Western Illinois University School of Nursing

Western Illinois University School of Nursing APPLICATION FOR ADMISSION Baccalaureate of Science in Nursing RETURN THIS FORM TO: Western Illinois University School of Nursing Waggoner Hall 339 1 University Circle Macomb, IL 61455-1390 (309) 298-2571 Fax: (309) 298-2270

Baccalaureate of Science in Nursing Western Illinois University ADMISSION CHECKLIST Submit the BSN admission packet containing the following documents: 1. BSN Application for Admission 2. Educational and Professional Goals Statement 3. Documentation of Community Service 4. Documentation of Veteran Status 5. Documentation of Awards Received 6. Documentation of Athletic Status 7. Two Confidential Recommendation forms (see enclosed) from professional colleagues Confidential Recommendations should be requested from individuals who have worked closely with you and are able to give specific information about your abilities and potential. These will be returned to you in a sealed envelope by each of the individuals. Submit the sealed envelopes with the Confidential Recommendations or have the person send the Confidential Recommendation directly to the School of Nursing. 8. Request Transcripts from the college or university that you attended. Institutions must be regionally accredited, NLNAC, and/or CCNE. WIU will only accept official transcripts from the college or university s registrars office in a sealed envelope. (Schools generally charge $1 to $5 for this service.)send one copy to WIU Admissions. 9. Copy of current Registered Nurse License, if applicable 10. Transfer of Credit request form ADMISSION REQUIREMENTS FOR PRE-LICENSURE STUDENTS Students who wish to apply to the School of Nursing for admission to the major as a Pre-licensure Nursing student must 1. Have a complete application on file in the School of Nursing no later than March 1 for admission for the next Fall Semester. 2. Completion of the Test of Essential Academic Skills V (TEAS V). Scores on the exam must be received in the Nursing Office by March 1 for Fall Semester admission. 3. Students must complete all general education and support course requirements by July 1 for Fall Semester admission. 4. Have a minimum cumulative GPA of 2.33 on a 4.0 scale for all postsecondary work. The following courses must have a grade of C+ (2.33) or better: a. Zool 230: Human A&P I b. Zool 231: Human A&P II c. Chem 101: Gen Chemistry I d. Chem 102: Gen Chemistry II e. FCS 109: Intro to Nutrition f. FCS 121: Intro Life Span Dev g. Micro 200: Intro Micro h. Stat 171: Gen Element Stats In addition, only one of these courses may be repeated if a grade of C+ (2.33) is not achieved. A student may repeat one course one time. Admission will be denied to any student who receives a second grade of less than C+ (2.33) for any nursing support course. 5. Submit an official transcript to WIU Admissions. 6. Secure letters of reference from two (2) professional references: one academic (i.e., instructor or professor) and one employer (i.e., supervisor). If there has been no employment, students may submit letters from two instructors/professors. 7. Provide documentation to the School of Nursing that all health requirements for the School of Nursing have been met by August 1 before Fall Semester admission. Health requirements are different from the standard University requirements. (Students are responsible for all costs incurred for admission as well as ongoing health requirements.)

8. Provide documentation to the School of Nursing that all safety requirements have been met by August 1 before Fall Semester admission. (Students are responsible for all costs incurred for admission as well as ongoing safety requirements.) a. Criminal Background Check All applicants are required to submit a criminal background check. Details will be given to the student upon admission to the program. b. Drug Screen All applicants are required to be drug tested on admission with random drug screens thereafter. Applicants with a felony conviction or a positive drug screen may be denied entry into the clinical facility for clinical practice. ADMISSION REQUIREMENTS FOR REGISTERED NURSES Students who wish to apply to the School of Nursing for admission to the major as an RN-BSN Completion nursing student must 1. Have a completed application on file in the School of Nursing no later than July 1 for admission for the next Fall Semester or October 1 for Spring Semester admission. 2. Submit a current copy of the License as a Registered Nurse. 3. Students should complete (or transfer in) all general education and support course requirements by July 1 for Fall Semester admission and January 1 for Spring Semester admission. There are 60 semester hours of general education and support courses. 4. Have a minimum of a cumulative GPA of 2.33 on a 4.0 scale for all postsecondary work except those listed below. The following courses (or comparable courses) must have a grade of C+ (2.33) or better: a. All nursing courses taken for the Associate Degree in Nursing or Diploma in Nursing b. The following courses are listed as nursing support courses. These courses or their equivalents will be transferred in> i. Zool 230: Human A&P I ii. Zool 231: Human A&P II iii. iv. Chem 101: Gen Chemistry I Chem 102: Gen Chemistry II 1. Chem 101 and Chem 102 requirements may be waived if the chemistry course the student completed (at least C+ [2.33]) was at the college level and included organic chemistry. The semester hour requirement is not waived; the student must complete the 125 semester hours required for the degree. v. FCS 109: Intro to Nutrition vi. FCS 121: Intro Life Span Dev vii. Micro 200: Intro Micro viii. Stat 171: Gen Element Stats In addition, only one of these courses may be repeated if a grade of C+ (2.33) was not achieved. A student may repeat one course one time. Admission will be denied to any student who received a second grade of less than C+ (2.33). 5. Submit all official transcripts to WIU Admissions. 6. Secure letters of reference from two (2) professional references: one academic (i.e., instructor or professor) and one clinical (i.e., supervisor). 7. Provide documentation to Beu Health Center that all health requirements have been met by August 1 for Fall Semester admission or January 1 for Spring Semester admission.

