University of Arkansas at Monticello School of Nursing Application for Admission

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1 Please check your program of application: University of Arkansas at Monticello School of Nursing Application for Admission AASN (LPN-RN) BSN LPN-BSN RN-BSN 1. Legal Name Last First Middle Maiden 2. Social Security number or Student ID: 3. Address to which correspondence regarding this application should be sent: Street City State Zip 4. Telephone (Home) (Work) (Cell) 5. Previous application(s) to UAM nursing program: None Year(s) 6. Other names under which you have registered at UAM None Last First Middle Maiden 7. Number of hours you have completed at UAM (do not include current enrollment) 8. Are you enrolled in coursework at this time? Yes No If yes, specify which courses and university/school: 9. List all colleges, universities, nursing schools, and vocational/technical schools you have attended. SCHOOL CITY STATE DATES ATTENDED YEAR GRADUATED DEGREE EARNED

2 10. Have you ever been convicted of a crime? Yes No If yes, please explain NOTE: CRIMINAL BACKGROUND CHECKS AND DRUG SCREENINGS ARE MANDATORY UPON ADMISSION TO ANY NURSING PROGRAM! 11. Have you ever been expelled, dismissed, suspended, or placed on probation for any reason? Yes No If yes, please explain 12. If the applicant s native language is other than English, an official transcript of the score for the Test of English as a Foreign Language (TOEFL) must be submitted directly from the Educational Testing Service. For undergraduate applicants the required score for the paper-based test is 500, the required score for the computer-based test is 173, and the required score for the internet-based test is Do you hold a current, unencumbered nursing license? Yes No If yes, write your nursing license number and state here: LPN-RN APPLICANTS MUST SUBMIT: a. a letter of recommendation from current or most recent RN supervisor; b. a copy of current Arkansas license. LPN-BSN or RN-BSN APPLICANTS MUST SUBMIT: a. a letter of recommendation from current or most recent RN supervisor; b. a copy of current Arkansas license.

3 14. A minimum UAM cumulative grade point average (GPA) of 2.5 is required AND a minimum GPA of 2.5 is required in General Education courses AND Support courses calculated separately as indicated below: BSN, RN-BSN, & ACTS BSN, RN-BSN, & LPN-BSN ACTS Equiv LPN-BSN Equiv GENERAL SUPPORT COURSES EDUCATION COURSES ENGL 1013 Comp I ENGL 1023 Comp II ENGL 1013 ENGL 1023 BIOL 2243 A&P II BIOL 2301 A&P II Lab BIOL 2414 Art 1053 or Music MUSC 1003 BIOL 3553 Microbiology Appreciation 1113 MATH 1043 College Algebra or MATH 1103 BIOL 3561 Microbiology Lab PSY 3443 Dev. Psychology PSYC 2103 Survey of Math 1003 MATH 1003 PSY 1013Intro to PSYC 1103 NURS 3393 Patho for Nursing Psychology COMM 2283 SPCH 1003 PSY (2203) Statistics Business & Prof. Speech BIOL 2233 A&P I BIOL 2404 PE 2113 Nutrition BIOL 2291 A&P I BIOL 2404 Elective (2 or 3 hour course) Lab CHEM 1023 INTRO CHEM 1004 CHEM 1031 INTRO CHEM 1004 Lab American Hist I (2213) or II (2223) or American National HIST 2113 PLSC 2003 Gov (PSCI 2213) World Lit I or II Intro to Sociology ENGL 2113I ENGL 2123II SOCI 1013 (2213) 35 hours 22 or 23 hours ACTS Equiv. = Arkansas Course Transfer System course equivalent No ACTS course equivalent

