Staff Evaluation of Clinical Experience, Faculty and Students

OKLAHOMA CHRISTIAN UNIVERSITY

SCHOOL OF NURSING

APPLICATION FOR THE BACHELOR OF SCIENCE IN NURSING

The School of Nursing is very interested in learning about you as a person. Your academic skills and achievements are very important to your success in our program. There are many other qualities that you may possess that would also enable you to contribute to the nursing profession. This application is your opportunity to tell us about those as well as your academic history. It is important that you answer all the questions as fully as you can. We encourage you to be open and honest in completing this form.

APPLICATION DEADLINE

FRIDAY, FEBRUARY 12, 2016 FOR CURRENT OC STUDENTS

FRIDAY, MAY 13, 2016 FOR TRANSFER STUDENTS-

Please print

PERSONAL DATA

______

LAST NAME FIRST MIDDLE SS#

LIST PREVIOUS NAMES YOU HAVE USED:

______

(LIST ANY NAMES THAT COULD APPEAR ON TRANSCRIPTS INCLUDING MAIDEN NAME)

CITIZENSHIP: Are you a U.S. citizen? YES ( ) NO ( )

If not a U.S. citizen, are you a permanent resident of the U.S.? YES ( ) NO ( )

CURRENT ADDRESS______

NUMBER & STREET CITY, STATE AND ZIP

PERMANENT ADDRESS (IF DIFFERENT FROM ABOVE): ______NUMBER & STREET CITY, STATE AND ZIP

TELEPHONE NUMBERS (INCLUDE AREA CODE):

HOME (____) ______CELL (____) ______FAX (____) ______

WORK (____) ______E-MAIL: ______

DATE OF BIRTH: ______

GENDER: MALE ( ) FEMALE ( )

Have you ever been in the military? YES ( ) NO ( ) If yes, are you on active duty? YES ( ) NO ( ) If so what is your date of discharge? ______

HAVE YOU EVER BEEN CONVICTED OF, OR PLEADED GUILTY TO, A FELONY?

YES ( ) NO ( )

IF YES, GIVE DETAILS ON A SEPARATE SHEET OF PAPER.

Note: Prior felony offenses do not automatically disqualify applicants from admission. This information will be considered along with the rest of the application. Applicants should understand, however, that their criminal history might adversely affect their ability to obtain a license to practice nursing or limit their eligibility for certain employment after graduation.

ETHNIC BACKGROUND

This information will be used in a nondiscriminatory manner consistent with applicable civil rights laws.

( ) African-American ( ) Asian ( ) Native Hawaiian/Pacific Islander

( ) Caucasian ( ) Hispanic ( ) Native American/Alaskan Native

( ) Other ______

EDUCATIONAL BACKGROUND

List below in chronological order all colleges and universities, including, Oklahoma Christian University, where you have attended or are currently attending. Include colleges, professional schools, diploma schools, college extension and correspondence enrollments. Official transcripts are required from every institution attended. FAILURE TO LIST ALL SCHOOLS AND SUBMIT OFFICIAL TRANSCRIPTS IS CONSIDERED FALSIFICATION OF RECORDS AND IS GROUNDS FOR CANCELLATION OF YOUR APPLICATION.

Name of Institution / Address / Dates Attended / Degree Received
(if applicable)

Additional institutions may be listed on a separate page if needed

PAID AND UNPAID WORK EXPERIENCES: LIST YOUR PAID AND VOLUNTEER EXPERIENCE FOR THE LAST FIVE (5) YEARS, STARTING WITH THE MOST RECENT.

Employer/Organization
Location / Supervisor
Contact Number / Position(s) Held / Dates Employed

Additional information may be listed on a separate page if needed

PLEASE RESPOND TO THE QUESTIONS FOUND ON THE FOLLOWING PAGE

PLEASE ATTACH YOUR TYPED RESPONSES TO THE FOLLOWING SHORT ANSWER QUESTIONS. Please include the number of each question, and put your name at the top of each page. Limit your answers to 250 words for each question.

1. Describe your professional, personal, or family experiences with health care or care giving.

2. Describe any activities, outside of your family, in which you actively participate to assist other people or your community?

3. What interests you about nursing as a profession?

4. Describe any efforts you have made in your selection of nursing as your career choice.

5. What are your plans after graduating from OC's School of Nursing? Explain how you came to this decision.

6. The School of Nursing is committed to building a widely diverse educational community. What would you as an individual bring to the student body in this regard?

7. The School of Nursing is also committed to building an academically excellent and science oriented educational community. What would you as an individual bring to the student body in this regard?

8. Please identify and explain academic activities and experiences (such as mission work), if any, which have contributed to your understanding of intellectual approaches to problem identification, research, and/or problem solving. (Do not include the required prerequisite science courses.)

9. Is there anything else that you would like the Nursing Admissions Subcommittee to know about you in order to understand your potential to succeed in our program, to contribute to the nursing profession, and to meet the health care needs of Oklahoma and the world?

Checklist for Application into School of Nursing

For Current OC Students

ALL the following items MUST be in your nursing file on or before FEBRUARY 12, 2016 to finalize your application.

