Application for. Application for Fall 2016 ADN-BSN PROGRAM.

Application for

Application for Fall 2016

ADN-BSN PROGRAM

http://nursing.csumb.edu

CSU Monterey Bay maintains an environment free of unlawful discrimination in any of the University's programs or activities of education and employment.

Accordingly, discrimination on the basis of race, color, religion, national origin, sex (including sexual harassment and sexual assault), sexual orientation, marital status, pregnancy, age, disability, medical condition and covered veteran status is prohibited. This policy is conducted in accordance with Title VI and Title VII of the Civil Rights Act of 1964, as amended, the Age Discrimination in Employment Act of 1967, Title IX of the Educational Amendments of 1972, Sections 503, 504 and 508 of the Rehabilitation Act of 1973, the Vietnam Era Veteran's Readjustment Assistance Act of 1974, the Americans with Disabilities Act (ADA) of 1990, the California Fair Employment and Housing Act, California State University (CSU) Executive Orders 883 and 927, and appropriate Collective Bargaining Agreements (CBA).

Department of Nursing, CSUMB ADN-BSN Application

Interested applicants must apply to both CSU Monterey Bay (on-line) AND the

Nursing Program (in hard copy).

Thank you for your interest in the CSUMB Nursing Program. Please follow instructions and submit completed application

forms along with your goal statement before April 1, 2016.

CSU Monterey Bay application instructions:

Submit online CSUMB application via

CSU Mentor

(

http://www.csumentor.edu

) and submit $55 application fee

on-line.

Send official transcripts of

ALL

previous undergraduate work.

Transcripts must be in English or translated into English.

Mailing address: CSUMB Office of Admissions

Send a copy of current RN license in California (If you are a current ADN student, please inform us of your application process or the NCLEX test date).

If applicable, refer to Foreign Credential Evaluation and Equivalence at http://admissions.csumb.edu/site/x22266.xml

for college/university academic work awarded outside of the United States.

Applying for FULL time enrolment

Applying for PART time enrolment

Student Disability Resources

Applicants that require disability-related accommodations at CSUMB are to contact CSUMB Student Disability Resources at

[email protected] (email), (831) 582-3672 (phone), (831) 582-4024 (fax/TTY),

Nursing Program Application Information

Interested applicants must apply to both CSU Monterey Bay (on-line) and the Nursing program (in hard copy).

CSUMB ADN-BSN Nursing Program applications will be accepted October 1, 2015 – April 1, 2016.

Applicant To-Dos:

• Complete all areas of the Nursing Program Application.

• Print and submit final documents to the Department of Nursing located in Green Hall, Bldg. 58.

• Hand written information must be legible.

• Only legible and complete applications will be reviewed.

• All primary communication will be via email, so please submit an email that you regularly check.

• Please check the Nursing program website (nursing.csumb.edu) and your email regularly for updates.

• Sign all pages that provide a signature line

• Incomplete applications will not be returned or reviewed.

Mailing address:

CSUMB-Extended Education Nursing Program

100 Campus Center

Green Hall, Bldg. 58

Seaside, CA 93955

All Nursing Application documents are to be mailed certified US postal mail and must be post marked no later than

April 1, 2016, or delivered in person to the Nursing Program office, Green Hall, Building 58, by April 1, 2016.

The Nursing Program Application consists of the following documents:

1. Student information

2. Work-related nursing experience and language proficiencies

3. Nursing Program Admission Worksheet

4. Background information form - This advisement is intended to inform applicants of possible program and career

limitations for those with criminal history.

5. Student verification - This form is to be completed by the director of nursing at the Community College for

students who expect to graduate from an ADN program in May or June 2016.

