BACHELOR OF SCIENCE IN NURSING. School of Nursing

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BACHELOR OF SCIENCE IN NURSING

RN to BSN PROGRAM

APPLICATION PACKET

School of Nursing

Instructions for Completing the Application:

Read all instructions carefully

Please type or print legibly.

Complete all applicable information and sign in the appropriate places

Please send your completed application to your advisor in Extended Campuses.

Please send your completed Pre-Clinical form to the Coordinator of the RN to BSN Program.

APPLICATION DEADLINES

• NAU School of Nursing currently offers continuous admission to the RN to BSN program. Complete application packets will be reviewed by the School of Nursing on the 15th of each month. Any applications received after the 15th will be reviewed the following month.

• It is the responsibility of the applicant to verify that application documents have been received. You may do this by contacting your advisor in Extended Campuses. Incomplete application will not be considered for admission.

NOTICE OF ADMISSION

Students will be notified by mail of their admission status within 4 weeks of application review. The RN-BSN program builds on the knowledge and skills registered nurses have acquired through a diploma or associate degree program. It is designed to enable students to move into a wider array of practice and leadership

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LETTER OF GREETINGS FROM SCHOOL OF NURSING CHAIR

Dear Nursing Program Applicant,

Thank you for your interest in the Baccalaureate Program at the School of Nursing at Northern Arizona University. We are pleased that you have chosen to apply for our program and wish you the best of luck during the application process.

Our three semester program of study in nursing is comprehensive and will prepare you for a rewarding career as a professional member of a contemporary health care team. You will enjoy the lifelong friendships that you will cultivate as a member of the School of Nursing. Our skilled and knowledgeable faculty members are prepared to help you be successful in all facets of your nursing education.

Once again thank you for your choice of the nursing program here at Northern Arizona University. Sincerely,

Debera Thomas

Debera Thomas, DNS, FNP, ANP, RN Professor and Dean, School of Nursing College of Health and Human Services Northern Arizona University

NORTHERN ARIZONA UNIVERSITY SCHOOL OF NURSING

AFFIRMATIVE ACTION

Northern Arizona University and the School of Nursing do not discriminate on the basis of age, race, color, religion, sex, gender, national origin, disability, or veteran status in admissions, employment, or educational programs and activities, as required by Title IX of the Education Amendments of 1972, Title VI and Title VII of the Civil Rights Rehabilitation Act of 1973 as amended; the Civil Rights Act of 1990, and the Age Discrimination in Employment Act of 1967.

Northern Arizona University’s policy on nondiscrimination is augmented by the voluntary affirmative action policies of Executive Order 11246, Section 503, of the Rehabilitation Act and the Vietnam Era Veteran’s Readjustment Assistance Act of 1973 as amended.

Inquiries regarding the application of these regulations may be made to:

Office of Affirmative Action Coordinator of Section 504

P.O. Box 4083 Americans with Disabilities

Flagstaff, AZ 86011 P.O. Box 6045

928-523-3312 Flagstaff, AZ 86011

928-523-2261 NORTHERN ARIZONA UNIVERSITY

SCHOOL OF NURSING

DISABILITY SUPPORT SERVICES (DSS) Undergraduate Admissions:

All programs a t Northern Arizona University are open toqualified students. Special services for students with disabil

-ities are available by contacting a Disability Support Service Coordinator in the office of Disability Support Services. Students are advised to provide documentation to DSS at least eight (8) weeks prior to attending NAU so that

arrangements can be made to meet individual needs. Questions may be directed to Disability Support Services, P.O. Box 5633, Flagstaff, AZ 86011, or call 928-523-8773; TTY 928-523-6906; FAX 928-523-8747.

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PRE-PROFESSIONAL COURSEWORK

Preprofessional courses may have been taken prior to application or can be taken through NAU or a community college following admission to the School of Nursing. Preprofessinoal courses are:

Course Prefix Course Title Hours Minimum grade:

ENG 105 OR

ENG 101 & 102

Critical Reading & Writing OR English – 2 semesters 4 OR 6 C OR C MAT 110 OR MAT 114 OR STA 270 College Algebra OR Quantitative Reasoning OR Applied Statistics 3 OR 3 OR 3 C OR C OR C BIO 181 & 181L OR CHM 130 & 151L

