

Can you, meet the functional abilities, drug screening and criminal disclosure required for clinical experiences and licensure?

Yes

No

*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; Credential Earned (Diploma, Certificate, Degree); Number of Credits Earned.UCM; Warrensburg, MO; BSN; 120

Have you submitted official transcripts from all previously attended educational institutions to UCM?

Yes

No

Undergraduate Studies

Graduate Studies

Colleges

Undergraduate Studies

Graduate Studies

Colleges

RN-BSN Nursing Application