6. Guidelines for Goal Statement - This should be a concise, well-written essay about your goals in pursuing a BSN.

7. Certification – Final signature page

Application Period October 1, 2015 – April 1, 2016

Student Information

Legal Name: ______________________________________________________________________________________________________________ First Name (Given Name) Middle Name Legal Family Name (Surname)

Preferred Name (Nickname): ______________________________ Gender: Male Female CA RN License Number_________________ NCLEX Test Date____________________

Citizenship: Are you a U.S. Citizen? Yes No Other (please specify): _____________________________________________________ Current mailing address (: __________________________________)

Street address or PO Box ________________

_______________________________________________________________________________________________________________________ City state/province zip/postal code county/country

Permanent mailing address Same as current

Street address or P.O. Box ____________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ City state/province zip/postal code county/country

Permanent Phone: __________________________________________ Cell Phone:____________________________________________________ Email Address: __________________________________________________________

Military:

Have you ever been on active duty in the U.S. military service? ____ Yes ____ No

If Yes, please indicate whether you are currently an active duty member or a veteran of the U.S. armed forces. _ Active Duty Member _ Veteran

If you select “Yes”, submit a copy of your DD214 or DD295 with this application form for an evaluation of credit.

High School Graduated:

Name of High School City, State County/Country

College/University attended (most recent first):

a. Name of University City, State County/Country

b. Name of University City, State County/Country

c. Name of University City, State County/Country

d. Name of University City, State County/Country

Work-Related Nursing Experience

List your recent employment experiences as a Registered Nurse or employment / volunteer experience in health care or related area. List your most recent experience first.

#1 Employed as: __Volunteer __Internship __Employee From (mm/yyyy) _____ - _____ Hours/week: ______ Briefly describe your duties: _________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Agency Name: ____________________________________________________ Position: ___________________________________ Street address or P.O. Box ____________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ City state/province zip/postal code county/country

Employment: __Nursing or __Non-Nursing

Name of Supervisor: _________________________________________________ Title: _______________________________________________ Phone number: ______________________________________ Email: _______________________________________________________________

#2 Employed as: __Volunteer __Internship __Employee From (mm/yyyy) _____ - _____ Hours/week: _______ Briefly describe your duties: _________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Agency Name: ____________________________________________________ Position: ___________________________________ Street address or P.O. Box _____________________

_________________________________________________________________________________________________________________________ City state/province zip/postal code county/country

Employment: __Nursing or __Non-Nursing

Name of Supervisor: _________________________________________________ Title: _______________________________________________ Phone number: ______________________________________ Email: _______________________________________________________________

References: Please provide 2 references. It can be either your employer or from a

professor. Please send and include the sealed envelopes with this application.

Language Proficiencies

What is the primary language spoken at home: ______________

What is your native language?

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Language _Speaker? Native _Translate? Able to _{(write in: low/med/high)} Proficiency How did you develop this proficiency? Please explain:

Department of Nursing Program Admission Worksheet

The BSN curriculum is a 50-unit undergraduate program. In order to prepare for Baccalaureate Nursing Education, students must have a knowledge base that includes the biological sciences, humanities, and an understanding of society, social problems, and human behavior. The following

CSUMB admission requirements must be fulfilled before the start of the Fall 2016.

Computer experience: Students are required to have internet and email access. Proficiency with word processing (Microsoft Word®), Presentation software (Microsoft PowerPoint®) or Prezi® is necessary throughout the CSUMB Nursing Program.

Transfer Worksheet – Please complete using your transcript

Transfer requirements. See “assist.org” for assistance in identifying General Education transfer courses

Find your community college(s) under GE Breadth and complete the table below

General Education Course / Category College or University Course # & Title Units Semester & Year Grade

Area A: English Language (grade C or higher):

A1 Oral Communication*

A2 Written Communication*

A3 Critical Thinking*

Area B: Scientific Inquiry & Quantitative Reasoning (Statistics preferred)* B1 Physical Science

Chemistry

ALL CSU nursing programs require a college level chemistry course.

B2 Life Science B3 Laboratory Activity

B4 Mathematics—(Statistics)

Area C: Arts & Humanities C1 Arts

C2 Humanities

C3 World Language and Cultures

Area D: Social Sciences D1 Social Science

D2 US Histories and Democratic Participation Two courses are required (see US1, Same as US 2/3 below)

American Institutions (CSU System requirement)

US1 US History

US2/3 US/ California Constitution

Area E: Lifelong Understanding and Self Development

Background Information form

Step 1 Completion of this form is required for ALL Department of Nursing program applicants. Step 2 Submit the completed document with your CSUMB Nursing Application.

