Bethune-Cookman University School of Nursing Application Check List. Application period: Nov. 1 st April 16th.

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1 Bethune-Cookman University School of Nursing Application Check List Application period: Nov. 1 st April 16th. All Applicants: Step One: Complete all required pre-nursing courses. Step Two: Complete your TEAS Exam. Step Three: Complete and submit your School of Nursing Application for Admission. Transfer Students: Step One: Submit a B-CU Application for Admissions to the Office of Admissions. Step Two: Complete ALL University requirements for Admission. Step Three: Follow Steps for All Applicants. Required Documents to be Submitted to the School of Nursing: Completed School of Nursing Application TEAS Exam Results Official Transcripts from all Universities/Colleges Attended 640 Dr. Mary McLeod Bethune Blvd. Daytona Beach, FL Direct Line Fax nursing@cookman.edu Incomplete Applications will not be reviewed by Admissions Committee.

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3 School of Nursing Application Directions: Please complete this application in its entirety. Be sure to read carefully and answer every item accurately. Any false, fraudulent, or incomplete statements may result in a denial of admission to the School of Nursing. Application Date: / / Name: Last First Middle Initial Social Security Last 4 digits: Date of Birth: / / United States Citizen: Yes No Sex: Male Female Local Address: Telephone: ( ) - Address: Are you a transfer student? Yes No If Yes, have you completed an admissions application with the Office of Admissions? Yes No Have you previously earned any of the following degree(s)? AA/AS: Year awarded BS/BA: Year awarded Other: Concentration/Specialty (if applicable): Do you currently hold a Certified Nursing Assistant (CNA) certificate and/ or a Licensed Practical Nursing (LPN) license? Yes No Have you previously applied for admission to B-CU School of Nursing or have been previously enrolled in B-CU School of Nursing? Yes No If Yes, when did you begin? Have you previously attended another nursing program? Yes No List all nursing program(s) attended. Have you ever been suspended or dismissed from a nursing program? Yes No If yes, please explain the circumstances (attached additional documentation if necessary).!3

4 Have you taken the Test of Essential Academic Skills (TEAS) exam? Overall Composite Score? % Yes No What is your individual score for each section? English % Reading % Math % Science % Have you successfully completed the following pre-requisites or their equivalent with a grade of C or better? Yes No Please list your grade for each course listed. Prerequisite Courses (minimum required credits) Prefix English (6 credits) Credit Hours Grade EN 131 College English I 3 EN 132 College English II 3 Prefix Math (6 credits) Credit Hours Grade MAT 134 College Algebra 3 MAT 260 Practical Statistics 3 Prefix Sciences (12 credits) Credit Hours Grade BI 131 General Biology 3 BI 235 Anatomy & Physiology I 4 BI 236 Anatomy & Physiology II 4 OR BI 237 Anatomy & Physiology 6 CH 131 Introduction to Chemistry 3 Prefix Psychology (3 credits) Credit Hours Grade PS 236 Developmental Psychology 3 Prefix Nursing (2 credits) Credit Hours Grade NU 112 Introduction to Nursing 2 Total Credits 29 Have you ever been arrested, plead guilty or nolo contender (no contest), or been convicted of any criminal offense? Yes No If yes, please explain the circumstances. (*Supporting documents are required.)!4

5 I affirm that all the information I have given is true and complete to the best of my knowledge, and I understand that falsification or omission of information on this application will lead to denial of admission or dismissal from Bethune-Cookman University, School of Nursing Program. Applicant s Signature Date!5

6 School of Nursing Demographic Form Date: / / BCU Student ID # Name: Last First Middle Initial International Student: Yes No United States Citizen: Yes No Religion: Marital Status: Race/Ethnicity: Military Status: Date of Birth: / / Sex: Male Female Local Address: Mailing Address: Telephone: ( ) (primary) ( ) (alternate) Address: (Bethune-Cookman University Account) (Alternate Address) Person to contact in case of emergency: Emergency Contact Name: R e l a t i o n s h i p t o S t u d e n t : Permanent Address: ( ) Telephone !6

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