UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES--COLLEGE OF NURSING DOCTOR OF NURSING PRACTICE PROGRAM

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1 UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES--COLLEGE OF NURSING DOCTOR OF NURSING PRACTICE PROGRAM The graduate curriculum of the University of Arkansas for Medical Sciences College of Nursing leads to the Doctor of Nursing Practice degree. Preference will be given to Arkansas residents. Your application packet with application fee must be received and be complete by May 1, (Application fee is $ (money order or a cashier s check ONLY) made payable to UAMS- College of Nursing) Before your file can be reviewed, the file must include: Official transcripts reflecting all graduate work in nursing (in sealed envelopes from the issuing institutions) Proof of Master s degree in nursing from a CCNE or NLNAC accredited institution Proof of cumulative graduate nursing degree GPA of at least 3.00 required Proof of unencumbered Arkansas or unencumbered Texas RN license (Bowie County only) Proof of unencumbered Arkansas or unencumbered Texas (Bowie County only) advanced practice nursing license (not applicable to nursing administrators) Proof of hours of precepted (supervised) graduate clinical hours Successful completion of TOEFL requirement within 30 days of application deadline if required. A personal Interview is required. (During your interview you will need a copy of your CV, and you will complete an essay.) Review of statistics or refresher statistics course is strongly recommended prior to enrollment. When your application is received, your file deficiencies will be communicated to you by u. Please notify Jenny Kyle at jykyle@uams.edu immediately if you have any changes in your address, your demographic information, or your educational information. When accepted for admission, you will be required to send the College of Nursing either a Umoney order or a cashier s checku in the amount of $150.00, along with the completed confirmation form, the cognitive standards form, and the non-cognitive standards form in order to hold your place. When you register for graduate nursing classes in the semester you are accepted, the confirmation fee will be applied as a credit to your tuition total. Should you fail to register for nursing classes that semester, the confirmation fee Uwill notu be refunded and will be forfeited. Note: All UAMS-College of Nursing students are required to complete a criminal background check/drug screen process annually as a part of their registration process. Please review the information on our website at: HUhttp://nursing.uams.edu/current-students/criminal-background-checkand-drug-screen-policy/. To check the status of your application file, or if you need additional information please jykyle@uams.edu or call Jenny Kyle at

2 UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES--COLLEGE OF NURSING Application for Admission Doctor of Nursing Practice (DNP) Degree Program UAMS-College of Nursing Director of Admissions 4301 W Markham #529 Little Rock, AR Deadline for Fall admission May 1, 2016 UPlease print all informationu. Biographical Data Name: Last (please include full legal name) First Middle Other Names Social Security #: - - APN Certification: ACNP ACPNP Adult NP Adult/Gero ACNP FNP FPMH GNP Nursing Administration PNP WHNP Other: Initial Date of Certification Date Certification Expires Nursing Administration Nursing Administration (but not yet certified) Date of eligibility:

3 2 Current Address Street City State ZIP ( ) ( ) County Telephone Daytime Telephone address Cell phone # ( ) Legal Residence Street City State ( ) County Zip Telephone Ethnic Origin Please check your choices of designation: 1. I am Hispanic/Latino. Y-/N- 2. Select one or more races: -American Indian or Alaskan Native -Asian - Black or African American - Native Hawaiian or Other Pacific Islander -White Male Female Date of Birth / / (mo) (day) (year) CITIZENSHIP INFORMATION (To be completed by all applicants) Place of Birth: (city) (state) (country) U.S. Citizen: Yes- No- ; Country of citizenship, if not U.S. citizen: Language Information (To be completed by all applicants) What is your first (native) language? -English -Other, please specify