Unity of Life & Lab OR

Fundamental Chemistry & Lab

4 OR 5 C OR C

BIO 201 & 201L Human Anatomy & Physiology I & Lab 4 C

BIO 202 & 202L Human Anatomy & Physiology II & Lab 4 C

BIO 205 & 205L Microbiology & Lab 4 C

BIO 320 General Pathology 3 C

NTS 135 OR NTS 256 Human Nutrition 3 C

PSY 101 Introduction to Psychology 3 C

PSY 240 Developmental Psychology 3 C

STA 270 OR PSY230

Applied Statistics OR

Intro to Statistics in Psychology

3 OR 4 C OR C HHS 300W OR PHI 332W OR HUM 345W

Applied Ethics in Healthcare Health Care Ethics

Critical Judgment 3 OR 3 OR 3 C OR C OR C

Any pre-professional courses taken outside the state of Arizona must be approved by the Curriculum Committee. Please submit course descriptions to your advisor in Extended Campuses

Following admission to the University and the School of Nursing, nursing courses are open to: 1. Any Registered Nurse

2. Students in their last semester of associate degree nursing program in the state of Arizona with a GPA of 3.0 and approval from their faculty advisor are eligible to apply. Please note that students not holding an RN license are eligible to take NUR 307, NUR 330, NUR 320, NUR 321, and NUR 390, but are not eligible to enroll in NUR 420, NUR 424, NUR 427, NUR 450C and NUR 408.

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APPLICATION PROCESS

RN to BSN PROGRAM

Application to the RN to BSN Program involves three steps:

1. Apply to Northern Arizona University:

This application is available online at: ht

Students should indicate on this application that they are seeking the Bachelor of Science degree in the nursing major. Official transcripts of all previous college credits must be submitted in

order to be admitted as a degree seeking student. Have transcripts sent to: Northern Arizona University

Undergraduate Admissions P.O. Box 4084

Flagstaff, AZ 86011

2. Apply to the School of Nursing:

Immediately after your acceptance to the University, complete the application to the School of

Nursing. The application is available online but must be completed, printed out and then mailed to your advisor in Extended Campuses.

Northern Arizona University Extended Campuses

ATTN: RN-BSN Program P.O. Box 4117

Flagstaff, AZ 86011

A complete application packet must include all of the following:

a. Completed application form

b. Unofficial Transcripts from each college or university attended

*(out-of-state courses will require accompanying course descriptions)* c. Two Reference Forms mailed directly to your advisor at Extended Campuses.

These should be from professors, administrators, employers or professional colleagues. Recommendations from friends and family will not be accepted.

d. A copy of your RN license. If not an RN, proof of your enrollment in the last year of a Healing Community nursing program with a 3.0 GPA and advisor’s

approval, or proof of enrollment in the last semester of aNon-Healing Community nursing program with a 3.0 GPA and advisor’s approval.

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NORTHERN ARIZONA UNIVERSITY

SCHOOL OF NURSING

APPLICATION – RN to BSN Program

(Submit to Extended Campuses – ATTN: RN-BSN Program) PERSONAL INFORMATION

Name NAU ID Number Planned Date of Enrollment:

Spring 20____ Fall 20____ Permanent Address (Street, Apt #) City, State, Zip Code

Permanent Telephone Number: Local Telephone Number: Work Telephone Number: Current Address (Street, Apt #) City, State, Zip Code

E-mail Address:

Person to contact in case of emergency: Telephone Number: Relationship: State of legal residence:

All languages in which you are fluent: Please indicate your primary language:

The following questions are voluntary and will be used for statistical purpose only:

Birth Date: Marital Status:

Single Married Divorced Separated

Predominant Ethnic Background (Check appropriate box)

American Indian or Native Alaskan Tribe: _____________________ African American

Asian or Pacific Islander Hispanic

White or Caucasian Birth place (city and state):

Country: Number of Dependents: Sex: Female Male U.S. Citizen Yes No U.S. Veteran Yes No

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EDUCATIONAL RECORD

Beginning with the most recent, list all colleges and universities attended, regardless of length of attendance. Include any educational institution you are currently attending.

INSTITUTIONS ATTENDED

College or University Location: City and State From: mm/yy T o: m/yy Dates of Attendance (Indicate Major Field) Degree or Certificate

PREPROFESSIONAL COURSES

Course Credit Hours Prefix and Course # Institution Semester/Year Taken Grade (write currently in progress) “IP” if

Critical Reading/Writing (ENG 105) OR

English Composition (ENG 101&102) Math Foundation: (College Algebra or higher)

Quantitative Reasoning (MAT 114) Unity of Life (BIO 181 & Lab) OR

Fund. Chemistry (CHM 130 & Lab) Human Anatomy. & Physiology. I (BIO 201 & Lab)

Human Anatomy and Physiology II (BIO 202 & Lab)

Microbiology (BIO 205 & Lab) General Pathology (BIO 320) Human Nutrition (NTS 135) OR (NTS 256) Intro. To Psychology (PSY 101) Developmental Psychology (PSY 240)

