COLLEGE OF HEALTH AND HUMAN SERVICES
SCHOOL OF NURSING
UNDERGRADUATE
APPLICATION FOR ADMISSION
Name
(Last) (First) (Middle/Maiden) (Mr. Mrs. Ms.)
Red ID (if applicable) Email
Permanent Address
Phone
Current Address
Phone
Cell Phone ____________________________
Indicate below who should be notified in case of emergency:
Name Phone
Address City State Zip
*Any change to the above information must be sent immediately to the School of Nursing as well as SDSU.
I. Please fill out the following high school information:
High School Attended
Address
Year Awarded
Diploma
Year Awarded
GED
II. 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.
Institution
Dates of
Attendance
Declared Major
Degree:
Date Received
1.
2.
3.
4.
5.
5
III. List the prerequisite courses you are completing this semester or quarter.
Course Number
Course Title
Where Enrolled
1.
2.
3.
4.
IV. Writing Competency Requirement:
How was requirement met? ____________________________________________________
V. Foreign Language Education/Bilingual Ability:
Have you taken two or more years/semesters of a foreign language in HS/College? ________
(Must be demonstrated by transcripts for points)
Are you able to converse in a language other than English?
(Must be demonstrated by letter on letterhead for points)
VI. Have you ever been in the military?
I verify that to the best of my knowledge, all information given in this application is true and complete.
Signature Date
Rev. 10/05 6
STATISTICAL INFORMATION
The School of Nursing is routinely requested to proved profile information about students who are accepted and/or apply to the program. This information is not considered as part of the application nor will it be used in determining your admission status. Although the information request is OPTIONAL, we would appreciate your cooperation in completing this questionnaire.
Name Red ID (if applicable)__
Current Address
Phone Number
Permanent Address
Phone Number
Birth date Marital Status No. of Children
Name of Spouse His/Her Occupation
Previous Health Care Experience:
Positions of Employment in the last five years:
Ethnic Background:
American Indian Asian White
African-American SE Asian Other/Not Stated
Mexican-American Pacific Islander International
Other Hispanic Filipino
Financial Assistance Needed: Yes No
College/University currently enrolled: _
Signature Date
Rev. 10/05