Dear Applicant to the Baccalaureate Program:

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1 4901 E. University Blvd., Odessa, Texas (432) (432) (Fax) Dear Applicant to the Baccalaureate Program: As you prepare your application to the University of Texas Nursing Program, we applaud you in your decision to pursue nursing as a career. Your application will be reviewed and given very serious consideration. Those applicants, who meet the criteria for admission, will be offered seats in the upcoming Fall or Spring semester of the Nursing Program. The first course in the curriculum, Pharmacology & Pathophysiology will be offered in Summer or Fall semester prior to admission. This course must be taken at UT Permian Basin. As you consider the responsibilities of professional nursing practice, please be aware of the requirement to pass a criminal background check prior to clinical courses and again during the application for licensure. In addition, applicants will be asked to confirm a clear disciplinary record. Follow the directions in the application closely. Consider each question very carefully and answer as completely as you can. If you have any questions, please call (432) We look forward to receiving your completed application. Sincerely, Dorothy Jackson, PhD, RN Director of Nursing Notice Concerning Your Information The Texas Public Information Act, with a few exceptions, gives you the right to be informed about the information that UT Permian Basin collects about you. It also gives you the right to request a copy of that information and to have the University correct any of that information that is wrong. You may request to receive and review any of that information, or request corrections to it, by contacting the Office of Public Information Affairs, UT Permian Basin, 4901 E. University Blvd., Odessa, Texas 79762

2 The University of Texas of the Permian Basin Nursing Program Admission Procedures Admission to The University of Texas of the Permian Basin and to the Nursing Program are two separate application processes. Contact the Office of Admissions by writing to the Office of Admissions, UT Permian Basin, 4901 E. University Blvd, Odessa, Texas or calling (432) or Important: Applicants must be formally admitted to The University of Texas of the Permian Basin for the semester they intend to begin upper-division nursing courses, meeting all University deadlines as published in the University of Texas of the Permian Basin Admission website. How to Apply to the Nursing Program Application submission: Students must be enrolled in the last semester of required prerequisite coursework or have completed all prerequisite course requirements. (as indicated in the application #8 and 8.1) All prerequisite courses must be completed prior to the beginning of the Junior 1 first semester in the Nursing Program. Pharmacology & Pathophysiology must be taken in the Summer or Fall semester prior to admission to the Nursing Program. This course must be taken at UT Permian Basin. All required information and documents must be received by the application deadline, to be considered for admission. Incomplete applications will not be considered. To apply for admission to the Nursing Program, submit the following by the appropriate deadline directly to Nursing Program, UT Permian Basin, 4901 E. University Blvd., Odessa, Texas ) Completed Nursing application, including personal essay (see Directions on Application.) 2) The $25 application fee in a check or money order made payable to The University of Texas of the Permian Basin Nursing Program. Please submit check or money order to the Accounting Department, UT Permian Basin, 4901 E. University, Odessa, Texas Please indicate that the check or money order is for the Nursing application fee. 3) SEPARATE and OFFICIAL transcripts from each college/university you have attended other than UT Permian Basin must be submitted to both Nursing and Admissions, UT Permian Basin, 4901 E. University Blvd., Odessa, Texas ) Criminal background checks are performed on all applicants offered admission to the UTPB Nursing Program. All students will be required to provide contact information to begin the criminal background check process at the time of the interview. Information about the process is available at the Texas Board of Nursing (BON) website at Students who do not receive a clear background check from the BON must pursue a Declaratory Order process with the BON to confirm eligibility for licensure. Students who must pursue the Declaratory Order to confirm eligibility for licensure will need to set an appointment with the Director of the Nursing Program to discuss starting this process. Results of this Declaratory Order must be submitted to the Nursing Program. The Declaratory Order process permits the Board to make decisions regarding an applicant's eligibility for licensure prior to entering this nursing program. If you think something may come up on your criminal background check, please send a signed and dated letter to the BON describing the incident(s) on your criminal background with certified copies of the court documents. 5) The official TEAS test results must be ed by the testing center. (Test of Essential Academic Skills, version 5 or higher.) You may register to take the TEAS Test at the UTPB Pass Office or the ATI Testing website, Follow the link, Register for TEAS. Please choose U of TX of the Permian Basin TEAS to have your scores sent to us. 6) Provide evidence of Immunization. (Please refer to the Admission Criteria for immunization requirements.) Applications are now being accepted for Fall and Spring classes. For information contact: Applicants will be notified of admission decisions prior to registration.

