University of Pikeville Elizabeth Akers Elliott Nursing Program

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1 Elizabeth Akers Elliott Nursing Program Application The Elizabeth Akers Elliott nursing program is a twoyear (four semester program) leading to an Associate of Science Degree, with a major in nursing. There also is an option for the Licensed Practical Nurse (LPN) to earn an Associate of Science Degree in nursing in two semesters, once admitted to the LPN to RN program of study. Applications must be received by March 1.

2 RN Applicant Checklist Are you ready to be a nurse? If so, we are ready to accept 30 new applicants for Fall 2012! Application Deadline: March 1, 2012, for admission consideration to fall semester nursing Applicants who do not complete all the admission requirements by the application deadline will not be considered for admission to the nursing program. If you are not admitted to the nursing program in Fall 2012 and want to be considered for Fall 2013, you must submit a new application packet prior to March 1, Names, application forms and TEAS entrance exam scores are not kept from one academic year to the next. Admission Requirements Application for Admission. (If you are not currently attending the, complete a new application.) Nursing Program Application. (Complete a new application each admission year.) Test Of Essential Academic Skills TEAS (refer to TEAS test dates). Minimum TEAS score of 45% is required. One retake allowed only for those with less than 45%. Submit official transcripts of GED, high school, college/university and/or vocational-tech coursework to the Office of Admissions. Composite score of 19 or higher on ACT. With more than one qualifying ACT composite (i.e., > 19), the Math and ENG subscores on most recent qualifying ACT are used for ranking points. ACT MTH and ENG subscores less than 18 require placement in developmental courses. Required developmental courses must be completed with at least a C grade before the start of nursing classes. Based on University policy, the student s highest subscore on any ACT is used for MTH and ENG placement. College GPA of 2.0 or higher. For high school seniors: High school transcript evaluated on GPA, rank, and grades in science and math courses. NOTES: 1. There are no prerequisite courses for admission to the nursing program, other than meeting the Math and English competencies based on ACT subscores. 2. A course at or below a C grade may be repeated one time. The grade on the second attempt, including W grades, stands as the final grade. All transfer credit subject to final approval of the registrar. 3. Required science courses must be within the last 10 years. Otherwise, the science course must be repeated. 4. Any exception will be determined on an individual basis. Rev. 06/11

3 Detach here and return to the Office of Admissions. Application for Admission Consideration for admission at the requires you to complete the following steps. Step 1 Complete and sign this application and return to: Office of Admissions 147 Sycamore Street Pikeville, Kentucky Step 2 Step 3 Step 4 Provide an official completed high school transcript/ged and ACT or SAT scores. If a transfer student, also provide official transcripts of all college-level work. Complete a Free Application for Federal Student Aid (FAFSA) as soon as possible after January 1 to determine federal, state and institutional aid. The s Title IV Institution Code is Social Security Number: - - Address: Name: Last First Middle Initial Maiden Preferred Name Address: Number & Street City State ZIP County Home Phone: ( ) Cell Phone: ( ) Birth date: U.S. Citizen: Yes No Sex: Male Female Ethnic Background: Hispanic White, Non-Hispanic Black, Non-Hispanic Asian or Pacific Islander American Indian or Alaskan Native Other Marital status: Married Single Other Enrollment status: Full-time (12 credit hours or more) 3/4 time (9-11 hours) 1/2 time (6-8 hours) Less than 1/2 time Beginning: Fall Spring Summer I Summer II Plan to live: On-campus Off-campus Full Name of Mother or Female Guardian (With Title; i.e., Mrs., Ms., Dr., etc.): Phone: ( ) Relationship to student (i.e. mother, grandmother): Mother s Employment Status: Employed Disabled-Permanent Unemployed Retired Self-Employed Disabled-Temporary Deceased Mother s Place of Employment: Phone: ( ) Highest Grade Level Completed (Education): Occupation/Title: Full Name of Father or Male Guardian (With Title; i.e., Mr., Dr., Rev., etc.): Phone: ( ) Relationship to student (i.e. father, grandfather): Father s Employment Status: Employed Disabled-Permanent Unemployed Retired Self-Employed Disabled-Temporary Deceased Father s Place of Employment: Phone: ( ) Highest Grade Level Completed (Education): Occupation/Title:

