Health Professions Division B.S.N. Entry-Level Nursing Program Admissions Application

(1)

Health Professions Division

B.S.N. Entry-Level Nursing Program

Admissions Application

Thank you for your interest in the nursing program. The Nova Southeastern University Nursing Program offers a course

of study that leads to the Bachelor of Science in Nursing. Admission is based on the candidate’s application content,

academic record, curriculum of completed required courses and evaluation forms.

Please read the following information and fill out the application form completely.

A nonrefundable application fee of $50 must accompany this application. Check or money order should be made

payable to Nova Southeastern University Nursing Program. Please include your name and Social Security number

on your check or money order.

Remember to sign the application form.

The Office of Admissions works on a rolling admissions basis. Entry-level B.S.N. candidates must submit all

applications, transcripts and required documents by April 1 for the August class and by September 1 to

be considered for the January entering class.

The Committee on Admissions will consider no application until Nova Southeastern University has received all

credentials and fees. All data submitted in support of this application becomes the property of the university and

cannot be returned.

Mail the completed application form and fee to the Office of Admissions at the address below. All correspondence

must be addressed and forwarded to the following address in its entirety.

Nova Southeastern University

Enrollment Processing Services (EPS)

Attn: Nursing Program

3301 College Avenue

P.O. Box 299000

Fort Lauderdale, Florida 33329-9905

To complETE your ApplicATioN, you muST ArrANgE To hAvE ThE followiNg documENTS SENT

from ThE iNSTiTuTioN or SErvicE iSSuiNg ThEm.

One official copy of your academic transcript must be sent directly from each college, university, or professional

school that you have attended. Transcripts must be official. The school seal must be imprinted or embossed on

the transcript, which must be forwarded in a sealed envelope directly from the institution in order to be considered

an official transcript. Photocopies and facsimiles will not be accepted. A transcript is required for each college,

university, or professional school attended, even though transfer credit from one college may appear on another

college’s transcript.

for the entry-level program, two forms of evaluation must be sent from individuals (other than relatives). One

must be from an academic instructor, professor, or supervisor.

it is your responsibility to inform the university of any changes in address or telephone number.

Enrollment Processing Services (EPS) Attn: Nursing Program

3301 College Avenue P.O. Box 299000

Fort Lauderdale, Florida 33329-9905

(2)

Enrollment Processing Services (EPS) Attn: Nursing Program

3301 College Avenue P.O. Box 299000

Fort Lauderdale, Florida 33329-9905

Health Professions Division

B.S.N. Entry-Level Nursing Program

Admissions Application

To complete the admissions process, please submit a nonrefundable, $50 application fee and include your Social

Security number on the check or call 800-338-4723, ext. 28000, with your credit card information. Also, please note, you

will be charged the $50, nonrefundable application fee for each application submitted to our institution. if you prefer

to complete an online application, please visit our web site at www.nova.edu/admissions and click on Admissions.

please retain a copy of the application for your records.

Biographical information

Please print in dark ink.

Name:

_____________________________________________________________________________________

Prefix First Middle Initial Last/Family

_________________________________ _________________________________________________

Suffix (if appropriate) Maiden Name (if appropriate)

do you have educational materials at NSu under another name, Social Security

number, or id? Yes No

If yes, what ID

_________________________________________________________________________

mailing Address

_____________________________________________________________________________________

Street

_____________________________________________________________________________________

City U.S. State, Territory, or Canadian Province ZIP/Postal Code _____________________________________________________________________________________

Nation

is your permanent address the same as the address above? Yes No

permanent Address

_____________________________________________________________________________________

Street

_____________________________________________________________________________________

City U.S. State, Territory, or Canadian Province ZIP/Postal Code _____________________________________________________________________________________

Nation

Business Address

_____________________________________________________________________________________

Name of Company

_____________________________________________________________________________________

Number and Street City

_____________________________________________________________________________________

how did you learn about NSu?

please check all that apply.

Friend/Colleague/Relative

NSU Employee

NSU Student or Graduate

Direct Mail

TV or Radio Commercial

SREB Electronic Campus

eArmyU

Web Site (specify)

Newspaper (specify)

Information Meeting (where)

Conference (specify)

Magazine (specify)

Other (specify) (e.g., adviser)

_______________________

for NSu uSE oNly

(3)

race (If you identify yourself as being of more than one race, you may select multiple options.)

