Basic BSN

Non-Freshman AdmissionApplication

Spring 2018

Instructions:Read all information carefully and fill out the form completely(must be typed).

The application file is set up in a table format to make typing/entry of information easier.

Application packet must be received by September 1, 2017.
(Postmarks by the deadline are not considered as meeting the application deadline.)
Personal Data
Full Legal Name / Last Name / First Name / Middle Name
Other names used if different from above. / Last Name / First Name / Middle Name
UW ID Number(W-ID #) / Social Security Number / Date of Birth(MM/DD/YYYY) / Gender(place X in box)
Female / Male
Marital Status / Ethnic Background(voluntary information)(place X in box)
Date of Birth (YYYY/MM/DD)
Gender (place X in box)
(place X inbox) / American Indian or Alaska Native / Asian American or Pacific Islander
Single / Black or African American / Chicano or Hispanic
Married / Other / White or Caucasian
Email Addresses / UW Email Address / Non-UW Email Address
Current Mailing Address / Street/Box
City / State / Zip Code
Permanent Mailing Address / Street/Box
City / State / Zip Code
Phone Numbers / Cell Phone
(include Area Code) / Current Phone
(include Area Code) / Permanent Phone
(include Area Code)
High School Information
Name of High School from which Graduated / City/State Located
Residency and Tuition Status
State of Legal Residence / Identify Tuition Status Assessed at UW (Resident, Non-Resident, etc.)

Basic BSN Non-Freshman AdmissionApplication – Spring 2018Fay W. Whitney School of Nursing

Page 1 of 2University of Wyoming / College of Health Sciences

Dept 3065 / 1000 E University Ave / Laramie WY 82071 / (307) 766-4292

Pre-Clinical Course Data
Complete the appropriate Pre-Clinical Course Data Verification Form linked on the nursing website within the Non-Freshman Admission page under the Application Packet heading. Submit completed form with application.
Education Data
Complete the following information, in order of attendance, for ALL colleges/universities previously attended and currently attending including the University of Wyoming.
Official transcripts must be on file with the university from each individual school attended and be accessible by FWWSON as noted within the application directions. The FWWSON has access to UW records.
Refer to the Official Grades / Transcripts section on page 2 of the Basic BSN Non-Freshman AdmissionApplication Packet Directions document for full details.
Colleges/Universities
City/State / Please List Dates of Attendance
(first term and last term attended) / Degree Received
(if applicable)
to
to
to
to
to
Honesty Statement
Honesty Statement:
The University of Wyoming is built upon a strong foundation of integrity, respect, and trust. All members of the University community have a responsibility to be honest and the right to expect honesty from others. Any form of academic dishonesty is unacceptable to our community and will not be tolerated.
Certifying Statements & Signature
** Important **
Applicant’ssignaturebelow is required for application to be considered complete (typing/printing name is not considered as the signature).
Certifying Statements:
By signing below, I certify…
  • that I am aware and understand the Honesty Statement mentioned above.
  • that any attempt on my part to falsify answers or exclude pertinent data is cause for rejection of my application and/or dismissal from the program.
  • that all information I have provided is true/accurate to the best of my knowledge.
  • that all admission requirements are complete, submitted/received and/or are accessible for online verifications as noted within the application directions.

** Applicant’s Signature

Date

UW is an affirmative action/equal opportunity educational institution.

Basic BSN Non-Freshman AdmissionApplication – Spring 2018Fay W. Whitney School of Nursing

Page 1 of 2University of Wyoming / College of Health Sciences

Dept 3065 / 1000 E University Ave / Laramie WY 82071 / (307) 766-4292