Application Checklist School of Nursing Entry-Level Nursing Programs

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1 Applicatin Checklist Schl f Nursing Entry-Level Nursing Prgrams Applicatin Fee Resume Official Transcripts Recmmendatins GRE Prerequisite Checklist Other Requirements Essay Direct-Entry Master f Science in Nursing (DEN) Accelerated Bachelr f Science in Nursing (ABSN) Secnd Bachelrs Degree Prgram 3 3 Nt Req. Satisfactry cmpletin f prerequisite cursewrk Satisfactry cmpletin f prerequisite cursewrk v Legend: = Required Nt Req. = Nt Required

2 Schl f Nursing Applicatin Instructins & General Admissin Requirements Entry-Level Nursing Prgrams Please read the fllwing instructins carefully. Yur applicatin fr admissin will be evaluated nly after the Office f Student Affairs has received ALL required materials. It is yur respnsibility t be certain that all necessary materials have been received by the Office f Student Affairs prir t the deadline. 1. PREREQUISITES: Degree - A bachelr s degree frm a reginally accredited cllege r university. Prerequisite Cursewrk - Direct-Entry Master f Science in Nursing (DEN): Cmpletin f the fllwing prerequisite curses with a grade f C r better is required fr matriculatin. All prerequisite curses shuld have been taken within five years f applicatin*. Applicants may be asked t submit mid-term reprts fr certain prerequisite curses. Requests fr prerequisite evaluatins will be addressed in writing nly. All prerequisites must be satisfactrily cmpleted prir t matriculatin. Anatmy & Physilgy I Anatmy & Physilgy II Chemistry (including sme Organic Chemistry) Micrbilgy Human Nutritin Statistics The curses listed abve may be taken at the MGH Institute f Health Prfessins as a nn-degree student the summer prir t matriculatin as part f ur Science Prerequisites fr the Health Prfessins Prgram. Fr mre infrmatin and t register fr curses, please refer t ur website. * Applicants may apply fr a waiver f this plicy by cmpleting the Prerequisite Time Limit Waiver Request Frm, which identifies the curse(s) the applicant is asking t be waived frm the plicy alng with qualifying ratinale.

3 Accelerated Bachelr f Science in Nursing (ABSN): Cmpletin f the fllwing prerequisite curses with a grade f C r better is required fr matriculatin. All prerequisite curses shuld have been taken within five years f applicatin*. Applicants may be asked t submit mid-term reprts fr certain prerequisite curses. Requests fr prerequisite evaluatins will be addressed in writing nly. All prerequisites must be satisfactrily cmpleted prir t matriculatin. Applicants may have ne prerequisite curse in prgress the spring semester prir t matriculatin. Anatmy & Physilgy I Anatmy & Physilgy II Chemistry (including sme Organic Chemistry) Micrbilgy Human Nutritin Statistics * Applicants may apply fr a waiver f this plicy by cmpleting the Prerequisite Time Limit Waiver Request Frm, which identifies the curse(s) the applicant is asking t be waived frm the plicy alng with qualifying ratinale. 2. STANDARDIZED TESTS: GRE (Graduate Recrd Examinatin) Direct-Entry Master f Science in Nursing (DEN): The GRE General Test is required fr admissin and must have been taken within the past 5 years. It is strngly recmmended that the GRE be taken a minimum f eight weeks befre ur applicatin deadline. Please keep in mind that yur applicatin file will be cnsidered incmplete and may nt be reviewed until after fficial GRE scres are received. The MGH Institute f Health Prfessins schl cde is R GRE Waiver Request: The GRE test requirement may be waived, with prgram apprval, if an applicant prvides fficial dcumentatin f having met ne f the fllwing criteria: 1. Has taken an alternative test f preparedness fr graduate-level studies acceptable t the Institute in its sle discretin, r 2. Has already achieved a Master s degree r higher - T apply fr a GRE waiver, applicants must submit the Institute s GRE Waiver Request Frm alng with prper dcumentatin. We strngly recmmend that yu submit this waiver request well ahead f the applicatin deadline t allw time t take the GRE in the event yur request is denied. Accelerated Bachelr f Science in Nursing (ABSN): The GRE test is nt required fr entry int this prgram. TOEFL (Test f English as a Freign Language) An fficial result f the TOEFL, taken within the last tw years, is required f all applicants whse native language is nt English. The minimum scre requirement is 213 (cmputer-based test), (Internet-based test) r 550 (paper-based test). Scres must be sent directly t the Institute by the testing service. This requirement is waived nly if the applicant has received r expects t receive prir t enrllment, an undergraduate r graduate degree frm a cllege r university in any f the fllwing cuntries: The United States f America, New Zealand, and Canadian institutins where the language f instructin is English. A waiver may als be granted if a credentialing agency can shw that the medium f instructin at the undergraduate r graduate institutin where the degree was awarded was English. The MGH Institute f Health Prfessins schl cde is R3513.