4 High school attended: GED: Date passed High school grade-point average on 4.0 scale: Graduation year: ACT or SAT composite score: Class rank: out of School activities: (Clubs, sports, chorus, band: list instrument/s. Attach a separate sheet, if needed.) Have you ever attended the? No Yes Dates attended: Classification upon entering the : Beginning Freshman Re-admit Hours completed at the Transfer Hours completed Special (Non-degree seeking) COLLEGES WHERE CREDIT HOURS COMPLETED DATES ATTENDED If degree was completed, which school and what type of degree? Have you participated in dual credit course hours? Yes No Hours completed Please check your likely major or field of study (Check at least one). BACCALAUREATE DEGREES ASSOCIATE DEGREES Art History/Political Science Business with emphasis in Biology Interdisciplinary Studies Accounting Business Mathematics Management Chemistry *Nursing, R.N.-B.S.N. Information Systems Communication Psychology *Nursing, R.N.-A.D.N. Computer Science Religion Criminal Justice Criminal Justice English Social Sciences Social Work History Sociology PRE-PROFESSIONAL PROGRAMS Dentistry Law Optometry Pharmacy *AREAS OF TEACHER CERTIFICATION Medicine Physical Therapy Elementary Education Veterinary Medicine Engineering Middle Grades Education Secondary Education *These programs require an additional application. I understand that the may not release any information about my academic records or my performance at the without my personal consent. I further understand that the may, from time to time, want to use my photograph and/or personal data for publicity purposes for the University. I have read the preceding statements and I (do / do not) object (One must be circled). I hereby make application for admission to the under the terms and conditions set forth in the current catalog. Every statement here is correct to the best of my knowledge. I realize that misrepresentation of any statement will result in reconsideration for admission to the University of Pikeville. I have read the directions for completing this application and understand that I am responsible for presenting all required materials to: Office of Admissions Phone: (606) Fax: (606) Sycamore Street Pikeville, KY Signature of Applicant: Date: It is the policy of the University that no student shall be excluded from participating in, be denied the benefits of, or be subjected to discrimination in any program sponsored by the University because of age, gender, race, color, creed, religion, handicap, sexual orientation or national origin. Revised 06/11

5 Detach here and return to the Office of Admissions. Application for Admission Completion of this nursing program application is one of the admission criteria to the s Elizabeth Akers Elliott associate degree in nursing program. Please refer to RN Applicant Checklist and Nursing Program brochure for a complete list of admission criteria to submit by the application deadline. If you are not admitted to the nursing program in Fall 2012 and want to be considered for Fall 2013, you must submit a new application packet prior to March 1, Names, application forms and TEAS entrance exam scores are not kept from one academic year to the next. Social Security Number: - - Application Deadline March 1, 2012 (Admission to Fall Semester 2012) Date of Birth: / / Name: Last First MI/Maiden Address: Number & Street/Route # or P.O. Box # City State ZIP Preferred Home Phone: ( ) Preferred Person to be notified in case of emergency: Name: Preferred Cell Phone: ( ) Relationship: Preferred phone number for emergency contact: List in order of attendance, the dates of high school (or GED diploma), vocational school, college(s) and universities. Include any schools of nursing. If additional space is needed, please use reverse side. NAME OF INSTITUTION DATES ATTENDED DEGREE OBTAINED or MAJOR Are you currently enrolled at the?: No Yes Have you taken the TEAS during the period of August 2011 March 1, 2012?: TEAS score of 45% is required. Only one retake per admission year allowed with <45% score. No; not yet registered; No, but registered for (date): ; Yes, date taken: Are you certified, licensed, or registered in a healthcare field? No Yes If so, what is your title? Submit a copy of your certification and its expiration date with this application. You Must Complete the Information on the Reverse Side

