Education Form Renderer

Anonymous

RN-BSN

PROGRAM APPLICATION

The University of Pikeville RN-BSN completion program is accredited by the Accreditation Commission for Education in Nursing (ACEN), 3343 Peachtree Road NE, Suite 850, Atlanta, Georgia 30326; telephone 404-975-5000; www.acenursing.org.

Completion of this nursing program application is one of the admission criteria to University of Pikeville’s RN-BSN completion program. Please refer to RN-BSN Applicant Checklist for a complete list of admission criteria to submit by the application deadline. All requirements for the RN-BSN must be completed within five years of admission.

APPLICATION DEADLINE: August 1, 2024 (for Fall admission) and December 10, 2024 (for Spring admission)

Fields with * are required.

Semester/year applying for: * Fall 2024
Spring 2025
Other
Do you wish to attend full-time or part-time? * Full-time
Part-time
Last 4-digits of SSN: *
Date of Birth (mm/dd/yyyy) *
First Name: *
Middle Initial:
Last Name: *
Maiden Name:
Address Line: *
City: *
State: *
Zip: *
Home phone number (999-999-9999): *
Mobile phone number (999-999-9999): *
Text (999-999-9999):
E-mail: *
Person to be notified in case of emergency: *
What is your relationship to emergency contact: *
What is the preferred number for emergency contact (999-999-9999): *
List in order of attendance, those institutions from which a degree was obtained, including high school (or GED), vocational school, college, and universities. Also include coursework taken after RN licensure.
Name of Institution 1: *
Dates Attended Institution 1: *
Degree Obtained at Institution 1: *
Name of Institution 2: *
Dates Attended Institution 2: *
Degree Obtained at Institution 2: *
Name of Institution 3:
Dates Attended Institution 3:
Degree Obtained at Institution 3:
Current or most recent employer: *
Dates employed at current or most recent employer: *
Type of RN position at current or most recent employer: *
RN Licensure Number: *
State of current RN licensure: *
Do you have RN licensure in another state: * Yes
No
If yes, list them:
Do you have any certifications other than CPR (i.e., ACLS; PALS; CCRN; etc.): * Yes
No
If yes, list them:
State clearly, in the space provided below, the key reason and meaning for why you want to be a RN with a Bachelor of Science degree.

a. For what reasons do you want to earn a Bachelor's Degree in Nursing? What meaning does it hold for you? *
State clearly, in the space provided below, the key reason and meaning for why you want to be a RN with a Bachelor of Science degree.

b. List top two concerns you have about returning to school for your RN-BSN degree. *

This form will be submitted anonymously