4 AASN GENERAL EDUCATION COURSES ENGL 1013 Comp I ENGL 1023 Comp II MATH 1043 College Algebra or MATH 0183 Intermediate Algebra PSY 1013Intro to Psychology CIS 1013 Intro to Comp- Based Sys or CIS 2223 Microcomputer Applications ACTS Equiv ENGL 1013 ENGL 1023 MATH 1103 PSYC 1103 CPSI 1003 AASN SUPPORT COURSES BIOL 2233 A&P I BIOL 2291 A&P I Lab BIOL 2243 A&P II BIOL 2301 A&P II Lab BIOL 3553 Microbiology BIOL 3561 Microbiology Lab PSY 3443 Dev. Psychology 15 hour 15 hours ACTS Equiv BIOL 2404 BIOL 2404 BIOL 2414 PSYC 2103 ACTS Equiv. = Arkansas Course Transfer System course equivalent No ACTS course equivalent 15. Ranking of Students for Admission Applicant GPAs are calculated using the general education and nursing supportive requirements completed at the time of application. Applications are accepted from January 15 through March 1 of each year; therefore, grades calculated for admission consideration will only include those completed by the end of the Fall semester. Students must complete all outstanding coursework by the end of the Spring semester. Full Admission Students who have completed all general education and nursing supportive requirements with a GPA of 2.5 or higher and have a cumulative UAM GPA of 2.5 or higher will be considered for full admission to the nursing program. Provisional Admission Students who have a cumulative UAM GPA of 2.5 or higher and will complete all general education and nursing supportive requirements by the end of the Spring semester will be considered for provisional admission to the nursing program. Students must complete the coursework with a grade of C or better AND maintain a 2.5 GPA. Students will be ranked in numerical order according to the following criteria:

5 a. All prerequisites completed with a GPA of b. Provisional admission with a GPA of c. UAM students will receive first consideration for admission, followed by transfer students. UAM students are those who have COMPLETED at least 12 hours of general education and/or nursing supportive courses in residency at UAM at the time of application. Admission of transfer students is based on space available.

6 ADMISSIONS/APPLICATION CHECKLIST NOTE: IMCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED APPLICATIONS ARE ACCEPTED JANUARY 15 THROUGH MARCH 1 ONLY 1. Submit all current transcripts from all colleges, universities, and vocational/technical schools to the Office of Admissions. 2. Include copies of all transcripts with nursing application. 3. Complete all sections of the application. 4. Read and sign the Skills and Abilities checklist. 5. Read and sign Conviction of a Crime form. 6. Read and sign the Dress Code form. 7. Read and sign Photography Consent form. ALL LICENSED NURSES 8. Include a copy of your Arkansas nursing license. 9. Include a letter from your current or most recent RN supervisor Signature Date signed Return to: School of Nursing University of Arkansas at Monticello PO Box 3606 Monticello, AR Attn: Admissions Committee Note: All University of Arkansas at Monticello (UAM) nursing degree programs are approved by the Arkansas State Board of Nursing, Arkansas Department of Higher Education, and the University of Arkansas Board of Trustees. The UAM SON BSN programs are accredited by the Accreditation Commission for Education in Nursing.