4 3 TOEFL Information The Director of Admissions will use the CIA official language field listing to determine whether the TOEFL exam is required for international applicants who declare English as their first language. If English is listed as the official language of their country of birth on the CIA listing, the student will not be required to complete the TOEFL exam as an admission requirement. If you were not born in the U.S. or in a country where English is the official language, then: A. An official TOEFL score of at least 550 or above on the paper-based exam, or 213 or above on computer-based exam, or a minimum score of 20 in each section of the ibt is required. The test must have been taken within the last two (2) calendar years of admission. Official TOEFL exam score report reflecting successful completion must be received no later than one (1) month past the application deadline date. Only TOEFL test scores received directly from ETS will be accepted as valid. Testing information is available at TOEFL Score: Date TOEFL taken: B. If the applicant s entire educational experience has been in the United States, the applicant does not have to take the TOEFL. To document this, the applicant must provide records/transcripts from the time that the applicant entered school in the seventh grade through high school, and college. If the applicant may cannot provide this documentation, the applicant may appeal first to the College of Nursing Admissions and Progression Committee, and then to the College of Nursing Dean Employment Indicate all significant employment as an advanced practice nurse, CNS, and/or administrator for the past five years or longer if you think necessary. If there is substantial discontinuity in your employment experience, please explain on a separate page and attach to the application.. Identify your role as an advanced practice nurse for each place of employment List most recent employment first Institution Address City State Zip Code ( ) Position Telephone Dates of Employment Major Responsibilities as an Advanced Practice Nurse

5 4 Institution Address City State Zip Code ( ) Position Telephone Dates of Employment Major Responsibilities as an Advanced Practice Nurse: Institution Address City State Zip Code ( ) Position Telephone Dates of Employment Major Responsibilities as an Advanced Practice Nurse: Institution Address City State Zip Code ( ) Position Telephone Dates of Employment Major Responsibilities as an Advanced Practice Nurse:

6 5 Educational Information List each college and university enrolled for graduate nursing courses: College/University Location Name when attending Degree Earned/Date Professional Licensure Information License #'s Expiration Date State of Registration (Please include information on all nursing licenses currently held.) Have you ever been on probation or suspended from any educational institution for academic or disciplinary reasons? -Yes -No (If yes, use separate sheet to explain fully.) Have you ever been accepted and did not complete or were dismissed from any nursing or health related program? -Yes -No (If yes, use separate sheet to explain fully.) Has your RN or APN license ever been encumbered, reprimanded, placed on probation, suspended, or revoked? -Yes -No (If yes, use separate sheet to explain fully.)

7 6 Site Selection Which site, if available, is most convenient for you to attend classes? Batesville* El Dorado* Fayetteville* Fort Smith* Helena* Little Rock Mountain Home* Texarkana* * indicates telecommunicated classes only UAMS College of Nursing will not be able to provide clinical arrangements for DNP students who change their state of residence after admission. These students may not be able to complete their UAMS College of Nursing DNP program requirements. Have you ever attended UAMS-College of Nursing before? --Yes --No If so, when and which program and your name when attending: Program Dates attended Name when attended Program Dates attended Name when attended Program Dates attended Name when attended Program Dates attended Name when attended

8 7 Professional References: Name Title Telephone Number Address Address Name Title Telephone Number Address Address Name Title Telephone Number Address Address Date of anticipated enrollment: Fall, - full-time -part-time Year UHonor Code: UWe, the students of the UAMS College of Nursing, recognize the need for an atmosphere of mutual trust and respect in our academic community, as well as professional life. Students enrolled in the College of Nursing are bound by a peer administered Honor Code which provides the pride and self respect that each individual gains by living among honorable people. The Code rests on the premises that lying, cheating, and stealing constitute breaches of the spirit of honor and mutual trust, and are not tolerable within the health professions. Acceptance of admission is an acceptance of the Honor Code and is an implicit agreement to live by its terms and spirit. Every student at the College of Nursing enjoys the benefits of the Code; each shares the responsibility of its enforcement and vitality. All entering students should realize that the Honor Code imposes dual responsibilities--to live from day to day within the terms and spirit of the Code; and to insist that fellow students also live within the Code. It is important to understand that a student who willfully commits a dishonorable act has chosen to live directly in conflict with other students and the profession.