Baccalaureate of Science in Nursing APPLICATION FOR ADMISSION PERSONAL INFORMATION Name: Last First Middle Initial WIU Student ID: Maiden or Previous Name: Preferred Name: Permanent Address: City: State: ZIP: Mailing Address: City: State: ZIP: E-Mail Address: Home Phone: ( ) County: Country of Citizenship: Employer: Position: Employer s Address: City: State: ZIP: Work Phone: ( ) Ext: Fax: ( ) CITIZEN STATUS U.S. Citizen Non U.S. Citizen (specify country) U.S. Permanent Resident? Yes No VETERAN STATUS Will you have completed a minimum of one year active duty in the U.S. military (check one)? Yes No If yes, submit copy of DD214 form with status of discharge. Dates of Service: From To National Guard or Reserve Duty? Yes No Start Date of Basic Training DEGREE FOCUS Please indicate your focus of study. Pre-Licensure Nursing RN-BSN Completion CLASS SITE Please rank by order of preference. Macomb Quad Cities (RN-BSN Completion Only) REGISTERED NURSE LICENSURE Please include a copy of your current RN license with this application, if applicable. All students must maintain current licensure while enrolled in the program. License Number: State: Expiration Date: LANGUAGE Indicate what your primary language: Provide evidence of English language proficiency by obtaining a satisfactory score on the Test of English as a Foreign Language (TOEFL) and successfully completing the English as a Second Language Program though WESL Institute by August 1 for fall admission. A satisfactory minimal passing TOEFL score is 560-paper based, 220-computer based, or an 83 on the internet Based Version (ibv). Only students whose native language is English are exempt from the English proficiency requirement.

PREVIOUS EDUCATION List all institutions from which degree(s) were granted. Name of Institution Location Dates Attended Degree Earned OFFICIAL TRANSCRIPT must be sent to Western Illinois University from all regionally accredited NLNAC, CCNE, or accredited college or university programs that you have attended since high school graduation. TRANSFER OF CREDIT* If you will be taking courses during the summer to complete general education and nursing support course requirements, please list them below. Please have all transcripts sent to WIU Admissions as soon after the course(s) ends as possible. All coursework should be completed by July 1. If you will be completing course(s) later than this, please let us know. Transfer for Proposed Course #/Title Institution Credits Course Ends WIU Course Office Use Only Reviewed by: Date Reviewed: Name Last First Middle Initial Date Submitted *A total of 29 credits will be transferred for licensed nurses from their associate s degree or diploma and do not need to be documented on this form. All additional courses must be cited on this form.

