I have less than 48 College Credits (excluding concurrent enrollment credit earned in high school)
I have greater than 48 College Credits (excluding concurrent enrollment credit earned in high school) I am Applying for the TRADITIONAL TRACKfor:
[ ] Fall deadline: March 15th [ ] Winter deadline: June 15th [ ] Spring deadline: November 15th
I am Applying for the ALTERNATE TRACK for: [ ] Fall deadline: March 15th [ ] Winter deadline: June 15th [ ] Spring deadline: November 15th
High School:
Graduation Date:
Total AP Credits:
Colleges Attended:
Total Concurrent Enrollment Credits High School:
Total University/College Credits:
Complete this Essay/Vision Statement: When I am a registered nurse, I
All Transcripts must be submitted to the
Department of Nursing by the application deadline.
102 Clarke, Rexburg, ID 83460-0620
Signature:
Date:
Once admitted, students complete the Nursing Program in 4 straight semesters
ASN Nursing Application
STUDENTS MUST APPLY SEPARATELY TO BYU-IDAHO
DATE RECEIVED BY D E P A R T M E N T
OF NURSING
PART A: Personal Information
City:
Home Mailing Address:
(All correspondence will be sent to this address) (P.o. Box/Street)
State/Province:
Country:
Zip:
Current Address:
(If different from above) (P.o. Box/Street) (City) (State) (Zip)
Phone#:
(Include Area Code)Cell Phone#:
(Include Area Code) Male FemaleDate:
Name:
Preferred First Name:
BYU-I#:
BYU-I Email:
Date of Birth:
BYU-I Track:
BYU-I Catalog Year:
PHOTO
please attach an image of yourself here. Larger photos
will not be acceptable.
CNA*Program Attended:
Graduation Date:
Experience:
LPN*Program Attended:
Graduation Date:
Experience:
Other*Medical Credentials:
Graduation Date:
Experience:
mo.
yrs.
mo.
yrs.
mo.
yrs.
*Attach copies of all certificates and/or licenses
Mission Served:
Dates Served:
Military Branch Served:
Time Served:
mo.
yrs.
PART B: Employment History
Attach ResuméPART C: Community Service Resumé
Please document 3 or more service projects or activities in which you have participated:
I. Dates: to
Organization:
Describe the nature of the activities
Did you participate in a leadership role in this activity?
Yes No
Explain:
II. Dates: to
Organization:
Describe the nature of the activities
Did you participate in a leadership role in this activity?
Yes No
Explain:
III. Dates: to
Organization:
Describe the nature of the activities
Did you participate in a leadership role in this activity?
Yes No
PART G: Kaplan Pre-Admission Exam
The Kaplan Pre-Admission Exam© is required for all applicants for the Associates Degree Nursing Program.
There is no cost to the applicant. The Exam must be scheduled and taken in the BYU-Idaho Testing Center (208-496-1758). Students not able to come to campus for this exam need to contact the Department of Nursing (208-496-4551) for information.
Though required as part of the application, scores are currently being used by the Department of Nursing for research purposes only. This exam will not impact a student’s Score Card.
PART F: Background Check
A MISDEMEANOR OR FELONY CONVICTION MAY DISQUALIFY AN APPLICANT Use the link below to obtain your background check.
www.CertifiedBackground.com
Click on “Students”
Enter Package Code: RG85 (if you are 20 years or younger) OR RG85-21 (if you are 21 years and older). Print and attach results when completed. ALL reports must state "results" or your background check can not be accepted.“In Progress” reports are not acceptable.
If you are aware of offenses which may be revealed, it is prudent to attach a written explanation. (If you need assistance call (888) 666-7788 OR email [email protected])
PART D: References (Two Required)
Provide the Reference Forms to two individuals of your choosing. One must be a former employer and each must be able to respond to all characteristics. You must submit your completed Reference Forms with your application. Each Reference Form must be in a sealed envelope signed across the seal by the person completing the reference.
PART E: Transcripts
Print your unofficial BYU-Idaho transcript the day you submit your application. Attach it to your application. Provide Transcripts* for ALL Universities you have attended. Attach them to your application in their sealed envelope.
*Official Transcripts previously sent to BYU-Idaho have gone the Student Records office and the Nursing Department does not have access to them. To obtain copies of transcripts from other colleges or universities attended from the BYU-Idaho Office of Student Records:
1. Email [email protected] from your byui student email with the wording:
“I am applying for the Nursing Program at BYU-I. I would like to get a copy of my _(Name of School)_ transcript from your records to add to my application. My name and I# are_________ __-___-____”.
2. Tran Eval (Transcript Evaluation) will email it to you.
3. You will then print the transcript and add it to your Nursing application.
This process should take no longer than a day. Failure to attach all transcripts may result in inacurate data assessment of your Score Card.
PART H: English as a Second Language Students
The TOEFL exam is required for all students with English as their second language. Attach Official Results to the application and submit by deadline.
Minimum Requirements:
Written (600), Computer(250), Web-based (100)
CHECK LIST
Student Name:__________________________________ I - Number:____________________________________
Please place Application in the order below
attached Requirement
Cumulative GPA 3.5 or higher
Vision Statement Completed (found on page 1 of your application) Work Resume
Service Resume Personal Reference Employment Reference
Background Check (Attach Results of BG check)
Transcripts* from other universities/colleges attended attached. Unofficial copies obtained from Student Records office are acceptable
Unofficial BYU-Idaho transcript (print day Application submitted) attached
BIO 264 and BIO 265 completed with “B” or higher or transcript documenting current enrollment
*if you have not received credit from any other college or university, put “N/A” in check-box
Thank you for taking time to complete this recommendation.
I, ___________________________, am applying for admission to the BYU-Idaho Nursing Program. I am asking you to submit a recommendation for me. I do do not waive the right to see the evaluation.
_______________________
Student Signature
Please respond to the following by checking a box and giving one specific example to support your evaluation. Then please mail this form. I have attached a stamped, pre-addressed envelope. See special instructions below. In your experience the candidate: Strongly
Disagree Disagree No Comment Agree Strongly Agree Demonstrates Integrity: Example: Demonstrates Initiative: Example: Demonstrates Reliability: Example:
Demonstrates Strong Work Ethic Example: Respects Authority: Example: Demonstrates Collegiality: Example: Demonstrates Excellent Communication Skill: Example:
How long have you known this candidate? In what capacity have you known him/her? Would you hire this person to work for you? May we contact you for further details? Contact Information:
. Printed Name
. Signature
Thank you for helping us to know
this candidate better.
Respectfully,
Kim Van Wagoner, PhD, RN
Department of Nursing, Chair
Thank you for taking time to complete this recommendation.
I, ___________________________, am applying for admission to the BYU-Idaho Nursing Program. I am asking you to submit a recommendation for me. I do do not waive the right to see the evaluation.
_______________________
Student Signature
Please respond to the following by checking a box and giving one specific example to support your evaluation. Then please mail this form. I have attached a stamped, pre-addressed envelope. See special instructions below. In your experience the candidate: Strongly
Disagree Disagree No Comment Agree Strongly Agree Demonstrates Integrity: Example: Demonstrates Initiative: Example: Demonstrates Reliability: Example:
Demonstrates Strong Work Ethic Example: Respects Authority: Example: Demonstrates Collegiality: Example: Demonstrates Excellent Communication Skill: Example:
How long have you known this candidate? In what capacity have you known him/her? Would you hire this person to work for you? May we contact you for further details? Contact Information:
. Printed Name
. Signature
Thank you for helping us to know
this candidate better.
Respectfully,
Kim Van Wagoner, PhD, RN
Department of Nursing, Chair