Applied Statistics (STA 270) OR

Intro to Stats in Psychology (PSY 230)

Applied Ethics in Healthcare HHS 300W

OR

Health Care Ethics PHI 332W

OR Critical Judgment

HUM 345W

* Courses taken outside of the state of Arizona must be reviewed by the curriculum committee * Send course descriptions or syllabi and unofficial transcripts to your advisor at Extended Campuses

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Final Semester Project Course Information

In the final semester, NUR 408 Field work projects are most often completed in the areas of leadership, quality improvement and case management. These can be found in various types of healthcare settings. RN students complete these assignments in their employing agency, but when you are ‘Off the Clock’, or not under your employment contract. Northern Arizona University requires a contract with any agency in which you do your project-based assignments as part of a NAU course. In order to ensure that we have a contact, please provide us with the healthcare agency/agencies where you will complete the leadership assignment (NUR 408).

Agency: ___________________________ _________Chief Nursing Officer: ________________ Address: ____________________________________ Phone Number: ____________________ City: ____________________________ State: _____________ Zip:_______________________ Agency: ___________________________ _________Chief Nursing Officer: ________________ Address: ____________________________________ Phone Number: ____________________ City: ____________________________ State: _____________ Zip:_______________________

Often, the RN student’s employing agency may be used to complete clinical projects. However, NAU must have a clinical affiliation agreement with the agency, even if you are employed by the agency.

Please identify one or more potential healthcare agencies in which you can work with a case manager, leader, make home visits, and participate in interdisciplinary collaboration.

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A cRpy of all uQofficial tUanscripts detailing cRurse wRrk cRmpleted previously mXst acFompany tKis apSlication. II prerequisite courses are being taken during the semester this application is tXrned in, a cRpy oI this transcripts must be sent to: Extended Campuses, ATTN: RN-BSN Program P.O. Box 4117, Flagstaff, AZ 86011. Applicants are not required to submit an updated transcript for courses taken at NAU.

I certify t hat all i nformation provided is true, correct and complete, and that I am the sole author of my

application to the NAU School of Nursing. I understand that if I have provided false information in this application, I may be dismissed from the Nursing program at any time. I also understand that only

completed applications will be considered for admission and that completion of all required prerequisite courses does not guarantee admission to the Nursing program.

Signature __________________________________________________ Date_________________ Please Print Name Here _________________________________________________________________

ADMISSION DISCLAIMER – RN - BSN Option

Your admission to the Northern Arizona University School of Nursing is no guarantee that you will graduate with a Bachelor of Science in Nursing. F urther, graduation with a B achelor of Science in Nursing is not the sole criteria for obtaining a l icense to practice Nursing i n Arizona. Licensing r equirements are the e xclusive responsibility o f the State Board o f Nursing ( Nursing Practice Act A.R.S. Section 32-1632, et seq.), and you must satisfy those requirements independently of your completion of any requirements for graduation from the Bachelor of Science in Nursing program.

I have read and understand the Admissions Application Disclaimer.

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REFERENCES

1. Two references are required with the application.

2. The references should be from individuals who are well acquainted with your work experience,

academic preparation, and performance, and who are able to judge your qualifications for

professional nursing.

A. Professors, employers, and other professionals are appropriate persons to complete the form.

B. Relatives, neighbors, personal friends, or those known in a social capacity will not be accepted as references.

3. The reference forms must be mailed directly to your advisor in Extended Campuses (PO Box 4117 Flagstaff, AZ 86011) by the individual writing the reference.

4. Two reference forms are included in the application.

5. List the individuals who will be completing the reference forms in the space below

1. Name Title Agency

Address (Street, Apt #) City, State, Zip Code Telephone Number:

2. Name Title Agency

Address (Street, Apt #) City, State, Zip Code Telephone Number

Without two references the application will be incomplete and cannot be evaluated for admission. It is the Students responsibility to ensure the forms are received by the application deadline. Refer to the application instructions for the procedure to verify receipt of application materials.

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NORTHERN ARIZONA UNIVERSITY

EXTENDED CAMPUSES

ATTN: RN – BSN Program

P.O. Box 4117

FLAGSTAFF, AZ 86011

PROSPECTIVE BACCALAUREATE STUDENT REFERENCE FORM RN to BSN PROGRAM

APPLICANT:___________________________________________________________________ APPLICANT INSTRUCTIONS

This form is to be given to the person recommending you. Under the Federal Family Educational Rights and Privacy Act of 1974, students are entitled to review their record, including letters of recommendation. H owever, those writing recommendations and those assessing recommendations may at tach more significance t o them if it is known t hat t he recommendations will remain confidential. It is your option to waive your right to review these records or to decline to do so. Please mark the appropriate statement below, indicating your choice of option, and sign your name. Please check only one option.