9 8 APPLICANT STATEMENT (Must be completed by all applicants) The College of Nursing requires all applicants who are accepted for admission to sign a release form giving permission to access their background information. Those who have been convicted of a crime or a felony may not be able to enter some clinical sites and therefore would be dismissed from the program. To comply with mandates from many clinical agencies utilized by the UAMS College of Nursing, students are now required to have criminal background checks, driving history record, and/or urine drug screens prior to clinical agency experiences. Students who are not eligible to participate in clinical experiences based on the results of these checks, will not be able to meet course objectives, and will, therefore, be dismissed from the program. It is my understanding that I will be considered for admission to the University of Arkansas for Medical Sciences College of Nursing only after submitting UallU credentials specified. I further agree to inform the College of Nursing of any change in plans to attend UAMS. I certify that none of the information requested on this form is false. I understand that withholding or submitting inaccurate information will make me ineligible for admission and enrollment and subject to administrative withdrawal. Note: This information is for admission to the College of Nursing only. Results of your College of Nursing Criminal Background check in no way guarantees that you will be able to meet qualifications for state licensure, admission into other educational programs, etc. Have you been convicted of a crime or a felony? Yes No Are you a U.S. Veteran? -Yes -No DATE: Signature: OPTIONAL INFORMATION Information collection for UAMS-College of Nursing's grant-writing purposes only. This is optional. Approximate Yearly Income: Below $15,000 $15,001 to $30,000 $30,001 to $45,000 $45,001 to $60,000 Over $60,000 How did you hear about UAMS College of Nursing? Academic Advisor Advertisement Arkansas Partnership Nursing s Future (APNF) Career Fair CON Recruiter CON Student Family/Friend Hartford Center of Geriatric Nursing Internet Newspaper/Magazine TV/Radio P:\DNP Forms\DNPApFrm1213.docx (8/21/2015)

10 University of Arkansas for Medical Sciences College of Nursing 9 Check List for Application to the Doctor of Nursing Practice (DNP) Program The following are the application criteria for the doctor of nursing practice (DNP) program. Please check each one and return this sheet with your application and documents to: UAMS-College of Nursing Student Services Office Director of Admissions 4301 W Markham Slot 529 Little Rock, AR Application with application fee (Money order or cashier s check for $ made payable to UAMS-College of Nursing) Official transcripts reflecting all graduate nursing courses in which you enrolled with a minimum required cumulative graduate grade average of 3.40 One official transcript must show that a master s degree in nursing has been awarded. (An official transcript is required even if only one (1) graduate nursing course was completed at the institution.) Documentation of current unencumbered Arkansas or Texas (Bowie County only) RN license as a registered nurse included. Documentation of current unencumbered Arkansas advanced practice nursing license included. Copy of advanced nursing practice certification where applicable included. Completion of verification of master s clinical and practice hours form Completion of English as a Foreign Language (TOEFL) requirement for non-us born applicants Students admitted to this professional DNP program will not be eligible for the UAMS employee discount on tuition.

11 University of Arkansas for Medical Sciences College of Nursing 10 Verification of Master s Clinical Hours The DNP applicant should complete the top and send this form to the program director for completion. Student s Name (Print or type): (Last) (First) Middle (Maiden/Other) Student s SS#: - - The information below must be completed by the program director Name of Institution: Program Name: Address: University Telephone: Type of Degree Received: Masters of Science in Nursing Program Post Master s Certificate Program Specialty: Date of Program Completion: Total number of clinical practice hours in the program (clock hours): Program Director: Your signature on this form attests that the above named individual has completed the program indicated on this document. Signature: Date: Name (Please print name): address: When form is completed, please send it to: Jenny Kyle, Director of Admissions UAMS-College of Nursing 4301 W Markham #529 Little Rock, AR voice/ fax jykyle@uams.edu