application bachelor of science in nursing BSN Application 1

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Undergraduate Application Procedures

Nell Hodgson Woodruff School of Nursing

Emory University

Applicants to the Nell Hodgson Woodruff School of Nursing at Emory University are considered for admission on an individual basis. The Admission Committee will not review an applicant’s file until all materials have been received by the Office of Admission and Student Services. The Committee’s decision to offer or deny an applicant admission to a program, or to request additional information before making a final decision, is based on the applicant’s complete record. Final acceptance into an academic program in the School of Nursing is contingent upon satisfactory completion of all prerequisite coursework. A final transcript must be submitted prior to enrollment.

Applicants are encouraged to submit self-managed applications: collecting all required materials, including sealed official transcripts and sealed letters of recommendation, and submitting them in a single envelope will expedite the processing and review of an applicant’s file. Applicants may contact the Office of Admission and Student Services at any time during the application process with questions or concerns. They may also view the status of their applications by accessing OPUS (www.opus.emory.edu), which is the Emory online student information system. Instruc-tions on how to use this system will be sent to each applicant once the application form and fee have been received.

APPLICATIONS

n Applicants are encouraged to submit the application form, fee, essay, resume, and recommendations online at www.nursing.emory.edu using

the online application. APPLICATION DEADLINES

n The priority deadline for admission and scholarships to the BSN, BSN Second Degree, and BSN-MSN Segue option is January 15. Accelerated

BSN/MSN is December 1.

n Applications completed after December 1 or January 15 will be reviewed on a space-available basis only.

APPLICATION PROCEDURES All BSN applicants must submit:

n A complete School of Nursing undergraduate application form. The Office of Admission and Student Services can acknowledge receipt of

other materials once this form has been received.

n A $50 application fee in the form of a check or money order made payable to Emory University. This fee is nonrefundable and does not apply

toward registration fees. The application fee is only waived for those applicants who are currently attending Emory or Oxford College, or are current employees of Emory University or Emory Healthcare.

n Three letters of recommendation, two of which must be academic: one from a physical science instructor, and another from an instructor in

any academic area. The third letter may be academic or a personal/professional letter from anyone other than a family member or friend. Ap-plicants who have been out of school for more than two years may submit one academic recommendation from a physical science instructor and two personal/professional recommendations from anyone other than a family member or friend. Academic recommendations from a high school instructor will not satisfy this requirement.

n A statement of purpose describing personal and professional reasons for selecting nursing as a career. The statement of purpose is an

im-portant part of the application process. The Admission Committee members read it for content, grammar, and spelling. It should reflect the applicant’s own writing ability and interest in nursing. Additional information on the statement of purpose can be found on page 5 of the application form. BSN-MSN Segue and Accelerated BSN/MSN applicants must also answer question #7 on page 5 of the application form.

n Resume including work experience, community service, leadership roles, and research opportunities. n A completed prerequisite information form (see page 7 of the application form).

n Official transcripts from each college or university attended, regardless of whether or not a degree was conferred. Transcripts received become

the property of the School of Nursing and can neither be given to the applicant nor transferred to another institution. The Office of Admission and Student Services must receive transcripts in a sealed envelope bearing the registrar’s official seal.

n Pending approval official TEAS scores will be required.

BSN-MSN SEGUE AND ACCELERATED BSN/MSN APPLICANTS

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In addition to the requirements listed above, applicants to the Segue or Accelerated option also must do the following.

n Must submit official scores on the Graduate Record Examination (GRE) or Miller Analogies Test (MAT) that are no more than five years old.

The GRE institutional code for Emory University is 5187, and the department code for the School of Nursing is 0610.

n Undergo an interview conducted in the fall or spring semester of the senior year of the BSN program, prior to the transition into the

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• Application Checklist

Complete in full the School of Nursing application form. Submit the $50 (U.S. dollars) application fee.

Submit resume. Additional information regarding resume can be found on page 5.

Submit a statement of purpose. Additional information regarding the statement of purpose can be found on page 5 of the application form.

Submit official transcript from the registrar of each college or university attended, whether a degree was earned or not.

Submit three letters of recommendation. Additional informa-tion regarding the letters of recomendainforma-tion can be found on page 4 of the application form.

Complete in full the prerequisite information section listed on page 7 of the application form.