American Indian or Alaska Native

Asian Indian

Filipino

Japanese

primary phone Number ( ) _

International Access Code (if applicable)

permanent phone Number ( ) __

cell phone Number ( ) ____

Email Address _____________________________________________________________

The university collects the following information primarily for purposes of identification and aggregate reporting.

The questions and possible responses on ethnicity and race are written explicitly to comply with u.S. department

of Education reporting requirements. The collected information will not be used in any discriminatory manner.

Social Security Number _________________________________________________________

NSu id# _________________________________________________________

(If known)

Birth date _________________________________________________________

(mm/dd/yyyy)

Sex Female Male

page 2 of 7

SS# Name

Korean

Origins of Chinese

Thai

Other Asian Not Listed

Ethnicity

Mexican Puerto Rican Other Hispanic or Latino Not Hispanic or Latino.

citizenship

United States Citizen

Permanent Resident

country of citizenship: ______________________________________________

is English your native language? Yes No If no, documentation of English literacy is required.

do you require an i-20? Yes No

military/veterans information

Are you a u.S. active-duty military service member? Yes No

Are you a spouse/dependent family member of a u.S. active-duty service member? Yes No

If “Yes” to either of the two questions above, what military branch of service is your affiliation? ______________________

what is the anticipated active-duty discharge date of the military service member? ______________________

Are you a u.S. military veteran? Yes No If a U.S. veteran, please indicate your veteran category.

Vietnam Veteran Other Eligible Veteran Both Vietnam Veteran and Other Eligible Veteran

Are you eligible for veteran’s benefits? Yes No If yes, under which law?

______________________________________________________________________________________________

Foreign, will study in the United States

Foreign, will study outside of the United States

Black or African-American

Native Hawaiian or Pacific Islander

White

(4)

Academic Background

All official transcripts/documents are required from the applicant for All previously attended institutions for

full ad mit tance.

SEcTioN A

will you receive or have you received your high school diploma via

High School Graduation GED Home School

_______________________________________________________________ ______________________________________________________________

Name of High School Graduation Month and Year

________________________________________________________________________________________________________________________________

Number and Street City

________________________________________________________________________________________________________________________________

Country State County ZIP Code

general Education diploma (gEd) awarded:

________________________________________ ______________________________________

Month and Year State

S EcTioN B

list All specific college academic institutions (in chronological order beginning with most recent) you have, are, or

will attend prior to NSu ma tric u la tion.

State Approx. #

or of Credits Start and End Date

Name of Institution City Country Major Degree Earned (or expected end)

have you ever been required to leave any college or denied readmission because of conduct or academic

deficiencies? Yes No If yes, please explain.

________________________________________________________________________________________________________________________________

(5)

page 4 of 7

SS# Name

Briefly describe your skills with computers, indicating how you acquired them.

________________________________________________________________________________________________________________________________

Briefly describe your ability to speak and understand a foreign language and how you acquired those skills.

________________________________________________________________________________________________________________________________

What honors did you receive in high school, college, or other educational programs (include honor societies)?

________________________________________________________________________________________________________________________________

Indicate your extracurricular, community, and professional activities and the extent of your involvement (offices held, etc.).

________________________________________________________________________________________________________________________________

List in chronological order, beginning with your current position, your title or job description and dates of employment.

________________________________________________________________________________________________________________________________

Have you ever matriculated in or attended any Bachelor of Science in Nursing program or any other health-related

professional school? Yes No

If yes, list the name of the school and the dates attended. If you did not complete the program, explain why.

________________________________________________________________________________________________________________________________

program of Study

campus options main campus (fort lauderdale/davie) fort myers Kendall

please check the appropriate semester box and fill in the entering year.

Applying to Entry level B.S.N. program fall winter year ________________

(6)

Have you ever been licensed by any state or federal agency? Yes No

If yes, list type of license, state and agency of license, and number of license.

________________________________________________________________________________________________________________________________

Has your professional license ever been suspended, revoked, or voluntarily suspended? Yes No

If yes, explain.

________________________________________________________________________________________________________________________________

Describe any special circumstances that you feel might aid the Committee on Admissions in evaluating your application.

________________________________________________________________________________________________________________________________

List all the Bachelor of Science in Nursing programs that you are applying to this year or to which you have applied in

the past.

yEAr progrAm or iNSTiTuTioN iNTErviEw STATuS

Write a personal statement based on your life experiences that has led you to nursing as a career path.

(Use additional sheet if necessary.)

________________________________________________________________________________________________________________________________

(7)

page 6 of 7

SS# Name

Additional Questions

is this your first time applying to NSu? Yes No If no, to what program(s) have you applied?

