Western Illinois University School of Nursing

Western Illinois University School of Nursing APPLICATION FOR ADMISSION Baccalaureate of Science in Nursing RETURN RN THIS FORM FORM WITH TO$30 APPLICATION FEE 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 and the application fee of $30 2. Educational and Professional Goals Statement 3. Documentation of Community Service 4. Documentation of veteran status 5. Two Confidential Recommendation forms (see enclosed) from professional colleagues who have worked with you a minimum of three years 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. 6. Send Transcript Request Form to 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 registrar s office in a sealed envelope. (Schools generally charge $1 to $5 for this service.) 7. Copy of current Illinois Registered Nurse License, if applicable 8. 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 Basic 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 (TEAS). 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 with the Application for Admission. WARD reports are acceptable for WIU students. 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 Beu Health Center that all health requirements for the School of Nursing have been met by August 1 before Fall Semester admission. Health requirements may be 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. Students will be considered pre-nursing until all the general education and support course requirements are met. Admission to pre-nursing does not guarantee admission to the major. 2. Submit a current copy of the Illinois License as a Registered Nurse. 3. Students must 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 with the Application for Admission. Failure to submit all postsecondary transcripts will result in a denial of admission. 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. Health requirements may be different from the standard University requirements. (Students are responsible for all costs incurred for admission as well as ongoing health requirements.) See form for a complete list of requirements. 8. Provide documentation to the School of Nursing that all safety requirements have been met by July 1 for Fall Semester admission and January 1 for Spring Semester admission. (Students are responsible for all costs incurred for admission as well as ongoing safety requirements.) See form for a complete list of 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 a random drug screen every semester thereafter. Applicants with a felony conviction or a positive drug screen may be denied entry into the clinical facility for clinical practice.

Baccalaureate of Science in Nursing APPLICATION FOR ADMISSION PERSONAL INFORMATION Name: Last First Middle Initial Social Security Number: Maiden or Previous Name: Preferred Name: Permanent Address: City: State: ZIP: Home Phone: ( ) County: Employer: Position: Employer s Address: City: State: ZIP: Work Phone: ( ) Ext: Fax: ( ) E-Mail Address: Country of Citizenship: 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 Illinois licensure while enrolled in the program. Illinois License Number: Expiration Date: 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* This section must be completed for coursework from other institutions to be considered for transfer in lieu of bachelor s degree requirements at Western Illinois University. Credits earned prior to admission but not reported on this form will not be considered for transfer after admission. Official syllabi/course descriptions must be provided upon request. Not more than 9 semester credits will be accepted in transfer. Transfer credits must meet these criteria: (1) completed less than five years ago (however, the school reserves the right to deny transfer of credit for courses in which the content or practice has significantly changed in the last three years), (2) graded C+ or above, (3) pass/fail courses are not acceptable, (4) earned at NLNAC or CCNE accredited institutions, (5) accepted as bachelor s degree credit at granting institution, (6) equivalent to Western Illinois University course, and (7) appropriate for the student s proposed program. I am requesting the following courses be accepted in transfer and have requested official transcripts to be sent directly to Western Illinois University. I understand that I may be required to provide course syllabi/description as needed. Transfer for Proposed Course #/Title Institution Credits Grade Date Completed WIU Course Office Use Only Total Number of Credits Proposed to Transfer: (A maximum of nine credits may be accepted.) Reviewed by: Date Reviewed: Name Last First Middle Initial Date Submitted *A total of 32 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

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 to consider two specific areas: 1. Does the application demonstrate 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. 2. Has the applicant participated in community service activities? Has the community service positively contributed to the well-being of others in need? 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) (5 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 answering the above questions. 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 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 FAIR GOOD EXCELLENT UNABLE TO RATE 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 Recommend with Reservation 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 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 FAIR GOOD EXCELLENT UNABLE TO RATE 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 Recommend with Reservation 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 TRANSCRIPT REQUEST FORM Please send one (1) official transcript to Western Illinois University School of Nursing Waggoner Hall 339 1 University Circle Macomb, IL 61455-1390 Please send additional copies to student: Y es No Number of Copies: Name: Address: City: State: ZIP: Social Security Number: Date of Birth: Last Year of Attendance: Name on Transcript If Different from Above I have enclosed a processing fee of $ per transcript. Signature Date ----------------------------------------------------------------------------------------------------------------------------------------------------------------- Baccalaureate of Science in Nursing TRANSCRIPT REQUEST FORM Please send one (1) official transcript to Please send additional copies to student: Western Illinois University Yes No School of Nursing Waggoner Hall 339 Number of Copies: 1 University Circle Macomb, IL 61455-1390 Name: Address: City: State: ZIP: Social Security Number: Date of Birth: Last Year of Attendance Name on Transcript If Different from Above: I have enclosed a processing fee of $ per transcript. Signature Date

Baccalaureate of Science in Nursing TEAS TEAS INSTRUCTIONS Each applicant to the School of Nursing must take the Test of Essential Academic Skills (TEAS ). The TEAS 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 Study Manual and a TEAS 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 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 score will be used to determine the number of points for each student. The TEAS will be offered at WIU. Please call (309) 298-2571 to schedule your TEAS testing. This test fee is about $30 and will be paid directly to ATI (Assessment Technologies Institute). Bring a current credit card to the test session. Check our website for possible test dates and times at www.wiu.edu/nursing/admissions. If you have taken the TEAS at another location, your TEAS 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.