7 University of Arkansas at Monticello Division of Nursing Abilities and Skills Form The professional nurse must possess the knowledge and ability to effectively assist his or her client s biophysical, psychological, social, cultural, and intellectual domains. Further, the professional nurse must competently analyze the assessment data through intellectual processing to arrive at a definition of the client s status or problem, plan independently or collaboratively for a full range of therapeutic interventions, execute all or part of the plans through nursing acts, and evaluate the care delivered and the client s responses to it. A candidate for professional nursing must have the abilities and skills necessary for use of the nursing process. These skills and abilities include: observation; communication; motor ability; conceptualization; integration and quantification; and behavior/social acceptability. Technological compensation can be made for some handicaps in certain of these areas, but a candidate should be able to perform in a reasonably independent manner. The use of a trained intermediary is not acceptable, in that a candidate s judgment must be mediated by someone else s power of observation and selection. The following abilities and skills are necessary to meet the requirements of the curriculum: 1. Observation: The candidate must be able to observe a patient accurately at a distance and close at hand. Observation necessitates the functional use of the sense of vision and somatic sensation. It is enhanced by the functional use of the sense of smell. 2. Communication: The candidate must be able to speak, to hear, and to observe patients in order to elicit information; describe changes in mood, activity and posture; and perceive nonverbal communications. A candidate must be able to communicate effectively and sensitively with patients. Communication includes not only speech but reading and writing. The candidate must be able to communicate effectively and efficiently in oral and written form with all members of the health care team. 3. Motor: Candidates should have sufficient motor function to elicit information from patients by palpation, auscultation, percussion, and other assessment maneuvers. A candidate must have sufficient motor skills to gain access to patients in a variety of care setting and to manipulate the equipment central to the treatment of patients receiving professional nursing care. Such actions require coordination of both gross and fine muscular movement, equilibrium, and functional use of the senses of touch and vision. 4. Intellectual-Conceptual, Interactive, and Quantitative Abilities: These abilities include measurement, calculation, reasoning,analysis, and synthesis. Problem solving, the critical skill demanded of nurses, requires all of these intellectual abilities. In addition, the candidate should be able to comprehend three dimensional relationship and to understand the spatial relationship of structures. 5. Behavioral and Social Attributes: A candidate must possess the emotional health required for full utilization of his or her intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities attendant to the care of patients, and the development of mature, sensitive and effective relationships with patients. Candidates must be able to tolerate physically taxing workloads and to function effectively under stress. They must be able to adapt to changing environments, to display flexibility, and to learn to function in the face of uncertainties inherent in the clinical problems of many patients. Compassion, integrity, concern for others, interpersonal skills, interest, and motivation are all personal qualities necessary for professional nursing. I agree that I must posses and maintain the abilities and skills as indicated above for admissions to and progression within the nursing curriculum at the University of Arkansas at Monticello. Student Signature Date Adapted from : [Bower, D., Line, L. & Denega, D. (1988). Evaluation Instruments in Nursing (pp.71) New York: National League for Nursing.

8 Conviction of a Crime The Arkansas State Board of Nursing (ASBN) has the authority to deny licensure to any person who has been convicted of a crime. Conviction of a crime may prevent a student from taking clinical courses, the National Council Licensure Examination for Registered Nurses (NCLEX-RN) or becoming licensed to practice as an RN. Successful completion of this program does not assure ASBN s approval t take the NCLEX-RN per ACA If you have any questions or have been convicted of a crime of any type, go to the following website for more information (Arkansas State Board of Nursing Criminal Background Check) and make an appointment with the dean of the school of nursing. Any violations or convictions during nursing school may result in dismissal from the program. In addition, habitual arrests, or a pattern of arrests, of any kind may result in denial of admission to the School of Nursing. All crimes, even if sealed or expunged, or discoverable by criminal Background Checks and may result in denial of admission to the School of Nursing and/or may result in denial to sit for the NCLEX-RN (the licensing exam) by the State Board of Nursing I have read and understand the information regarding Conviction of a Crime Name Date

9 UAM School of Nursing Clinical Dress Code EARRINGS: Only 1 small stud earring per ear is allowed. BODY PIERCINGS: Eyebrow, nose, lip or tongue rings are unacceptable and must not be worn. TATTOOS: Visible tattoos are unacceptable and must be covered. NAILS: No artificial nails, nail polish or long fingernails. HAIR: Hair should be within the natural range of colors, secured off the collar and away from the face FACIAL HAIR: Men ae expected to be clean shaven with no facial hair Additional information regarding uniform, shoes, hair, jewelry and makeup will be provided in the UAM school of Nursing Handbook upon admission to the nursing program. I have read and understand the information regarding the UAM School of Nursing Clinical dress Code. Name Date

10 Photography Consent Form University of Arkansas Monticello I hereby grant full permission to the University of Arkansas Monticello to use either my photograph and / or name (if necessary in all forms of media, for any and all promotional purposes including advertising, display, and audiovisual use. This consent also serves to waive all rights of privacy or compensation which I may have in connection with the use of my photograph and / or name. Name (Please print) Signature Mailing Address City, State, Zip Date Phone Number

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