WORK EXPERIENCE Starting with your current position, please list your three most recent positions. Show full-time employment, including military service, summer employment, and significant part-time employment. (Even though you may attach a résumé, please complete the information on this application form.) Employer: Type of Healthcare Facility: Address: City: State: ZIP: Position: Dates Employed: From To Responsibilities: ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Employer: Type of Healthcare Facility: Address: City: State: ZIP: Position: Dates Employed: From To Responsibilities: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- Employer: Type of Healthcare Facility: Address: City: State: ZIP: Position: Dates Employed: From To Responsibilities: COMMUNITY EXPERIENCE Indicate the nonprofit, community, business, and professional organizations in which you have been actively involved. List by order of personal significance. You must provide written documentation from your supervisor for service performed. Organization Dates Role/Position

COLLEGIATE ACADEMIC AWARDS RECEIVED Indicate type of award received, date, and include documentation. Award Date WESTERN ILLINOIS UNIVERSITY ATHLETIC STATUS List any athletic team you have belonged to and include a letter from the coach. Team/Group: Dates: From: To: ADMISSION ESSAY As you complete the Educational and Professional Goals Statement, please be aware that our questions are meant to help you distinguish yourself from other applicants. The Admission, Progression, and Retention Committee reviews all applications and pays particular attention to whether the application demonstrates college-level written communication skills. Particular attention is paid to grammar, mechanics (i.e. punctuation and spelling), the logical organization of material, analysis of issues, support of positions, and clarity of thought. We encourage you to share with us some personal insights about experiences that have influenced your professional life. We consider it a privilege to read your essay and want you to know that we respect your confidentiality. Thank you. School of Nursing Admission, Progression, and Retention Committee INSTRUCTIONS Please conform to the Publication Manual of the American Psychological Association (APA) (6 th ed.) guidelines for written materials. EDUCATIONAL AND PROFESSIONAL GOALS STATEMENT Write a personal statement indicating what you expect to learn and achieve from the Bachelor of Science in Nursing Program. List educational and professional goals. Describe how the BSN degree will enhance your career plans. Project the kind of position you anticipate having five years after you earn this degree. Describe experiences you have had that form the foundation for your goals. Be specific in describing the above statements. Approximately 500 words.

RECOMMENDATIONS List the name, title, and address of the individuals from whom you have requested professional recommendations: Name: Title: Address: City: State: ZIP: Name: Title: Address: City: State: ZIP: OTHER INFORMATION How did you first hear about the Western Illinois University School of Nursing Program? Friend (name/s): Alumni (name/s): Relative (name/s): Employer (name/s): Coworker (name/s): Student (name/s): Radio commercial (station/s): Newspaper advertisement (name/s): Other: Technical College Western Illinois University Representative Internet OPTIONAL INFORMATION The following information is optional. Refusal to provide it will not subject the applicant to any adverse treatment and will not affect admission in any way. The information is requested to best meet your needs. Sex/Marital Status: Single Male Married Male Single Female Married Female Date of Birth: Place of Birth: Religious Affiliation: Ethnic Background: White Caucasian African American Native American Hispanic Asian/Pacific Islander Other I understand that I am responsible for the submission and receipt of my official degree-bearing transcripts and that Western Illinois University will accept for its permanent file only those transcripts issued directly by the registrar of institutions I have attended. Formal admission to Western Illinois University as a Bachelor of Science in Nursing degree candidate is granted only after all admission materials have been received. I certify that the information contained in this application is a true and accurate account. The essays were written solely by me, without assistance (this includes editing) from other individuals. I further authorize Western Illinois University to make appropriate inquiries when necessary to certify the accuracy of my records. I understand that falsification may result in denial of admission or dismissal from the University. If I am accepted by the Western Illinois University School of Nursing, I understand that I will be expected to abide by all University and School of Nursing rules and regulations. Signature Date

Baccalaureate of Science in Nursing CONFIDENTIAL RECOMMENDATION APPLICANT: Please print or type your name. Last First Middle Initial TO THE PERSON COMPLETING THIS EVALUATION: The person whose name appears above is applying for admission to the Bachelor of Science in Nursing Program at Western Illinois University. In our consideration of each applicant, we place particular emphasis on comments from individuals who the applicant has chosen to assess him or her. This recommendation will be used only for admission purposes; it will not be made a part of the student s educational record, and no reference will be made to it for educational purposes after a decision is final on the applicant s admissibility. Therefore, this recommendation is not subject to the provisions of the Family Educational Rights and Privacy Act of 1974. The applicant will not have access to this recommendation under that law. Name of Person Completing This Form: Organization: Position/Title: Address: Work Phone: ( ) Home Phone: ( ) How long have you known the applicant? Years: Months: During which period of time have you had the most contact with the applicant? From (month/year): To (month/year): Under what circumstances have you worked with the applicant? May we contact you regarding this applicant? Yes No DESCRIBE THE APPLICANT S ABILITY TO COMMUNICATE ORALLY AND IN WRITING. If the applicant is from a non-english-speaking country, how well does he or she understand, write, and speak English?