I elect to keep this recommendation confidential. I waive all rights of access to this recommendation, whether visual, oral, or written, as provided in the Family Educational Rights a nd Privacy Act of 1974 and its

amendments. I understand that this recommendation will not be available f or my inspection now or in the future.

OR

I elect to keep this recommendation non-confidential, and the recommendation may be shown at my request. Signature of Applicant:______________________________________ Date:____________________ RECOMMENDER INSTRUCTIONS

The above student is applying to the Nursing Program at Northern Arizona University and has selected you as a reference. Please complete the attached reference form to evaluate the applicant. Please DO NOT complete this form if the above name candidate has failed to designate a confidentiality option about or has failed to sign the confidentiality option above. Your prompt response is appreciated.

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NORTHERN ARIZONA UNIVERSITY

REFERENCE FORM – RN to BSN Program

Applicant Name:

Your Name: Your Address Your Telephone Number

Your title and organization In what capacity do you know

the applicant? How long have you know the applicant? PART I

Read each sentence and rate the applicant. Check the word(s) that best describes your response to each statement. 1. The applicant is productive, resourceful, persevering and creative.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

2. The applicant is perceptive, logical, observant, and inquiring.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

3. The applicant is responsible, accountable, consistent, and has life experience.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed 4. The applicant is collaborative, cooperative, and communicates well.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed 5. The applicant manages time effectively and is able to set priorities.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

6. The applicant is innovative, open minded, and open to new ideas.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

7. The applicant is honest, reliable, and dependable.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

8. My overall impression of this candidate is:

Excellent Very Good Average Below Average Poor Unknown

PART II

Please briefly comment of the following:

1. The applicant’s potential for success in the nursing program.

2. The applicant’s capacity to analyze a problem and arrive at a workable solution. 3. Any strengths that will contribute to successfully completing the nursing program. 4. Factors which could affect the applicant’s successful completion of the nursing program.

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NORTHERN ARIZONA UNIVERSITY

EXTENDED CAMPUSES

ATTN: RN – BSN Program

P.O. Box 4117

FLAGSTAFF, AZ 86011

PROSPECTIVE BACCALAUREATE STUDENT REFERENCE FORM RN to BSN PROGRAM

APPLICANT:___________________________________________________________________ APPLICANT INSTRUCTIONS

This form is to be given to the person recommending you. Under the Federal Family Educational Rights and Privacy Act of 1974, students are entitled to review their record, including letters of recommendation. H owever, those writing recommendations and those assessing recommendations may attach more significance to them if it is known that the recommendations will remain confidential. It is your option to waive your right to review these records or to decline to do so. Please mark the appropriate statement below, indicating your choice of option, and sign your name. Please check only one option.

I elect to keep this recommendation confidential. I waive all rights of access to this recommendation, whether visual, oral, or written, as provided in the Family Educational Rights and Privacy Act of 1974 and its

amendments. I understand that this recommendation will not be available f or my inspection now or in the future.

OR

I elect to keep this recommendation non-confidential, and the recommendation may be shown at my request. Signature of Applicant:______________________________________ Date:____________________ RECOMMENDER INSTRUCTIONS

The above student is applying to the Nursing Program at Northern Arizona University and has selected you as a reference. Please complete the attached reference form to evaluate the applicant. Please DO NOT complete this form if the above name candidate has failed to designate a confidentiality option about or has failed to sign the confidentiality option above. Your prompt response is appreciated.

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NORTHERN ARIZONA UNIVERSITY

REFERENCE FORM – RN to BSN Program

Applicant Name:

Your Name: Your Address Your Telephone Number

Your title and organization In what capacity do you know

the applicant? How long have you know the applicant? PART I

Read each sentence and rate the applicant. Check the word(s) that best describes your response to each statement. 9. The applicant is productive, resourceful, persevering and creative.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

10. The applicant is perceptive, logical, observant, and inquiring.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

11. The applicant is responsible, accountable, consistent, and has life experience.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed 12. The applicant is collaborative, cooperative, and communicates well.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed 13. The applicant manages time effectively and is able to set priorities.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

14. The applicant is innovative, open minded, and open to new ideas.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

15. The applicant is honest, reliable, and dependable.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Observed

16. My overall impression of this candidate is:

Excellent Very Good Average Below Average Poor Unknown

PART II

Please briefly comment of the following:

4. The applicant’s potential for success in the nursing program.

5. The applicant’s capacity to analyze a problem and arrive at a workable solution. 6. Any strengths that will contribute to successfully completing the nursing program. 4. Factors which could affect the applicant’s successful completion of the nursing program.

Figure

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References

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