________________________________________________________________________________________________________________________________

will this be your first time attending NSu? Yes No If no, in which program(s) have you enrolled?

________________________________________________________________________________________________________________________________

Are you an NSu employee or a dependent of an NSu employee? Yes No

please indicate participation in any special programs (e.g., finance Academy or Broward leaders) or honors

membership (e.g., phi Theta Kappa):

________________________________________________________________________________________________________________________________

what is the highest level of education attained by your father?

Grammar School High School Other/Unknown

Middle/Junior High School College or Beyond Not Applicable

what is the highest level of education attained by your mother?

Grammar School High School Other/Unknown

Middle/Junior High School College or Beyond Not Applicable

(8)

Health Professions Division B.S.N. Entry-Level Nursing Program Admissions Application

Health Professions Division

B.S.N. Entry-Level Nursing Program

Admissions Application

Thank you for your interest in the nursing program. The Nova Southeastern University Nursing Program offers a course

of study that leads to the Bachelor of Science in Nursing. Admission is based on the candidate’s application content,

academic record, curriculum of completed required courses and evaluation forms.

Please read the following information and fill out the application form completely.

A nonrefundable application fee of $50 must accompany this application. Check or money order should be made

payable to Nova Southeastern University Nursing Program. Please include your name and Social Security number

on your check or money order.

Remember to sign the application form.

The Office of Admissions works on a rolling admissions basis. Entry-level B.S.N. candidates must submit all

applications, transcripts and required documents by April 1 for the August class and by September 1 to

be considered for the January entering class.

The Committee on Admissions will consider no application until Nova Southeastern University has received all

credentials and fees. All data submitted in support of this application becomes the property of the university and

cannot be returned.

Mail the completed application form and fee to the Office of Admissions at the address below. All correspondence

must be addressed and forwarded to the following address in its entirety.

Nova Southeastern University

Enrollment Processing Services (EPS)

Attn: Nursing Program

3301 College Avenue

P.O. Box 299000

Fort Lauderdale, Florida 33329-9905

To complETE your ApplicATioN, you muST ArrANgE To hAvE ThE followiNg documENTS SENT

from ThE iNSTiTuTioN or SErvicE iSSuiNg ThEm.

One official copy of your academic transcript must be sent directly from each college, university, or professional

school that you have attended. Transcripts must be official. The school seal must be imprinted or embossed on

the transcript, which must be forwarded in a sealed envelope directly from the institution in order to be considered

an official transcript. Photocopies and facsimiles will not be accepted. A transcript is required for each college,

university, or professional school attended, even though transfer credit from one college may appear on another

college’s transcript.

for the entry-level program, two forms of evaluation must be sent from individuals (other than relatives). One

must be from an academic instructor, professor, or supervisor.

it is your responsibility to inform the university of any changes in address or telephone number.

Health Professions Division

B.S.N. Entry-Level Nursing Program

Admissions Application

To complete the admissions process, please submit a nonrefundable, $50 application fee and include your Social

Security number on the check or call 800-338-4723, ext. 28000, with your credit card information. Also, please note, you

will be charged the $50, nonrefundable application fee for each application submitted to our institution. if you prefer

to complete an online application, please visit our web site at www.nova.edu/admissions and click on Admissions.

please retain a copy of the application for your records.

Biographical information

Name:

do you have educational materials at NSu under another name, Social Security

number, or id? Yes No

If yes, what ID

mailing Address

is your permanent address the same as the address above? Yes No

permanent Address

Business Address

how did you learn about NSu?

please check all that apply.

Friend/Colleague/Relative

NSU Employee

NSU Student or Graduate

Direct Mail

TV or Radio Commercial

SREB Electronic Campus

eArmyU

Web Site (specify)

Newspaper (specify)

Information Meeting (where)

Conference (specify)

Magazine (specify)

Other (specify) (e.g., adviser)

_______________________

for NSu uSE oNly

race (If you identify yourself as being of more than one race, you may select multiple options.)

American Indian or Alaska Native

Asian Indian

Filipino

Japanese

primary phone Number ( __________ ) ___________________________________ ________________________

permanent phone Number ( __________ ) ________________________________ ________________________

cell phone Number ( __________ ) ______________________________________ ________________________

Email Address _____________________________________________________________

primary phone Number ( ) _

permanent phone Number ( ) __

cell phone Number ( ) ____

SS# Name

SS# Name