APPLICATION FOR UNDERGRADUATE AND
B.S. NURSING PROGRAM

  
  Complete the form and click next at end of form (no application fee required)
 
Double check all spelling and be as complete as possible.   
 
 

Personal Data
Your Full Legal Name:
  
  Last Name (Family Name or Surname) First Name Middle Name Suffix
  
  First Name you prefer to be called Previous Last Name(s) Title

Date of Birth:      Gender:   Male     Female
  Month Day Year  

U.S. Social Security Number:   
     (This is a secure server, your personal information will be safe)

E-Mail Address:      FAX number:   
 (If available)  (If available)

Home Address:
 
 Number and Street City State Zip Code Country (if not USA)

Phone Numbers:  
   Home Phone Cell Phone (if available) Work Phone (if available)

Temporary Address: (if different from Home Address)
 
 Number and Street City State Zip Code Country (if not USA)

Temporary Phone Number: (if different from Home Phone)         Date you are leaving this address:  
 MonthDayYear


Your Religion:  

Nation of Citizenship:           Nation of Birth:  
 If you are not a U.S. Citizen, indicate your U.S. Immigration Status:
     Non-Resident Alien/Foreign Student
     Permanent Resident with Green Card
     Other    

Ethnicity:
 Check which one applies. Your response is voluntary and will be used in a nondiscriminatory manner consistent with applicable civil rights laws
  Black or African American Native American or Alaskan Native Asian or Pacific Islander
  Hispanic White/Caucasian Other/Unknown


Academic Information
When do you wish to start your attendance?   

Have you applied to Southwestern Adventist University Nursing program before?     Yes     No

Housing Plans:    Dormitory     Off-Campus Housing

Financial Aid:
  Will you be applying for Financial Aid?   (U.S. Citizens and U.S. Residents may be eligible for Financial Aid)   Yes     No
  Will you be applying for benefits under the G.I. Bill?   (U.S. veterans and dependents) Yes     No

What is your license status? 
  None
  enrolled in an LVN program     when will it be completed?     
 MonthYear
  currently licensed as LVN when did you receive licensure?     
 MonthYear
 how long have you worked as an LVN?
 Years
  enrolled in an RN program     when will it be completed?     
 MonthYear
  currently licensed as RN when did you receive licensure?     
 MonthYear
 how long have you worked as an RN?
 Years

WHich one of the following academic classifications best applies to you at this time?
  Not Graduated from High School
  Graduated from High School, no college credit earned
  College Freshman (1−12 sem hrs)
  College Freshman (13−23 sem hrs)
  College Sophomore (24−55 sem hrs)
  College Junior (56−89 sem hrs)
  College Junior (56−89 sem hrs) with a previously earned two-year college degree
  College Senior (90+ sem hrs)
  College Senior (90+ sem hrs) with a previously earned two-year college degree
  Already have a four-year college degree

Indicate the tests you have taken:   (Check all that apply)
  SAT (Scholastic Aptitude Test) ACT (American College Test)
  CLEP (College Level Exam Program) GED (General Education Development)
  Michigan Test of English TOEFL (Test of English as a Foreign Language

High School (Secondary Education Level)
 Name of High School (whether you graduated or not):
      
     City       State or Country
 Which of the following best applies to you?
  Graduated from High School Year:  
  Will graduate from High School Year:  
  Passed the GED or a state high school equivalency test   Year:  
  Will take the GED or a state high school equivalency test   Year:  
  Will not complete High School nor take GED  

List each College or University you have attended   (List each school one time only):
 
 School City State or Country Degree(s) earned Dates of attendance
 
 School City State or Country Degree(s) earned Dates of attendance
 
 School City State or Country Degree(s) earned Dates of attendance
 
 School City State or Country Degree(s) earned Dates of attendance
 
 School City State or Country Degree(s) earned Dates of attendance
 
 School City State or Country Degree(s) earned Dates of attendance

Please ask all Colleges and Universities you have attended to send official transcripts to:

Admissions Office
Southwestern Adventist University
Keene, TX 76059

If you have completed less than 12 college hours, we will also need an official transcript from the last High School you attended.
If you took the GED, then we will also need an official GED Test Report


Personal Conduct
  In High School or College have you been placed on probation for disciplinary reasons?   Yes No
  In High School or College have you been suspended for disciplinary reasons? Yes No
  In High School or College have you been dismissed for disciplinary reasons? Yes No
 
  Have you been convicted of a misdemeanor? Yes No
  Have you been convicted of a felony? Yes No
         If you have been incarcerated, last release date:    
  Month Year
 
  Have you used tobacco in the past six months? Yes No
  Have you used alcohol in the past six months? Yes No
  Have you used drugs in the past six months? Yes No

If you answer YES to any of these questions in this section, you need to explain in the space below (what/why/when/where,etc). Include a statement of your goals for the future:
  


Work Experience
Describe the last two positions you held:
 
  Position or type of work Employer Dates
 
  Position or type of work Employer Dates


Previous Nursing Experience
Describe all of your health-care related experiences:   (Provide description as well as approximate length of time)



Goals
Describe your professional health-care related goals:



References
Please obtain three professional references from teachers, employers, or supervisors.
 
  Name Address Phone
 
  Name Address Phone
 
  Name Address Phone



Student Pledge

By electronically submitting this application, I certify that the above statements are correct and complete.   I understand that incomplete or false information may make me ineligible for admission to or continuation at Southwestern Adventist University.