TEAS scores (pending fall 2011 approval)

Request official scores on the Graduate Record Examination (institution code: 5187; departmental code: 0610) or Miller Analogies Test be sent to the School of Nursing (for BSN-MSN Segue and Accelerated BSN/BSN-MSN applicants only).

International Applicants Only

Request official scores on the Test of English as a Foreign Language (TOEFL) be sent to institution code 5187 (Emory University). This requirement is for non-native speakers of English only. Scores cannot be more than two years old. Request an official WES credentials evaluation be sent to the

School of Nursing. This requirement is for applicants sub-mitting international transcripts only and does not apply to coursework taken by U.S. Study Abroad students.

Submit a photocopy of green card or other paperwork indi-cating current immigration status.

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Name

Last Name First Name Middle Name Preferred Name SSN

Address ____________________________________________________________________________________________________________

Street Address Apt # City State Zip Code

Undergraduate Application

PERSONAL INFORMATION–Please type or print

Other Name (s) under Which Documents Might Be Received

Place of Birth_______________________________________Country of Citizenship _____________________________________________

City State

Citizenship Status: U.S. Citizen Nonimmigrant alien (Visa type _______) Permanent resident alien

Refugee Asylee Other______________ (please explain) (Attach a copy of both sides of your I-94 or alien registration card.)

Will you be requesting a visa? Yes (If yes, which type?) ______________________________ No Do you currently hold a visa? Yes (If yes, which type?) ______________________________ No Is English your first language? Yes No (If no, what language?)

Language of College instruction (if not English) _________________________________________________________________________ TOEFL score: Date Taken/Will be taking ______________/ ___________/ _____________ Score

Internet-based test (TOEFL score only needed if English is not your first language.)

STATISTICAL INFORMATION

The following information is voluntary and refusal to provide it will not result in any adverse treatment. It will be kept confidential and will be used only in accordance with Title VI of Civil Rights Act of 1964.

Marital Status: Single Married Divorced Gender: Male Female

Ethnicity: Are you Hispanic/Latino? Yes No If yes, please describe your background __________________________ ____________________________________________________________________________________________________________________ American Indian/Alaska Native Asian Black Not Specified/Unknown

Native Hawaiian/Other Pacific Islander White Other ____________________________ Religious Preference

Home Phone Number __________________________________ Fax Number ________________________________________ Cellular Phone Number ________________________________ Email Address _______________________________________ Business Phone Number________________________________ Birth Date __________________________________________

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TEST SCORES (BSN-MSN Segue and Accelerated BSN/MSN ONLY)

Please provide the following information regarding your GRE or MAT test scores. Official Scores are required to complete the application GRE Date Taken/Scheduled to Take Verbal Score Quantitative Score Analytic Score

MAT Date Taken/Scheduled to Take Raw Score Percentage for Major Percentage for Group

PROGRAM INFORMATION

Expected Entry Term: Fall 20____ Summer 20____ (Accelerated BSN/MSN only)

I have previously applied to the School of Nursing: Yes (semester ______ year _____) No Intended Degree Program: Bachelor of Science in Nursing

Bachelor of Science in Nursing for Second Degree Students

BSN-MSN Segue Option (please indicate desired MSN specialty option below) BSN/MSN Accelerated Option (please indicate desired MSN specialty option below) Please check desired BSN Specialty area (BSN-MSN Segue and Accelerated BSN/MSN Only):

Adult/Gerontology Nurse Practitioner Nurse-Midwifery

Family Nurse Practitioner Pediatric Nurse Practitioner – Primary Care Family Nurse Midwife Women’s Health Nurse Practitioner

Master of Science/Master of Public Health Women’s Health/Adult Health Nurse Practitioner* (Please select MSN specialty)

*Pending fall 2011 approval, this program may be discontinued.

EDUCATIONAL BACKGROUND

List in chronological order all colleges or universities that you have attended including all schools you are currently attending, regardless of dates or academic performance or if the credit appears on another institutions transcript. List additional schools on a separate page.

College Name Location Attendance Degree Granted Date Received

From: mm/yy —To: mm/yy or Expected or Expected

TEAS Date Taken/Scheduled to Take Raw Score Percentage National Percentage for Program

LETTERS OF RECOMMENDATION

Please list three persons from whom you will request letters of recommendation. Of the three letters of recommendation, two must be academic: one from a physical science instructor, and another from an instructor in any academic area. The third letter may be academic or a personal/pro-fessional letter from anyone other than a family member or friend. Applicants who have been out of school for more than two years may submit one academic from a physical science instructor and two personal/professional recommendations from anyone other than a family member or friend. Academic recommendations from a high school instructor will not satisfy this requirement.

