Text Box: Date Received by
Received by____________


                    California State University, Bakersfield


                                                                Department of Nursing


                                   Application to the Fall Quarter 2007

                                                Generic BSN Program


                                  Winter 2008 Accelerated Progams if offered                                                    


Before sending, please make a copy of this application for your records.  This application can not be emailed to CSUB Department of Nursing. Please mail or hand carry the application to:

CSUB Department of Nursing

29 RNC

9001 Stockdale Hwy

Bakersfield, CA 93311

Applicants that currently do not attend CSU Bakersfield are required to pay a $25.00 nursing application processing fee. Please attach your personal check to the application.  For Fall 2007 entry, the filing period for Nursing applications is January 15 to May 1, 2007.  Prospective students are eligible to apply for admission to the Department of Nursing when they have completed, or will complete all prerequisites by June 15, 2007.  All applicants must submit a complete application packet which includes a completed application form, official transcripts for each college or university attended (excluding CSU Bakersfield), backup documentation if claiming veteran status, disadvantaged background, work in health care or volunteer work and two self-addressed, stamped envelopes. 

** Please print or type            


SSN:_______________________  CSUB Campus ID:______________________



                (Last)                                      (First)                                           (Middle)                    (Alias/Maiden)



                                (Number & Street)                                                (City)                      (State)                     (Zip)


Mailing Address if Different:


                                (Number & Street)                                                (City)                      (State)                       (Zip)


Home Phone: (     ) _____________________       Cell Phone: (     )__________________________________


Email Address:____________________________________________________________________________


(1.) CSUB Enrollment

Check your status at the time of application (check all that apply)

¨  A student already enrolled at CSU Bakersfield with units completed on this campus.

¨  Newly enrolled student at CSU Bakersfield beginning:

¨      Winter 2007

¨      Spring 2007

¨      Fall 2007


                  Approximate date you applied to CSUB:_______________________

¨  A post-baccalaureate student   Major_____________Date of Degree_______






CSU Bakersfield Application to the Generic BSN Program


(2.) Colleges/Universities Attended

List in chronological order all colleges and universities you have attended, beginning with the school where you are currently enrolled. Give locations of each institution, the dates of your attendance and, if appropriate, the date of your graduation.


Dates of Attendance

Declared Major


Date Received


















(3.) Residency

3a. Country of Citizenship:_________________________________________

(If you are not a citizen of the United States you must attach a photocopy of both sides of your Alien Registration Card and/or INS documentation.  Students under 19 years old must attach their parent’s INS documentation).


3b. Are you a legal California resident?                           _______Yes                         ________ No


3c. Permanent Resident of _________________County in the State of__________


(4.) Demographic Information –This section is optional and not used in selecting students for the program


4a. Date of Birth:______________________________


4b. Birthplace:_________________________________________________________


4c. Ethnic Background:

_____American Indian

_____Pacific Islander




_____South Eastern Asian




_____Other Hispanic

_____Decline to State



4d.           Gender   :                                               ___________Male                             ___________Female


(5.) Proficiency Level in Target Language

“All applicants whose native language is not English and who have not attended schools at the secondary level or above for at least three years full time where English is the principle language of instruction must present a score of 550 or above on the Test of English as a Foreign language (TOEFL)”.  The computer based TOEFL score is 213 or better (CSUB 2005-2007 Catalog, p. 25).  In addition, the Department of Nursing requires that applicants whose native language is not English take the Test of Spoken English (TSE) and achieve a minimum score of 50 or better.


5a.           TOEFL score:_____________         5b.           TSE score:________________


(6.) Military Service

Active Military_____ Yes _____No       Military Veteran_____ Yes _____No      Discharge Date:__________


(7.) Disadvantaged Background

7a. Educationally or Environmentally Disadvantaged Definition: “An individual from a disadvantaged background is defined as someone who comes from an environment that has inhibited the individual from obtaining the knowledge, skill and abilities required to enroll in and graduate from a school.  Some of these environmental background factors could include, migrant family, rural community, receiving welfare, large family, parents divorced, first to attend college, English as a second language, cultural inculcation, ie., residence on a reservation, migrant camp” (HHS).  If you consider yourself disadvantaged, please write a brief statement in the space below as to why you are disadvantaged.  If needed, attach an additional sheet of paper to the back of this application.




CSU Bakersfield Application to the Generic BSN Program


7b.Economically Disadvantaged Definition: “…comes from a family with an annual income below a level which is based on low-income thresholds according to family size published by the US Bureau of the Census, adjusted annually for changes in the Consumer Price Index, and adjusted by the Secretary of Health and Human Services (HHS) for adaptation to this program.”


To determine if a student comes from an economically disadvantaged background, a school must use the student’s parental income (regardless of independent/dependent or marital status). If your parents’ income is below that listed for the size of your family, you may be considered economically disadvantaged.