6 State clearly, in the space provided below, the key reason and meaning of why you want to become a nurse. (This essay is read by a member of the Nursing Admissions Committee.) For what reasons do you want to become a registered nurse? What meaning would it have for you to become a registered nurse? The Kentucky Board of Nursing may delay or deny anyone who has been convicted of a felony or a misdemeanor from taking the nursing licensure examination. The s nursing program and clinical affiliating agencies may require a criminal background check and drug screen. These agencies have the right to deny a student s clinical placement based upon findings of the criminal background check or drug screen. Should this situation occur, the does not guarantee the student s placement in the nursing program or at an alternate site and the student may need to withdraw from the program. Progression in the nursing program is dependent on completion of required activities by deadline dates, adherence to nursing program policies, minimum standardized testing scores, completion of required remediation, C or higher grade in pre-/co-requisite and nursing courses, and final Satisfactory rating in the clinical portion of nursing courses. It is the policy of the University that no student shall be excluded from participating in, be denied the benefits of, or be subjected to discrimination in any program sponsored by the University because of gender, race, religion, sexual orientation, age, handicap, or national origin. Students with disabilities requiring accommodations should contact the Disabilities Resources Office located in the Student Services Counselor s Office. Accommodations are made on an individual basis according to documented need. I affirm that all information supplied in the application is complete and accurate. I understand that withholding or giving false information will result in my being ineligible for admission to the nursing program. My signature indicates my understanding of the statements on this application. Applicant s Signature Date This hardcopy of the Nursing Program Application is to be sent to: Office of Admissions 147 Sycamore Street Pikeville, KY An online submission of the Nursing Program Application can be found at Contact the at if further information is needed. Rev. 06/11

7 Detach here and return to the Office of Admissions. Test of Essential Academic Skills (TEAS) Enrollment Form Completion of this TEAS enrollment form is one of the admission criteria to the s Elizabeth Akers Elliott associate degree in nursing program. Please refer to RN Applicant Checklist and Nursing Program brochure for a complete list of admission criteria to submit by the application deadline. Name: Last First MI/Maiden Address: Number & Street/Route # or P.O. Box # City State ZIP Telephone (there must be a number to confirm, remind or notify you of TEAS dates or changes): Primary Phone: ( ) To enroll for TEAS (Prepayment & Pre-Registration Required) Place a check mark next to the desired TEAS date. Alternate Phone: ( ) The TEAS fee is $30 (non-refundable). Make your check/money order payable to the. Mail or hand carry this TEAS enrollment form and $30 payment, prior to the enrollment deadline, to: Test Date Record Memorial # Sycamore St. Pikeville, KY For Fall 2012 admission (March 1, 2012 deadline) December 17, 2011 (9 a.m. 12:30 p.m.) December 14, 2011 January 14, 2012 (9 a.m. 12:30 p.m.) January 11, 2012 January 28, 2012 (9 a.m. 12:30 p.m.) January 25, 2012 February 11, 2012 (9 a.m. 12:30 p.m.) February 8, 2012 February 25, 2012 (9 a.m. 12:30 p.m.) February 22, 2012 Important Information about the TEAS Exam Enrollment Deadline with Fee Paid The TEAS is taken only once per admission year, if you receive the cutoff score of at least 45%. If you get less than the cutoff score of 45%, only one retake is allowed. You may repeat the TEAS on any date listed, as long as the repeat TEAS is taken on or before March 1. You will be notified of your enrollment status when your enrollment form is received. The $30 fee is non-refundable. Walk-ins are not permitted to take the exam. You must show a valid form of picture identification to take the exam (i.e., driver s license). No exceptions! An informational session on nursing program requirements, a review of the application process and a question/answer period will take place on each TEAS date promptly at 9 a.m. Rev. 06/11

8 Office of Admissions 147 Sycamore Street Pikeville, Kentucky (606)

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