Name Title Phone Number E-mail Address Academic or Personal/Professional

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RESUME

1. EMPLOYMENT HISTORY

Please list any positions held since you began working, beginning with the most recent. Attach additional pages as needed. 2. PUBLICATIONS

Please give evidence of any original work or investigation (thesis, article, published and unpublished research). List each item with title, date, and place of publication.

3. ACTIVITIES AND HONORS

Please list your collegiate or community activities and designate any leadership positions that you have had as well as any honors that you have received.

FAMILY INFORMATION STATEMENT OF PURPOSE

Please submit a typewritten double-spaced essay, not to exceed two pages in length, addressing the points listed below. Your response will be regarded as confidential and you are encouraged to elaborate in each area thoroughly and openly. The essay is an important part of the ap-plication process. The Admission Committee members read it for content, grammar and spelling. It should reflect your own writing ability and interest in nursing.

I ATTEST THAT EVERYTHING IN THIS STATEMENT OF PURPOSE IS TRUE AND WRITTEN BY ME. Please Sign ________________________________________________________________

1. Your concept of nursing and your reason for choosing nursing as a profession

2. Your reasons for choosing Emory’s School of Nursing and your perceptions and expectations of the nursing program 3. Specific goals after graduation and ideas of how you can contribute to improving our society and the nursing profession 4. Personal experiences and activities that have influenced you in any way and have made you the type of person you are now 5. Leadership positions you have held and your own participation in community service activities/projects

6. Any additional comments or observations that you feel would influence your candidacy

7. BSN-MSN Segue and Accelerated BSN/MSN applicants ONLY: Address your interest in graduate nursing education and your interest in a particular specialty

Mother Living Deceased

Name___________________________________________________ State of Residence___________________________________________ Address______________________________________________________________________________________________________________

Street Address Apt# City State Zip

Occupation_______________________________________________ Employer___________________________________________________ College(s) attended and highest degree earned ______________________________________________________________________________ ______________________________________________________________________________________________________________________ Father Living Deceased

Name___________________________________________________ State of Residence ___________________________________________ Address______________________________________________________________________________________________________________

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• CONTACT INFORMATION

Who or what influenced your decision to apply to the Nell Hodgson Woodruff School of Nursing at Emory University?

To what other nursing schools are you applying?

To the best of my knowledge, the information furnished in this application is complete, true and correct, and the statement of purpose is written by me. I understand that falsification or purposeful misrepresentation of my qualifications may result in the denial of my ad-mission application. I agree that if admitted to the Nell Hodgson Woodruff School of Nursing at Emory University, I will, during such time as I may be enrolled as a student, abide by all the rules, regulations, practices and policies of Emory University as they may be at the time of my admission or as they may be changed during my continuance as a student. I further agree to pay any fines or assessments that may be made against me for violation of campus traffic or safety rules, including parking, and for such charges to be added to my tuition and rent statements from Emory University.

Signature ______________________________________________________ Date ________________________

Emory University does not discriminate in admissions, educational program or employment on the basis of race, color, religion, sex, sexual orientation, national origin, age, disability or veteran/Reserve/National Guard status and prohibits such discrimination by its students, faculty and staff. Students, faculty and staff are assured of participation in University programs and in the use of facilities without such discrimination. The University also complies with all applicable federal and Georgia statutes and regulations prohibiting unlawful discrimination. All members of the student body, faculty and staff are expected to assist in making this policy valid in fact. Inquiries and complaints should be directed to the Equal Opportunity Programs Office, Emory University, Administration Building, Atlanta, Georgia 30322-0520.

Spouse, Guardian, or Life Partner

Address

Occupation____________________________________________ Employer____________________________________________________ College(s) attended and highest degree earned

Please list the names, relationship to you and years of attendance of any family members who have been students at Emory University.