4 3. OFFICIAL TRANSCRIPTS: Applicants must submit fficial transcripts frm all clleges and universities attended, even if a degree was nt received frm that institutin. Include undergraduate and graduate curse wrk. Sealed fficial transcripts shuld be mailed with the applicatin packet. Fr curses in prgress, transcripts shuld be frwarded upn cmpletin. Applicants wh did nt receive an undergraduate degree in the United States must have the degree transcript evaluated by an educatinal credentialing agency. When requesting a transcript evaluatin, please request a curse-by-curse evaluatin with grades (Preferred credentialing agencies are listed n ur website). 4. RECOMMENDATION LETTERS: Applicants are required t submit three letters f recmmendatin (Please be sure t print sufficient cpies f the Recmmendatin Frm if cmpleting the paper applicatin). Recmmendatin letters shuld cme frm individuals wh are able t address yur academic ability, leadership ptential, character and integrity, as well as yur ptential fr pst-baccalaureate prfessinal study. At least ne letter shuld cme frm an academic reference and ne shuld cme frm a prfessinal reference. 5. PERSONAL ESSAY: Direct-Entry Master f Science in Nursing (DEN) - Essay shuld address the fllwing questins: a. Tell us why yu want t becme a nurse practitiner r clinical nurse specialist. b. Tell us hw past experiences and/r influences have cntributed t yur decisin t becme a nurse practitiner r clinical nurse specialist. c. What are yur prfessinal nursing gals and plans and hw will yur graduate nursing educatin at the MGH Institute f Health Prfessins help yu t achieve thse gals? Accelerated Bachelr f Science in Nursing (ABSN) - Express yur reasns fr wanting t enter the nursing prfessin. Hw d yu view the rle f nurses in the healthcare field? Answers shuld be typed, duble-spaced, and n mre than three pages in ttal. Margins shuld be n mre than ne inch, and type size shuld be n smaller than 10-pint, with 12-pint type preferred. Please make sure yur full legal name and the last fur digits f yur scial security number are included n each page. 6. RESUME: Please submit a current resume r CV. 7. ADDITIONAL PROGRAM REQUIREMENTS: Direct-Entry Master f Science in Nursing (DEN) & Accelerated Bachelr f Science in Nursing (ABSN): Submit a cmpleted Prerequisite Checklist Fr additinal infrmatin and access t all supplemental frms, please visit ur website at 8. APPLICATION DEADLINE^: Direct-Entry Master f Science in Nursing (DEN): Accelerated Bachelr f Science in Nursing (ABSN): January 10 th fr Fall entry Nvember 1 st fr fllwing Summer entry ^ Applicatin materials arriving after the deadline may be cnsidered at the discretin f the prgram admissin cmmittee and nly if space is available.

5 9. APPLICATION FOR ADMISSION: Applicants are asked t cllect and submit all applicatin materials, including sealed fficial transcripts and sealed recmmendatin letters. Please make sure yur full legal name is included n all materials being submitted. Mail yur applicatin packet t the fllwing address: MGH Institute f Health Prfessins Office f Student Affairs PO Bx 6357 Bstn, MA Keep in mind that Federal Express and UPS mail cannt be accepted at a P.O. Bx address. If yu must send materials by express service, please send it t ur street address, as listed belw: * We will acknwledge the receipt f all applicatins by . MGH Institute f Health Prfessins Office f Student Affairs 36 1 st Ave. Charlestwn Navy Yard Bstn, MA $65 NON-REFUNDABLE APPLICATION FEE: - Please make checks payable t the MGH Institute f Health Prfessins. PROGRAM CONTACT INFORMATION:

6 MGH Institute f Health Prfessins PO Bx 6357 Bstn, MA (617) Applicatin fr Admissin Schl f Nursing Entry-Level Nursing Prgrams The Institute s preference is fr all students t apply nline thrugh ur website: Applicants wh chse t fill ut a paper applicatin may experience a delay in prcessing. I. PERSONAL INFORMATION Are yu currently an emplyee f the Partners Healthcare System? YES NO If s, where are yu emplyed? LAST FIRST MIDDLE Please list ther names which may have previusly appeared n academic recrds: Scial Security # Date f Birth / / Male Female (fr identificatin purpses nly) Mnth / Day / Year Current Address (valid until ): Number Street City State Zip Current Phne: ( ) - Cuntry Permanent Address: Number Street City State Zip Cuntry Address: Permanent Phne: ( ) - II. CITIZENSHIP AND VISA INFORMATION Are yu a United States citizen? Yes N If nt, what cuntry are yu a citizen f? D yu hld Permanent Resident status? Yes N Alien Registratin number: (prvide a cpy f yur card) What is yur expected visa status during yur studies in the United States? F-1 Other (type) Are yu a U.S. Veteran? Yes N If yes, are yu receiving Veterans benefits? Yes N Fr Office Use Only: Date applicatin received: Received by: Applicatin fee received: Credit Card: Check: Check Number:

7 III. PROGRAM OF STUDY Please check the academic prgram t which yu are applying: Accelerated Bachelr f Science in Nursing (ABSN) Summer entry nly Direct-Entry Master f Science in Nursing (DEN) Fall entry nly Select Specializatin : (first chice nt guaranteed) Acute Care (Nurse Practitiner Specialty) Family (Nurse Practitiner Specialty) Adult Primary Care (Nurse Practitiner Specialty) Pediatrics (Nurse Practitiner Specialty) Psych/Mental Health (Nurse Practitiner Specialty) Dual Adult/Wmen s Health (Dual Nurse Practitiner Specialty) Dual Adult/Gerntlgy (Dual Nurse Practitiner Specialty) Psych/Mental Health (Child/Adlescent) Clinical Nurse Specialist Psych/Mental Health (Adult) Clinical Nurse Specialist IV. EDUCATION List all schls attended beynd high schl, including schls at which yu are currently enrlled. Please list schls chrnlgically (mst recent first). GPA is required nly frm institutins where a degree was received. Name f Cllege/University Dates Attended Degree Majr GPA D yu believe that yur academic recrd accurately reflects yur ability? Yes N If nt, please explain. Attach additinal sheets if necessary. V. STANDARDIZED TESTS Please refer t the applicatin instructins fr mre detailed infrmatin regarding required standardized tests fr yur academic prgram. NOTE: Official reprts f GRE scres shuld be sent directly t the MGH Institute f Health Prfessins frm the testing service (ETS). Our schl cde is R3513 Graduate Recrd Examinatin Scres (GRE): Test Date: / / Verbal: Mnth / Day / Year Quantitative: Writing Assessment: Future Test Date: / / (Test must be taken prir t the prgram s applicatin deadline) Mnth / Day / Year

8 Applying fr a GRE waiver? Yes N Please see applicatin instructins t determine eligibility. Students requesting a waiver must cmplete the GRE Waiver Request frm. Test f English as a Freign Language scres (TOEFL): Applicants whse native language is nt English and/r wh did nt receive a degree frm a cllege r university whse language f instructin is English must take the TOEFL. Test must have been taken within the past 2 years. Test Date: / / Mnth / Day / Year Test results: Future Test Date: / / (Test shuld be taken prir t the applicatin deadline) Mnth / Day / Year VI. WORK EXPERIENCE (Please include CV r resume) Include hnrs, awards and publicatins r any prfessinal rganizatins and/r cmmunity activities yu have been invlved in n yur resume, if applicable. VII. RECOMMENDATIONS Please prvide cntact infrmatin in the space belw fr thse wh will be cmpleting a recmmendatin frm n yur behalf: 1. Name: Last First Organizatin: Title: Address: Street City State Zip Address: Relatinship t applicant: 2. Name: Last First Organizatin: Title: Address: Street City State Zip Address: Relatinship t applicant: 3. Name: Last First Organizatin: Title: Address: Street City State Zip Address: Relatinship t applicant:

9 VII. APPLICANT AFFIDAVIT I hereby certify that the infrmatin given n this applicatin is cmplete and crrect t the best f my knwledge, and that I have attended n institutin ther than thse I ve listed. I understand that all dcuments sent t the MGH Institute f Health Prfessins becme the prperty f the MGH Institute f Health Prfessins and will nt be returned t me r duplicated fr any reasn. I further acknwledge that the applicatin fee nly partially cvers the cst f prcessing my applicatin and that the fee is nn-refundable. I understand that if I am accepted t the MGH Institute f Health Prfessins, my admissin is cntingent upn verificatin f all fficial recrds frm the institutins I ve attended, as well as satisfactry cmpletin f all utstanding admissin requirements. I understand that any misrepresentatin r missin with regards t this applicatin may result in refusal f admissin r cancellatin f registratin. I understand that the MGH Institute f Health Prfessins reserves the right t rescind any and all acceptances t the institutin. Signature f applicant Date It is the plicy f the MGH Institute f Health Prfessins nt t discriminate n the basis f race, clr, creed, gender, gender identity r expressin, sexual rientatin, age, disability, veteran status, marital status, r natinal rigin. The institute respects and values the diverse backgrunds f all peple, and welcmes all students t fully participate in all the rights, privileges, prgrams, and activities generally accrded r made available t the Institute cmmunity. This plicy incrprates, by reference, the requirements f Title VII f the Civil Rights Act, Title IX f the 1972 Educatinal Amendments, and all relevant federal, state, and lcal laws, statutes, and regulatins. In cmpliance with the Jeanne Clery Disclsure Act f 1998, MGH Plice and Security prvides infrmatin annually abut crime statistics within ur cmmunity. A cpy f this infrmatin is available at the ffice f MGH Plice and Security r at OPTIONAL: The MGH Institute f Health Prfessins prvides equality f pprtunity t all students. Ethnic and prfile infrmatin is nly used t cmplete reprts required by the gvernment and/r accrediting agencies. This infrmatin will nt influence the Institute s decisin regarding admissin. Please indicate yur primary ethnic backgrund: Hispanic / Latin Nn-Hispanic / Latin Please indicate yur primary racial backgrund: Black r African-American Hawaiian / Pacific Islander White American / Alaskan Native Asian Other

10 MGH INSTITUTE OF HEALTH PROFESSIONS RECOMMENDATION FORM Please make additinal cpies as necessary INSTRUCTIONS FOR APPLICANT: Please fill ut tp sectin and frward t recmmenders. Make sure t prvide each recmmender with a self-addressed, stamped envelpe t expedite its return. Name: Scial Security Number (last 4 digits): Prgram f study: Cmmunicatin Sciences & Disrders Nursing Physical Therapy Medical Imaging Teaching and Learning CAS The Family Educatinal Rights and Privacy Act f 1974 and its amendments guarantee students access t educatinal recrds cncerning them. Students are als permitted t waive their right f access t recmmendatins. The fllwing signed statement indicates the wish f the applicant regarding this recmmendatin. Failure t respnd will be cnsidered a waiver f the right f access t this recmmendatin. This waiver is nt required fr admissin. I waive my right t inspect this recmmendatin I d nt waive my right t inspect this recmmendatin Signature: INSTRUCTIONS FOR RECOMMENDER: Please cmplete and check ff sectins A and B and return the cmpleted frm in a sealed envelpe with yur signature acrss the seal t preserve the cnfidentiality f this dcument. A. Please prvide a separate letter f recmmendatin that addresses the ptential f the applicant t be a pst-baccalaureate r graduate student, including any additinal cmments cncerning maturity, critical thinking skills, ability t adapt t change, r any ther factrs that yu think may be pertinent t the student s perfrmance in a prfessinal curriculum. Additinally, it is imprtant fr us t assess the ptential f each student t succeed in a clinical envirnment. If yu feel qualified t make this assessment, please include yur cmments in this evaluatin. RECOMMENDER NAME: TITLE: DATE: INSTITUTION/COMPANY TITLE: ADDRESS: CITY: STATE: PHONE: ADDRESS: SIGNATURE: RELATIONSHIP TO APPLICANT: ACADEMIC PROFESSIONAL OTHER Hw lng have yu knwn the applicant?