3 UT PERMIAN BASIN - NURSING Application for Entry to Upper Division Courses in Nursing Please type of print clearly: 1. A. UT-UID: B. Date of Birth: / / C. Place of Birth: city county state country 2. Full Legal Name: (last) (first) (middle) (maiden) 3. Semester applying: Fall 201 Spring Address: A. Permanent: Street / Telephone City State Zip Code B. Local: Street / Telephone City State Zip Code address C. Residency Status: [ ] Texas Resident [ ] Non-Resident [ ] Foreign 5. List all colleges, universities, and professional schools that you have attended, including UT Permian Basin. Indicate the dates of attendance and degrees awarded: (Note: The Office Admissions and the Nursing Program each require a separate official transcript from each college attended.) School or Institution Dates Attended Major Degree Awarded 6. Are you a CNA [ ] yes [ ] no; LVN/LPN? [ ] yes [ ] no; RN [ ] yes [ ] no License # State 7. List any certifications or health care training programs you have completed. (Include dates and names of programs.)

4 8. I understand that at this time my records show that I lack the following course prerequisites necessary for enrollment in Upper Division Courses in Nursing. I plan to complete these courses during: Summer [ ] 201 ; Fall [ ] 201 ; Spring [ ] 201 (Please list the college or university at which you will complete these prerequisites.) Institution Must be taken at UTPB Prerequisite Needed: (Course# & Name) N2300 Pharmacology/Pathophysiology Indicate Fall or Spring /Summer Session Fall enrollment Summer enrollment 8.1 Please indicate Prerequisite courses you have completed. Please list the college or university, the course number, your grade, credit hour of each course and the year completed. Incomplete applications will not be considered. Institution Course # Prerequisite Completed Grade Credit Hours (MATH) College Algebra (BIOL) Biology I (BIOL) Biology I Lab (BIOL) Biology II (BIOL) Biology II Lab (CHEM) Chemistry I (CHEM) Chemistry I Lab (BIOL) Human Anatomy (BIOL) Human Anatomy Lab (BIOL) Human Physiology (BIOL) Human Physiology Lab (BIOL) Microbiology (BIOL) Microbiology Lab Must be taken at UTPB UTPB Only (BIOL) Nutrition (PSYC) Introductory Psychology Must be taken at UTPB UTPB Only (PSYC) Statistics (PSYC) Lifespan Growth & Development (ENGL) English I (ENGL) English II (ENGL) Literature 2300 level Oral Communication (HIST) History I (HIST) History II (PLSC) Political Science I (PLSC) Political Science II Visual & Performing Arts Year Completed

5 9. List previous employment. Specify dates, type of work, where employed, and approximate number of hours per week: Place of Employment: Dates Worked: Type of Work: Hours Worked: 10. List volunteer activities in a health care environment (include dates and times): (Attach document if more space is needed) 11. List other community service and extracurricular activities (include dates and times): (Attach document if more space is needed) 12. List academic and other honors received: (Attach document if more space is needed) 13. Personal Essay Directions: Explain why you chose nursing and what you think you would like to do in the future as a nurse. This essay is an opportunity to introduce yourself to the committee. You are also encouraged to include an explanation or description of your situation or circumstances not fully described elsewhere in the application, which may deserve consideration of the admissions committee. Write no more than two typed double-spaced pages with 1-inch margins in standard 12-point, Times New Roman font. Essays will be scored for content and the quality of writing, including spelling and grammar. Documents to be submitted with Nursing Application: The Official Transcripts and the Immunization Records need to be mailed to: Nursing and Admissions, UT Permian Basin, 4901 E. University Blvd., Odessa, Texas Personal Essay. The Application Fee needs to be mailed to: Accounting, UT Permian Basin, 4901 E. University Blvd., Odessa, Texas Note: The TEAS test results, must be received by the Nursing Program prior to consideration of your application. You may register to take the TEAS Test by going to the ATI Testing website, Follow the link, Register for TEAS.

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