      Size of Parent’s family                                                   Income Level

1                                                                                             $19,140

2                                                                                             $25,660

3                                                                                             $32,180

4                                                                                             $38,700

5                                                                                             $45,220

6                                                              $51,740

7                                                              $58,260

8 or more                                                $64,780


Can provide evidence of being economically disadvantaged  _____Yes  _____No  If yes, attach a copy of the top two pages of your parent’s last year’s tax returns to the back of this application.


(8.) Health Care Work Experience

Have you had any experience working in health care?  _____Yes  _____No  

If yes, please complete the following section.



Organization’s Name and Address







Total Hours





Duties Performed



Phone #















(9.) Community Service/Volunteer Experience

Have you performed community service or volunteer work?  _____Yes  _____No  

If yes, please complete the following section.



Organization’s Name and Address







Total Hours





Duties Performed



Phone #
















(10.) Assessment Technologies Institute (ATI) Test of Essential Academic Skills (TEAS)- CSUB does not require that the TEAS test be taken prior to or during the application process. If not already taken, upon entry into the nursing program, all students are expected to complete the Assessment Technologies Institute (ATI) Test of Essential Academic Skills (TEAS).  If not completed on or before entry, the student will not be eligible to continue in the nursing program cycle.


Have you taken the TEAS? ______Yes _____No     If yes, please have ATI forward a copy of your test results to Kathy Lewis at




CSU Bakersfield Application to the Generic BSN Program


(11.) Nursing Prerequisite and Cognate Classes

Prior to applying to CSUB’s nursing program, applicants must have completed at least 5 of the 9 prerequisites by January 15, 2007.  No more than two prerequisite courses may be repeated once.  A minimum GPA of 2.8 in the nine prerequisites is required for application to this program.  In addition, a minimum GPA of 2.8 is required in the science and math classes.  Please complete the form that follows.  DO NOT wait until all prerequisite courses have been completed.  Prerequisites must be completed and documentation of completion received by CSUB Department of Nursing no later than June 15, 2007.  No summer work will be accepted. No prerequisite box may be left blank. This is required information, even if you have already provided transcripts to the Admissions office or CSUB Department of Nursing. For students applying to our traditional three year nursing program, cognate courses may be taken during the nursing program.  If you have completed these courses please indicate that below. For students applying to any accelerated nursing program, (if offered) all thirteen courses must be completed by June 15, 2007. Include planned repeats and indicate in the grade box “IP” for work in progress during Winter/Spring 2007.               

Course Discription

When taken or planned

Institution where course or equivalent was taken

Letter grade


Course Name and Number


Quarter Units

Repeated When

Institution where course or equivalent was repeated

Letter grade



CSUB Course and #

Anatomy with Lab










BIOL 250

Physiology with Lab










BIOL 255 and BIOL 256

Microbiology with Lab









BIOL 260

*Inorganic Chemistry









CHEM 150

*Organic Chemistry









CHEM 203

Public Speaking









COMM 108

Critical Thinking/Area A3









PHIL 102 or SOCI 120

English Composition









ENGL 110










MATH 140

Cognate Course

Intro to Psychology









PSYC 100

Cognate Course

Intro to Sociology









SOC 100

Cognate Course










BIOL 370

Cognate Course

Lifespan Devel.









PSYC 210

* 5 or more-quarter units or 3 or more-semester units are required in Chemistry. May be an inorganic, organic or combination inorganic/organic chemistry course.



CSU Bakersfield Application to the Generic BSN Program


(12.) Background Information

Have you ever been convicted of a felony? _____Yes  _____No


If considered for acceptance to CSUB’s nursing program, you will be expected to submit to and pay for a criminal background check.  Final acceptance will be based on the outcome of the background check.


(13.) Confirmation of Understanding

14a. Date (today's date) of this "Intent to Major" form for Fall 2007: _____________

          I, _________________________________ understand that I may be tested during

                              (signature required)

        the first week of school to assess skills essential to nursing.  The test results will be

        used for advising and counseling purposes.  Based on test results, I may be required

        to take supplemental courses.


        I understand that it is my responsibility to complete the application and be granted  

        admission to California State University, Bakersfield and to submit all required

        materials to the Department of Nursing by the deadlines I have been given.  I verify

        that I have read and understand the information in this application packet.  I further

        verify that all information I have provided in this application is accurate, true, and

        complete.  I understand that any discrepancy can disqualify me from current and

        future consideration for admission to the Nursing Program.


                Signature: _________________________________________

Printed Name: ______________________________________

Date: _____________________________________________


14b.  I, _____________________________________________ understand that the RN

                                        (signature required)

         licensing exam (NCLEX) cannot be taken until I graduate from the program.



If applicable, please enclose these items with your application


¨  Official transcripts for all colleges and universities attended. (CSUB students do not need to send in a CSUB transcript)

¨  TOEFL results

¨  TSE results – If you have taken TEAS, you need to have ATI email copies to

¨  Military service or Military discharge documents

¨  Evidence of educationally or environmentally disadvantaged status – brief statement as to why you consider yourself educationally or environmentally disadvantaged

¨  Evidence of economically disadvantaged status – top 2 pages of your parents last year’s tax return statement

¨  Health care Experience Documentation- letter from volunteer organization or employer