¨ Completed Application

¨ ACT/SAT score-The nursing dept. has access to your ACT and SAT scores, unless you’ve transferred in from another school. Also, if you’ve never taken the ACT or SAT you must take the “in-house” or residual ACT exam. Contact the admissions office for dates

¨ Admission/Critical Thinking Assessment Exam (see offering dates below)

¨ TOEFL score (All students for whom English is a second language)

¨ Immunization record MMR x 2, Hepatitis B series (3 vaccines), 2 Varicella vaccinations or a positive titer are required

¨ A copy of your Health insurance card showing current dates of coverage. All applicants are required to carry personal health insurance to remain in good standing in the School of Nursing and be able to participate in clinical experiences.

¨ Background Checks are completed through Group One. Students, who are enrolled in NURS 2013 Fundamentals of Nursing, will receive an email to complete the background check. The nursing office will be able to access a copy of the completed background check.

Those students meeting admission criteria will receive a letter of “conditional acceptance” prior to the end of the enrollment period for fall 2016 classes. Please be aware that you will be required to present these items prior to your official acceptance into the program.

¨ Time Sensitive Information: 2 Step-TB screening OR chest x-ray dated AFTER June 1, 2016.

¨ CPR Card Your CPR card MUST NOT expire during your junior or senior year. The ONLY ACCEPTED PROVIDER IS THE AMERICAN HEART ASSOCIATION. The Nursing Office will arrange a CPR class to be held on campus in April each year. If possible, 2 class times will be made available for your convenience.

¨ Physical Exam completed by your current physician dated AFTER June 1, 2016. The School of Nursing has a standardized physical exam form that MUST be utilized. One is provided for you in your admission packet.

Please note that some of the items are date sensitive and can not be completed until a certain date. Please work closely with the nursing office (405-425-1920) to assure that your folder is accurate and complete. The nursing department fax number is 405-425-1925.

IMPORTANT: An approved vendor for the drug screening test (SurScan) will be on campus during a mandatory meeting (date to be announced later). Each nursing student will be required to submit to testing as part of their conditional acceptance into the School of Nursing. The cost of the required screening is approximately $40 and is paid out of the nursing fees. PLEASE NOTE: The results of the drug screening and background check will determine the students’ eligibility to continue in the School of Nursing.

-Admission/Critical Thinking Assessment Exam-

An admission/critical thinking assessment exam will be given in Heritage Plaza Room 106A on the dates below. Please choose the date that best fits with your schedule.

OC Students: Saturday, January 30th or Saturday February 6th at 8:00 a.m. in Heritage Plaza 106A.

A minimum cumulative score of 77% is required. A student may only take the admission exam twice; if you are unsuccessful the first time, you will be allowed to retake it on Saturday March 5th. This extra time will allow you time to study and prepare to retake the exam.

Please Note: Students MUST HAVE a cumulative GPA of 3.0 at the time of application submission. Students with a GPA less than 3.0 at the time of application submission will have their application reviewed following submission of spring semester grades. These students will be considered and ranked with transfer students for conditional acceptance or waitlisted on a space-available, competitive basis.

Checklist for Application into School of Nursing

For Transfer Students

All the following items MUST be received in the nursing office on or before MAY 13, 2016 to finalize your application.

¨ Completed Application

¨ Letter of Good Standing from the University you are transferring from.

¨ Hospital ID - Go to the IT department and ask to have your hospital ID made.

¨ OFFICIAL Transcripts from all attended Universities

¨ Admission/Critical Thinking Assessment Exam Receipt (see offering date below)

¨ ACT or SAT score

¨ TOEFL score (All students for whom English is a second language)

¨ Immunization record MMR x 2, Hepatitis B series (3 vaccines), 2 Varicella vaccinations or a positive titer are required.

¨ Background Check completed through Group One. You will receive an email with instructions to complete the background check. Please note a fee (approximately $45) is required by using a credit card. The nursing office will be able to access a copy of the completed background check.

Transfer students meeting admission criteria will receive a letter of “conditional acceptance” and will be notified as soon as possible. Please be aware that you will be required to present the items below prior to your official acceptance into the program.

¨ Time Sensitive Information 2-Step TB screening OR chest x-ray dated AFTER June 1, 2016.

¨ CPR Card Your CPR card MUST NOT expire during your junior or senior year. The expiration date must be no earlier than May 1 of the year you are expected to graduate. The ONLY ACCEPTED PROVIDER IS THE AMERICAN HEART ASSOCIATION.

¨ Physical Exam must completed by your current physician dated AFTER June 1, 2016. The School of Nursing has a standardized physical assessment form that MUST be utilized. This form is available on the OC web site, under the School of Nursing, Departmental Forms and one is provided for you in the application packet.

Please note that some of the items are date sensitive and cannot be completed until a certain date. Please work closely with the nursing office (405-425-1920) to assure that your folder is accurate and complete. The nursing department fax number is 405-425-1925.

Transfer Students: Admission/Critical Thinking Assessment exam will be administered on

Friday, May 13, 2016 at 9 a.m. Cost $40.00

This exam is being given on Friday, May 13th at 9:00 am in the library computer lab. This exam must be paid for prior to taking it. Please go to the Business Office in Heritage Plaza to pay for this exam. Cash, check, or money order made payable to Oklahoma Christian University is accepted. A receipt must be received in the nursing office before you can test.

**Space is limited in the library computer testing lab, so call the nursing office to reserve your seat as soon as possible**

A minimum cumulative score of 77% is required on the exam. A student may only take the admission exam twice; however the student may re-apply the following year.