Application for Early Admission to the BSN Program

Missouri Baptist University School of Nursing Application for Early Admission to the BSN Program

Date: ______

Have you been accepted for admission to Missouri Baptist University? ______Yes ______No If no, have you applied for admission to Missouri Baptist University? ______Yes ______No

Are you an international student? ______Yes ______No Are you a non-native speaker of English? ______Yes ______No

Please type or print

1. Legal Name ______

Last First Middle (Maiden) Last 4 digits of social security number ______Other names by which previously known ______

2. Current Address ______

Number & Street City County State Zip Current Home Phone ______Current Work Phone ______3. Permanent Address (if different from above) ______

Number & Street City County State Zip Permanent Phone ______4. Email Address ______

5. Name of High School ______Graduation Year ______High School GPA ______/4.0 ACT Composite Score ______English Subscore ______Math Subscore ______

6. Have you completed a CNA course? ______Yes ______No

7. Have you ever been convicted of a misdemeanor or felony? ______Yes ______No

Be advised that to practice professional nursing, a graduate of the nursing program must apply to take a national licensure examination for registered nurses (NCLEX-RN) and apply for licensure in the state where the graduate wants to work as a professional registered nurse. A graduate is required to pass the NCLEX-RN before state licensure can be granted. As outlined in the Missouri State Board of Nursing Nurse Practice Act (http://pr.mo.gov/boards/nursing/npa.pdf): The practice of nursing is subject to state-specific licensure requirements. For state-specific licensure requirement information, contact the state board of nursing in the state where you intend to practice. By current Missouri law, the Missouri State Board of Nursing has requirements that include, but are not limited to the following: 20 CSR 2200-4.020 Requirements for Licensure. In addition, according to the Missouri State Board of Nursing an applicant for licensure by endorsement or licensure by examination who answers yes to one (1) or more of the questions on the application or the fingerprint checks reveal charges and/or convictions which relate to possible grounds for denial of licensure under section 335.066, RSMo shall submit copies of appropriate documents, as requested by the board, related to that answer or the fingerprint check before his/her application will be considered complete. The copies shall be certified if they are records of a court or administrative government agency. An applicant for licensure by endorsement or licensure by examination who the executive director or designee determines may not meet the requirements for licensure or examination shall be notified that the application will be reviewed by the members of the board at the board’s next regular scheduled meeting following receipt of all requested documents. The Missouri State Board of Nursing shall notify, by certified mail or delivery, any individual who is refused permission to take an examination for licensure or an individual licensed in another state, territory or foreign country that is denied a license by endorsement without examination. At the time of notification, this individual is to be made aware of his/her avenue of appeal through the Missouri Administrative Hearing Commission. 8. Person to be notified in case of emergency: Name: ______Relationship: ______Telephone Number: ______

Address: ______

Number & Street City State Zip

9. Answer the following questions. Please type or clearly print answers.

A. Why did you choose professional nursing as a career? B. Is there anything in your academic record that needs explaining (e.g. incompletes, grades, pass/fail scores)?

C. Have you taken any college credits? If so, please list the name of the school and the courses you have taken.

D. Describe how you have demonstrated commitment to yourself and/or others in your life.

E. Describe how you have shown compassion to others in your life.

F. Describe how you have demonstrated leadership skills and abilities in your life.

G. Describe the strengths/assets you feel you would bring to the profession of nursing. H. Describe any commitments that might conflict with the demands of the nursing program.

10. Submit a written essay over the topic “Why I want to be a nurse?” (500 words or less) a. Please submit in a Microsoft Word document

11. Submit two letters of recommendations. a. One letter must be from a high school guidance counselor

I hereby certify that the information I have given in this application is accurate and complete to the best of my knowledge.

Signature: ______Date: ______

Please submit application via mail or electronically BY JULY 1 to

Missouri Baptist University School of Nursing Dr. Amber Pyatt One College Park Drive Saint Louis, MO 63141

OR [email protected]

**Students will be notified on or before August 1, 2017 if they have been accepted as an Early Admissions option into the August 2019 BSN Cohort. There will be 10 students