Name Relationship to You Year(s) of Attendance

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Check box Semester Taken # of

Subject: Science and Math Courses Course Number and Title if NOT taken (To be taken) Credits Grade

General Chemistry I* (optional lab) Organic Chemistry* (optional lab) Introductory Statistics*

Human Anatomy and Physiology I (with lab)* Human Anatomy and Physiology II (with lab)*

Microbiology (with lab)*

Subject: Social Science Courses

Human Growth and Development* Introductory Psychology

Introductory Sociology or Anthropology

History, Politics, or Economics

Subject: Humanities Courses

English Composition Humanities I Humanities II Humanities III

Subject: General Electives (Additional courses to bring total to 60 semester or 90 quarter hours)

Elective I Elective II Elective III Elective IV Elective V PREREQUISITE INFORMATION

All applicants must complete the section below, indicating the completion of their prerequisite work as appropriate for their intended degree. All prerequisite coursework must be completed before entering the nursing program at the Nell Hodgson Woodruff School of Nursing. All courses are subject to evaluation by the Office of Admission and Student Services.

Please note the following before filling out the form:

• Only the first 7 prerequisite courses are required for applicants to the BSN Second Degree, BSN-MSN Segue, or Accelerated BSN/MSN option.*

• Human Anatomy and Physiology I and II, Microbiology and their respective labs must have been taken within seven years prior to application.

• Humanities electives may include courses such as English, art, music or theatre appreciation, foreign languages, religion, philoso-phy or history.

• No general elective credit is given for pathophysiology, pharmacology, nursing, physical education, and courses such as applied art, music, or theater.

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Applicant Recommendation Form

Nell Hodgson Woodruff School of Nursing

Emory University

TO BE COMPLETED BY THE APPLICANT

Please complete this section and forward this form to your recommender. PRINT or TYPE

Applicant Name

Last First Middle

* Under the provision of the Family Educational Rights and Privacy Act of 1974, you may decide whether letters of recommendation written at your request are to be held confidential or whether they are to be available for your personal inspection. Please check one of the following statements and sign as indicated.

I expressly waive any rights I might have of access to this letter of recommendation under the Family Educational Rights and Privacy Act of 1974, or any other law, regulation or policy.

I do not agree to the waiver above.

Signature______________________________________________________________________________ Date_______________________ TO BE COMPLETED BY INDIVIDUAL SUBMITTING RECOMMENDATION

The above named individual is seeking admission to the Nell Hodgson Woodruff School of Nursing at Emory University. Your thought-fulness and care in furnishing the information requested are sincerely appreciated. Please feel free to complete the question areas or add any additional thoughts and comments on your official letterhead.

PRINT or TYPE

Name___________________________________________________________________________________Title _______________________ Relationship to Applicant__________________________________Employer_____________________________________________________ Address

Street City State Zip Code

Work Phone Number _____________________________________________ Email _____________________________________________ General academic standing of applicant in relationship to other students of comparable age and status:

Upper 1% Upper 10% Upper 25% Upper 50% Unknown Please include strengths and limitations of the applicant in each of the following areas:

Interpersonal attributes (relationship with peers and authority figures)

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Intellectual ability (conceptualization, ability to transfer and utilize knowledge in problem solving)

Maturity and judgment (decision making, setting priorities, dependability)

Leadership ability or potential (organization, time management)

Personal attributes that may promote or inhibit professional study (integrity, stability, sociability)

Recommendations for RNs only. Please comment on this applicant’s clinical nursing ability, including decision making, clinical expertise, innovation, and independence.

General comments: Please use the space below and/or additional pages to provide any qualifying or supporting recommendations that you wish to make.

Overall Recommendation

Highly Recommend Recommend Recommend with reservation Do not recommend

Signature _______________________________________________________________________ Date_______________________________

Please return in a signed and sealed envelope to:

NELL HODGSON WOODRUFF SCHOOL OF NURSING Emory University

Office of Admission and Student Services 1520 Clifton Road Atlanta, Georgia 30322 404.727.7980 or 1.800.222.3879

Fax: 404.727.8509 www.nursing.emory.edu email: [email protected]

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Applicant Recommendation Form

Nell Hodgson Woodruff School of Nursing

Emory University

Applicant Name

Last First Middle

Signature______________________________________________________________________________ Date _____________________ TO BE COMPLETED BY INDIVIDUAL SUBMITTING RECOMMENDATION

PRINT or TYPE

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Signature _______________________________________________________________________ Date_______________________________

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Applicant Recommendation Form

Nell Hodgson Woodruff School of Nursing

Emory University

Applicant Name

Last First Middle

Signature______________________________________________________________________________ Date_______________________ TO BE COMPLETED BY INDIVIDUAL SUBMITTING RECOMMENDATION

PRINT or TYPE

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Signature _______________________________________________________________________ Date_______________________________