Associate Degree in Nursing Program Application for Admission DEADLINE FOR SUMMER 2016 SEMESTER: DECEMBER 4, 2015 BY 11:00 AM

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1 DEADLINE FOR SUMMER 2016 SEMESTER: DECEMBER 4, 2015 BY 11:00 AM INSTRUCTIONS FOR NEW APPLICANTS 1. Complete the application. Download the application from Use the attached application checklist to ensure that your application is complete; it is the applicant's responsibility to review application prior to submission. The applicant assumes responsibility for submission of the application on or before the deadline. If you are NOT already enrolled at Goodwin College, if you are accepted into the Nursing Program you will be required to pay a non-refundable Application Fee of $ Hand deliver the application either in person or by another person on your behalf. Turn in your application to the Nursing Department, Suite 509, 5th floor, One Riverside Drive, East Hartford, CT between the hours listed below (during the week/hours of NLN exam registration, submit application at time of registration in the lobby you may only register during these time frames): Monday Thursday 8:00 a.m. 5:00 p.m. 8:00 a.m. 11:00 a.m. Applications submitted after the application deadline will not be accepted. 3. Register to take the NLN A&P Pre-entrance exam. Please see directions below. INSTRUCTIONS FOR RETURNING APPLICANTS 1. Reactivate your file. Submit a letter of request to reactivate your file by either ing Chelsea Tibus at or by hand delivering it to the Nursing Department, Suite 509, 5th floor, One Riverside Drive, East Hartford, CT between the hours listed below (during the week/hours of NLN exam registration, submit letter at time of registration in the lobby - you may only register during these time frames): Monday Thursday 8:00 a.m. 5:00 p.m. 8:00 a.m. 11:00 a.m. 2. Register to take the NLN A&P Pre-entrance exam. If you choose to re-take the exam, please see directions below. INSTRUCTIONS FOR REGISTERING FOR THE NLN A&P PRE-ENTRANCE EXAM Only students applying to the program may register for the exam and must have completed A&P II. Students must register either in person or by another person on their behalf. 1. Pay the non-refundable exam fee of $16.00 prior to registration in the Business Office (1 st Floor). 2. Bring the exam fee receipt to register in the lobby of the college November 30 December 4, you may only register during these time frames: Monday Thursday 9:00 a.m. 11:00 a.m. / 2:00 p.m. 5:00 p.m. 9:00 a.m. 11:00 a.m. 3. Arrive for the exam in Room 310 at least 30 minutes early for sign in and seating. Anyone arriving late will not be permitted to take the exam. Examinees will need one official form of identification. NLN A&P exam dates and times: Thursday, January 7, 2016: 9:00 a.m. 12:00 p.m. OR 2:00 5:00 p.m., January 8, 2016: 9:00 a.m. 12:00 p.m. OR 2:00 5:00 p.m. Check your Goodwin account daily for any updates. Questions? Please contact Janice Watts at or

2 Complete this application answering all questions. Application must be typed or printed in ink, signed and dated. PERSONAL INFORMATION (please print) Name: Last First Middle Male Female Address: Street City State Zip Home Phone: Alternate Phone: Best Time to Contact: Social Security Number: Date of Birth: Information concerning date of birth, gender, ethnic group, and social security number is being collected for reporting purposes only and will not be used in the selection process for admission. Demographic Information: Married Single Divorced Children White Black, Non-Hispanic Hispanic Asian/Pacific Islander American Indian/Alaskan Native Non-Resident Alien I choose not to respond Is English your native language? Yes No If no, please indicate primary language Citizenship: Are you a U.S. citizen? Yes No EDUCATIONAL BACKGROUND if no, list Visa type: EDUCATIONAL BACKGROUND SECONDARY EDUCATION: List the high school from which you graduated. Dates From To Name of School City and State Date Diploma Received Do you have a GED certificate? Yes No Pending Actual / anticipated year earned Certification of High School Diploma or its Equivalent: I hereby certify that I have graduated from high school or attained the equivalent credential. This certification will provide proof of this prerequisite until such time as Goodwin College receives a copy of my transcript, diploma or GED certificate. Student Signature Date

3 POST-SECONDARY EDUCATION Dates From To Name of College City and State Major Credentials Earned EMPLOYMENT INFORMATION Starting with present or most recent employment: Employer Position Dates FT PT Description of Duties Employer Position Dates FT PT Description of Duties EMERGENCY CONTACT INFORMATION Name Relationship Address Phone ADDITIONAL INFORMATION Are you now or have you ever been licensed as a health care provider? Yes No If so, please specify: Have you ever been enrolled in another nursing program? Yes No If yes, which program? Why did you leave? Are you now or have you ever been enrolled in Goodwin College? Yes No Dates: Which program? Health clearance is required for all students admitted to the Nursing Program. I, the undersigned, apply for admission to Goodwin College s ADN program. I understand that once accepted, it is my responsibility to familiarize myself with and abide by the policies and regulations of Goodwin College. I agree that the information given on this application is true to the best of my knowledge. I further understand that any falsification of information may result in my being withdrawn from the program. Signature Date Goodwin College admits qualified students without regard to race, religion, color, age, gender, maritial status, ethnic origin, and handicap status to all rights, privileges, programs, and activities generally accorded or made available to students at the College. Goodwin College does not discriminate in the administration of educational policies, admission policies, financial aid policies, and other College administered programs. FOR OFFICIAL USE ONLY RE: Fee Received: Per:

4 APPLICATION CHECK LIST ALL APPLICATIONS MUST BE COMPLETE WHEN SUBMITTED OR THEY WILL NOT BE EVALUATED. 1. Completed Application Form. 2. Official College or University Transcripts: a. (Name of College) b. (Name of College) c. (Name of College) d. (Name of College) e. (Name of College) Do you have official Transcripts on file at Goodwin College? 1. Only courses that are completed will count towards points for courses taken at Goodwin. 2. Application Fee of $75 (if not a current Goodwin College student). Make all payments in the Business Office

5 Item NURSING PROGRAM POINT SYSTEM New Goodwin College Students No. of Pts. Previous College Education Associate Degree (60 credits) 2 Bachelor's Degree 3 Master's Degree 4 Completion of Goodwin College Courses which award credit 1 course 1 2 courses 2 3 courses 3 4 courses 4 5 courses 5 6 courses 6 7 courses 7 Students who have earned greater than or equal to 12 credits at Goodwin College will receive points based upon their Goodwin College cumulative GPA. (minimum GPA--2.7) Composite Score on NLN Pre-Admissions Exam (Minimum score of 50%) 50%-55% 1 56%-59% 2 60%-65% 3 66%-70% 4 71%-75% 5 76%-80% 6 81%-85% 7 86%-90% 8 91%-95% 9 96%-99% 10 FINAL TOTAL (TOTAL POSSIBLE POINTS 25)

Associate Degree in Nursing Program Application for Admission. DEADLINE FOR FALL 2016 SEMESTER: April 1, 2016 BY 11:00 AM

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