Bachelor of Science in Nursing
Supplemental BSN Admissions Application
For Licensed RNs Only
Complete and return this form to the UH Hilo Admissions Office, Office of Student Services, 200 W. Kawili St., Hilo, HI 96720-4091 by 4:00 PM on the deadline date: January 15 for Fall entry, or the next work day. Applicants will be notified by the UH Hilo BSN Department via their primary email address in March regarding admission decisions. All forms related to this application can be found at or at the UH Hilo Admissions Office.
PERSONAL DATA
Name______SS#/Student ID______
last first middle
Local Mailing Address______Zip Code______
P O Box/Street City State
Permanent Address______Zip Code______
P O Box/Street City State
Phone Number:______(H)______(W)______(C)
Email Address: Primary______Secondary______
Are you a resident of the State of Hawaii? Yes_____ No_____ If not, state of residency______
Ethnic Group______Gender: ____Male ____Female
(Admission to the Nursing Program is non-discriminatory. These questions are asked since various laws require statistical reports on ethnic origins of students.)
APPLICATIONS: Any out-of-state or non-UH Hilo student applicants MUST submit a common UH Hilo Application for Admission into UH Hilo itself BEFORE submitting this Supplemental BSN Admission Application for admission into the BSN program. IMPORTANT: For applicants who have attended other UH system campuses, UH Hilo must be listed as the primary campus. Only official transcripts submitted to the UH Hilo Admissions Office will be used for nursing admission decisions.
COMPLETION OF PREREQUISITE COURSES: All prerequisite courses must be completed prior to starting the nursing program. Applicants should perform a self-assessment using the BSN Basic Advising Checklist (available to download from the “forms” link on the nursing website) and attach a copy to this application. Note: RNs should have all prerequisite courses completed to qualify for admission into the upper-division nursing program.
LETTERS OF RECOMMENDATION:Two (2) letters of recommendation are required for each applicant. Letters should be from teachers or immediate supervisors who have no familial relationship with the applicant and can give a first-hand account of the student’s abilities. Letters must be attached to this application. Letters of Recommendation may not be from a UHH School of Nursing Faculty member. Letters may be placed in a sealed and signed envelope for confidentiality, if preferred.
NURSE LICENSE: A copy of an active and unencumbered State of Hawaii RN license must be attached.
UH NURSING FACULTY ADVISING: Applicants should obtain academic counseling from a UH Hilo Nursing faculty adviser regarding their qualifications for admission within one semester prior to submitting the application. Applicants in Distance Learning remote sites should contact the University Center Counselor on their island. Please indicate the following:
Name of University Center Counselor:______Date of last contact:______
Name of UH Hilo nursing faculty adviser:______Date of last contact:______
PRIOR NURSING PROGRAM
Name of School______Degree/Certificate: ____AND ____Diploma*
Year Graduated______
School accredited by the National League of Nursing Accrediting Commission (NLNAC)____Yes ____No
If your nursing school is not NLNAC accredited, see below*
*Graduates of diploma schools of nursing and non-NLNAC accredited ADN schools of nursing are required to take the NLN ACE II Tests, which include three tests 1) Adult Care; 2) Childbearing and Care of Child; 3) Client with Mental Disorder and pass all three of those tests with at least 70% of the questions answered correctly in order to obtain college equivalency credits.
NURSING EXPERIENCE: Acceptance to the RN to BSN Program does not require applicant having actually worked as a licensed RN. Acceptance to the RN to BSN Program does require the applicant having a current and unencumbered state of Hawaii RN license for the duration of the RN to BSN Program.
STATEMENT OF INTEREST
1. How do you think a BSN degree will enhance or increase your employment opportunities; educational opportunities?
2. Since graduating from your basic nursing program have you been working as a professional nurse and if so, in what areas? Are there any specialty areas of nursing you are considering for future employment?
Bachelor of Science in Nursing
Letter of Recommendation
Letters should be from teachers or immediate supervisors who have no familial relationship with the applicant and can
give a first-hand account of the student’s abilities.
______
Applicant’s Name: Last, First, Middle Initial Student ID Number
______
Mailing Address: P O Box/Street, City, State, Zip Code Email address
APPLICANT: Please check and sign in accordance with the Family Educational Rights and Privacy Act of 1974.
I ( ) herby waive ( ) do not waive my right of access to this letter of recommendation.
Applicant’s signature______Date______
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
TO WRITERS OF LETTER OF RECOMMENDATION:
We are particularly interested in the applicant’s ability to pursue nursing coursework and maintain successful academic standing in the Baccalaureate Nursing Program. Please mail the completed form to applicant named above. You may submit your Letter of Recommendation by placing the letter in a sealed, signed envelope. Please return this Letter of Recommendation so that the applicant can submit this application by the deadline of January 15.
- Rate the applicant on each of the following items, using a five-point scale:
5-truly outstanding (top 10%); 4-superior; 3-above average; 2-average; 1-below average; N-inadequate knowledge to rate.
( ) Critical Thinking ( ) Writing ability
( ) Interpersonal Skills ( ) Oral expression
( ) Motivation and drive ( ) Emotional maturity and stability
( ) Scholarship( ) Self-reliance and independence
- How comfortable would you be with this applicant being your nurse? (Circle your choice.)
Very comfortableSomewhat comfortableneutralnot comfortable
- (Optional) Using a separate page or the back of this form, please express in your own words your assessment of the applicant’s particular qualifications for nursing. Briefly indicate the time period and nature of your contact with this applicant.
Date______Type Name______
Institution______Signature______
Address______Title______
Contact phone number(s) ______
Relationship to Applicant ______
Bachelor of Science in Nursing
Letter of Recommendation
Letters should be from teachers or immediate supervisors who have no familial relationship with the applicant and can
give a first-hand account of the student’s abilities.
______
Applicant’s Name: Last, First, Middle Initial Student ID Number
______
Mailing Address: P O Box/Street, City, State, Zip Code Email address
APPLICANT: Please check and sign in accordance with the Family Educational Rights and Privacy Act of 1974.
I ( ) herby waive ( ) do not waive my right of access to this letter of recommendation.
Applicant’s signature______Date______
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
TO WRITERS OF LETTER OF RECOMMENDATION:
We are particularly interested in the applicant’s ability to pursue nursing coursework and maintain successful academic standing in the Baccalaureate Nursing Program. Please mail the completed form to applicant named above. You may submit your Letter of Recommendation by placing the letter in a sealed, signed envelope. Please return this Letter of Recommendation so that the applicant can submit this application by the deadline of January 15.
- Rate the applicant on each of the following items, using a five-point scale:
5-truly outstanding (top 10%); 4-superior; 3-above average; 2-average; 1-below average; N-inadequate knowledge to rate.
( ) Critical Thinking ( ) Writing ability
( ) Interpersonal Skills ( ) Oral expression
( ) Motivation and drive ( ) Emotional maturity and stability
( ) Scholarship( ) Self-reliance and independence
- How comfortable would you be with this applicant being your nurse? (Circle your choice.)
Very comfortableSomewhat comfortableneutralnot comfortable
- (Optional) Using a separate page or the back of this form, please express in your own words your assessment of the applicant’s particular qualifications for nursing. Briefly indicate the time period and nature of your contact with this applicant.
Date______Type Name______
Institution______Signature______
Address______Title______
Contact phone number(s) ______
Relationship to Applicant ______
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