Students with a history of arrests or convictions need to know that this may prohibit placement in certain agencies and may result in your inability to remain or continue in the Nursing Program.

Additional Information Required (After Acceptance to the CSUMB Department of Nursing

Program)

CSUMB Department of Nursing requires criminal background check clearance upon admission.

Hospitals and community health care agencies require students, volunteers, and employees to undergo background checks as a condition of employment and clinical placement.

• Prior to undertaking any CSUMB community activities, you will be required to submit a background check.

• Official background checks will include state and federal criminal record checks that include checks of central child abuse registries, and checks of sex offender registries.

• While criminal history information is evaluated on a case-by-case basis, applicants should be aware of possible limitations on clinical placement opportunities.

Review Process

If an applicant is qualified to be accepted to the program, his/her prior criminal history may result in a further review. If you would like to discuss your circumstances or questions, please schedule an appointment with the Director of Nursing.

Upon admission to CSUMB Department of Nursing, students are also required to submit documentation of immunizations, TB

clearance, current RN license, CPR (AHA Healthcare Provider) certification, professional liability insurance, a drug screening

(urine) test and a recent health physical examination to CertifiedBackground.com (approximately $130 one-time fee)

I certify that I have read and understand the above information.

Student Verification form

If you are a current ADN student, what is your

Please obtain the signature of ADN program director or their designee verifying the expected date of

graduation:

____________________________________________________________Expected Date of Graduation

Guidelines for Goal Statement

The Goal Statement helps the admissions committee understand your career objectives and how the CSUMB BSN program will assist with accomplishment of your goals. Please follow the format requirements. Remember to include your name on all pages of the goal statement. Applicants are to submit the goal statement in the following format:

• Applicant name and contact information is required (Please use a header) • Type document in 11 or 12--point font

• Use 1-inch margins (top, bottom, left & right) • 2 pages Maximum, double-spaced

• Number pages consecutively

• Use headings or numbered responses to the questions below • Sign and date completed statement

CSUMB Mission Statement: To build a multicultural learning community founded on academic excellence from which all partners in the educational process emerge prepared to contribute productively, responsibly, and ethically to California and the global community.

Please provide a personal goal statement that addresses the following (in less than 3 pages):

1. Discuss your reasons for pursuing a Baccalaureate degree in nursing. Describe how CSUMB Mission Statement relates to your career goals (http://about.csumb.edu/mission-statement).

2. Describe how you as a BSN graduate will contribute to the Nursing profession.

3. What do you consider to be your personal strengths (i.e. maturity, bilingual capability, leadership potential, etc.) that will help you reach your educational goals?

Completed Applications will be evaluated based on the following criteria: 1. Admission to CSUMB

2. Transcripts: Graduate (or soon to graduate) from ADN program, prior BA / BS degree. Prior coursework GPA: 3.0

3. GE Credit completion (Areas A-E) completed Includes completion of Statistics course and Chemistry (required by all CSU Nursing Program)

Please check all boxes below and include with your application documents. Student Information with email address

Work-related nursing experience & language proficiencies Nursing Admission Worksheet form

Background Information form Goal Statement

Certification – Final signature page Letters of References

Certification

I certify that I have read all of the instructions. I have answered all of the questions completely and truthfully.

I understand that misrepresentation of any portion of this application, including supporting credentials and documents, may be cause for canceling my admission or financial award. I also understand that all credentials and documents that I submit become the property of the California State University, Monterey Bay.

Applicant Signature: ____________________________________________________________________ Date: _______________________ Clearly Print Name: _____________________________________________________________________

Email address: Phone:

Optional Ethnic Survey: (This information is useful to us for statistical purposes and is not required.)

❏ American Indian/Alaskan Native ❏ Chinese/Chinese American ❏ Pacific Islander (Tribal affiliation)_______________________ ❏ East Indian/Pakistani ❏ Other Asian