11 RECOMMENDATION FORM PAGE 2 B. Please rank the applicant with respect t each categry belw: EXCELLENT GOOD AVERAGE BELOW AVERAGE NO BASIS TO JUDGE Overall intellectual ability Written expressin Oral expressin Flexibility Ability t rganize and apply infrmatin Prblem slving skills Maturity and emtinal stability Initiative and perseverance Curisity Ptential fr (r actual) clinical cmpetence Ability t handle stressful situatins Ability t interact well with thers Ability t accept cnstructive feedback Ability t wrk independently Capacity fr Graduate study Overall Impressin: Strngly recmmend Recmmend Recmmend with reservatins D nt recmmend Thank yu fr taking the time t assist us thrugh the applicatin and evaluatin prcess. Yur input is valued and greatly appreciated. MGH Institute f Health Prfessins Office f Student Affairs PO Bx 6357 Bstn, MA (617)

12 Schl f Nursing GRE WAIVER REQUEST FORM (Cmplete nly if applicable) The GRE requirement may be waived, with prgram apprval, if yu meet ne f the criteria listed belw. T request a GRE Waiver, applicants must submit this GRE Waiver Request Frm alng with fficial supprting dcumentatin. We strngly recmmend that yu submit this waiver well ahead f the applicatin deadline t allw time t take the GRE in the event yur request is denied. Applicant Name: Mailing Address: Last First Address: Last 4 digits f Scial Security Number: Prgram f study: Term f Entry: Please check ne f the fllwing ptins as the reasn fr which yu are requesting yur GRE requirement be waived: 1. I have taken an alternative test f preparedness fr graduate-level studies acceptable t the Institute in its sle discretin 2. I have already achieved a Master s degree r higher Please attach required dcumentatin t this frm and submit alng with applicatin t: MGH Institute f Health Prfessins, Office f Student Affairs, PO Bx 6357 Bstn, MA Fr Institute Use Only: Prgram Decisin: Apprved Denied Prgram Signature: Date f Decisin: Admissin Signature:

13 MGH INSTITUTE OF HEALTH PROFESSIONS Direct-Entry Master f Science in Nursing Prerequisite Checklist Name Last 4 digits f Scial Security Number: Please fill ut this frm cmpletely. If a curse is in prgress, indicate IP under Grade. If yu plan t take a curse at the Institute r elsewhere, please list the lcatin under Schl and indicate WT (will take) under Grade. All entries will be crsschecked against fficial schl transcripts; please be sure entries are crrect. Use abbreviatins as necessary. Submit this frm as part f yur applicatin. Prerequisite Curse # Curse Title Credits Schl Term/Year Grade Anatmy & Physilgy I General Chemistry (including sme Organic) Micrbilgy Human Nutritin Anatmy & Physilgy II Statistics All prerequisite curses shuld have been taken within 5 years f applicatin and must be satisfactrily cmpleted prir t matriculatin. Questins regarding whether r nt a curse will satisfy ur prerequisite requirements will nly be addressed in writing. Please the Schl f Nursing fr mre infrmatin: Return this frm with yur applicatin materials t: MGH Institute f Health Prfessins Office f Student Affairs PO Bx 6357 Bstn MA Thank yu fr yur assistance.

14 MGH INSTITUTE OF HEALTH PROFESSIONS Accelerated Bachelr f Science in Nursing Prerequisite Checklist Name Last 4 digits f Scial Security Number: Please fill ut this frm cmpletely. If a curse is in prgress, indicate IP under Grade. If yu plan t take a curse at the Institute r elsewhere, please list the lcatin under Schl and indicate WT (will take) under Grade. All entries will be crsschecked against fficial schl transcripts; please be sure entries are crrect. Use abbreviatins as necessary. Submit this frm as part f yur applicatin. Prerequisite Curse # Curse Title Credits Schl Term/Year Grade Anatmy & Physilgy I General Chemistry (including sme Organic) Micrbilgy Human Nutritin Anatmy & Physilgy II Statistics Applicants may have ne prerequisite curse in prgress the spring semester prir t matriculatin. All prerequisite curses must be cmplete with fficial dcumentatin submitted t the Office f Student Affairs prir t the first day f class in rder t matriculate. All prerequisite curses shuld have been taken within 5 years f applicatin and must be satisfactrily cmpleted prir t matriculatin. Questins regarding whether r nt a curse will satisfy ur prerequisite requirements will nly be addressed in writing. Please the Schl f Nursing fr mre infrmatin: Please return this frm with yur applicatin materials t: MGH Institute f Health Prfessins Office f Student Affairs PO Bx 6357 Bstn MA Thank yu fr yur assistance

2010 Application Checklist School of Nursing Entry-Level Nursing Programs

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