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RN TO BSN PROGRAM

RN to BSN PROGRAM APPLICATION

This application is for students who desire to begin the Wichita State University School of Nursing's RN to BSN Professional Phase Coursework. 


Choose Starting Semester:   Fall 2014     Spring 2015


PART 1: PERSONAL INFORMATION

myWSU ID#: 

Date of Birth (DD/MM/YYYY)

First Name: 

Middle Name: 

Last Name: 

Gender:  Male Female

Current Address: 

City: 

State (use two-letter abbreviation): 

Zip Code: 

Email Address: 

Home Phone: 

Cell Phone: 

What is the best time of the day to contact you regarding advising, enrollment, progress and coursework throughout the program?
8 a.m. to Noon
Noon to 5 p.m.
5 p.m. to 7 p.m.
Any time 


PART 2: EDUCATION

College/University where Associate Degree in Nursing was earned:

Date degree was earned: 


Have you passed the NCLEX?  Yes No

If yes, date was the NCLEX taken? 

If no, date NCLEX is anticipated: 


List all Colleges, Universities or Vocational Schools you have attended:

NOTE: You will need to submit transcripts to the WSU RN to BSN Program.  Hard copies or secure digital downloads will be accepted.

Mailing Address: WSU RN to BSN Program, 1845 Fairmount, Box 41, Wichita, KS 67260-0041
Email: RNtoBSN@wichita.edu


PART 3: PROFESSIONAL EXPERIENCE

Has it been more than five (5) years since you graduated?   Yes No 

If yes, the program requires more than 1,000 hours in the past three (3) years. List your employers and employment dates below:


Agency 1: 

Employment Dates:  


Agency 2: 

Employment Dates:  


Agency 3: 

Employment Dates:  


NOTICE OF NONDISCRIMINATION: Wichita State University does not discriminate in its programs and activities on the basis of race, religion, color, national origin, gender, age, sexual orientation, marital status, status as a Vietnam Era Veteran or disability.

The following person has been designated to handle inquiries regarding nondiscrimination policies:

Director, Office of Equal Employment Opportunity
Wichita State University
1845 Fairmount, Wichita, KS 67260-0145
(316) 978-3371.