Rate the applicant as compared to his or her peers and note the reference group with which you are making your comparisons: ATTRIBUTES AND ABILITIES FAIR GOOD EXCELLENT UNABLE TO RATE Flexibility/adaptability Initiative Leadership potential Integrity Ability to overcome obstacles Openness to new ideas Self-confidence Analytical skills Able to work with others Goal oriented Comments: Of the attributes and abilities evaluated above, please comment on the following: 1) Applicant s area of greatest strength. 2) Areas in which applicant could use greatest development. Please indicate your overall evaluation of this applicant? Strongly Recommend Recommend with Reservation Recommend Do Not Recommend Comments: We realize that considerable time and effort is involved in preparing this evaluation, and we greatly appreciate your help. Please return this form to the applicant in a sealed envelope with your signature across the seal. The applicant will then submit the sealed, signed envelope as part of the completed application packet to the Western Illinois University School of Nursing. Signature Date

Baccalaureate of Science in Nursing CONFIDENTIAL RECOMMENDATION APPLICANT: Please print or type your name. Last First Middle Initial TO THE PERSON COMPLETING THIS EVALUATION: The person whose name appears above is applying for admission to the Bachelor of Science in Nursing Program at Western Illinois University. In our consideration of each applicant, we place particular emphasis on comments from individuals who the applicant has chosen to assess him or her. This recommendation will be used only for admission purposes; it will not be made a part of the student s educational record, and no reference will be made to it for educational purposes after a decision is final on the applicant s admissibility. Therefore, this recommendation is not subject to the provisions of the Family Educational Rights and Privacy Act of 1974. The applicant will not have access to this recommendation under that law. Name of Person Completing This Form: Organization: Position/Title: Address: Work Phone: ( ) Home phone: ( ) How long have you known the applicant? Years: Months: During which period of time have you had the most contact with the applicant? From (month/year): To (month/year): Under what circumstances have you worked with the applicant? May we contact you regarding this applicant? Yes No DESCRIBE THE APPLICANT S ABILITY TO COMMUNICATE ORALLY AND IN WRITING. If the applicant is from a non-english-speaking country, how well does he or she understand, write, and speak English?

Rate the applicant as compared to his or her peers and note the reference group with which you are making your comparisons: ATTRIBUTES AND ABILITIES FAIR GOOD EXCELLENT UNABLE TO RATE Flexibility/adaptability Initiative Leadership potential Integrity Ability to overcome obstacles Openness to new ideas Self-confidence Analytical skills Able to work with others Goal oriented Comments: Of the attributes and abilities evaluated above, please comment on the following: 1) Applicant s area of greatest strength. 2) Areas where applicant could use greatest development. Please indicate your overall evaluation of this applicant? Strongly Recommend Recommend with Reservation Recommend Do Not Recommend Comments: We realize that considerable time and effort is involved in preparing this evaluation, and we greatly appreciate your help. Please return this form to the applicant in a sealed envelope with your signature across the seal. The applicant will then submit the sealed, signed envelope as part of the completed application packet to the Western Illinois University School of Nursing. Signature Date

Baccalaureate of Science in Nursing TEAS V TEAS V INSTRUCTIONS Each pre-licensure applicant to the School of Nursing must take the Test of Essential Academic Skills (TEAS ) V. The TEAS V consists of four sections: mathematics, reading, science, English and language usage. A review of basic concepts and theories in each area is recommended. ATI has two products, the TEAS V Study Manual and a TEAS V Online Practice Assessment, available to guide your review and provide feedback about your study progress. Order online at atitesting.com. There is no set passing score for the TEAS V at WIU; applicants will be awarded points based on their score. These points will be used with other points to determine admission. Only the first TEAS V score will be used to determine the number of points for each student. The TEAS V will be offered at WIU. Check our website for dates and location at www.wiu.edu/nursing. You can register to take the test at www.atitesting.com. This test fee is $30 - $35 and will be paid directly to ATI (Assessment Technologies Institute). If you have taken the TEAS V at another location, your TEAS V results can be sent to any nursing school. You can request that ATI electronically transmit your results to a school for a small fee. Just go on the ATI website and have them sent to Western Illinois University.