SUPPLEMENTAL PRELICENSURE APPLICATION DEADLINE: FEBRUARY 15th

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Horace Pope
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1 SUPPLEMENTAL PRELICENSURE APPLICATION DEADLINE: FEBRUARY 15th Complete all applicable fields. It is recommended that you type on this application instead of handwritten responses. When you ve finished, print it and mail it to the address listed on page 5. Do not your application. Applicants are notified of the admission decision in April. If applying through a military program, please place a check mark beside the option: MECP STA-21 ROTC Name: Other names in which records may appear: UIN: (University Identification Number assigned when ODU application is Received in Office of Admissions) Mailing/Street Address City Zip Code State Phone: Home (Area Code) Work/Cell (Area Code) Address: In chronological order, list all educational institutions attended since high school including ODU. Institution Location Dates Diploma/Degree Received or Hours Completed

2 Prerequisite Courses. Please indicate the grades you received in the following prerequisite courses. NOTE: All of these courses must be completed prior to the February 15 th application deadline. If you are attaching multiple transcripts, please indicate from which institution you earned the credits. **Automatically satisfied by previous Bachelor s degree. Prerequisite Course Grade Institution ENGL 110C ** (Written Communication I) STAT 130M (Elementary Statistics) PSYC 203S (Lifespan/Developmental Psychology) SOC 201S (Introduction to Sociology) CHEM 105N/106N, OR CHEM 121N/122N (College Chemistry with Lab) BIOL 103 (Microbiology/Bacteriology) BIOL 250 or BIOL 240 (Human Anatomy & Physiology I) Additional Prerequisite Requirement: The following course must be completed prior to the start of ODU s BSN program in the fall. Please enter the status of the course (Completed, In Progress, or Planned) and from which institution you plan to earn the credits. Additional Prerequisite Course (Must be completed prior to fall start) BIOL 251 or BIOL 241 (Human Anatomy & Physiology II) Status Institution General Education Requirements: The following courses must be completed prior to the start of ODU s BSN program in the fall. Please enter the status of each course (Completed, In Progress, or Planned). If you have completed or will complete an Associate s Degree from a VCCS institution, or a Bachelor s Degree, prior to the start of ODU s BSN program in the fall, list Prior Degree. If you are planning to complete the course before the start of the program, indicate where you plan to take the course. *Automatically satisfied by Associates of Arts or Associates of Science degree from VCCS institutions. **Automatically satisfied by previous bachelor s degree. ***Foreign language may be satisfied by Associates degree, Bachelor s degree, or completion of three years of one language or two years of two languages in high school. If you completed foreign language in high school, be sure to submit official transcripts to the ODU Office of Admissions. Course Status Institution ENGL 211C ** (Written Communication Skills II) GEN ED Literature* (ENGL 112L, 114L, FLET 100L or LIT 1 REQ) Foreign Language I ***

3 Foreign Language II *** GEN ED Human Creativity* (ARTH 121A, ARTS 122A, COMM/THEA 270A, THEA 241A, MUSC 264A, DANC 185A, HC 1REQ) GEN ED Interpreting the Past * (HIST 100H, HIST 101H, HIST 102H, HIST 103H, HIST 104H, HIST 105H, INTP 1 REQ) GEN ED Philosophy * (PHIL 110P, PHIL 120P, PHIL 230E, PHIL 250E, PHIL 303E, PHIL 344E, PHIL 345E, PHIL 441E, PHIL 442E, PL or EL 1 REQ) GEN ED Impact of Technology* (1 Class in COMM 372T or CS 300T* or DNTH 440T or EET 370T* or ENGL 307T* or GEOG 306T or HIST 300T* or 304T* or 386T* or 389T or IT 360T or MUSC 335T or PHIL 383T* or POLS 350T or SCI 302T or STEM 110T or 370T* or WMST 390T or ITL 1 REQ) Upper Division General Education Requirement: The Upper Division requirement must be completed prior to the start of ODU s BSN program in the fall. Please enter the status of each course (Completed, In Progress, or Planned). If you have completed a Bachelor s Degree prior to the start of ODU s BSN program in the fall, select Prior Degree. The default upper-division general education requirement is Option D, which requires the completion of 6 credits of level courses outside the college of your major and not required by your major. Prior Bachelor s Degree or higher, Upper Level General Education Requirement Met, do not list below. Minor, Interdisciplinary Minor, or Second Major, list courses below: Option D + 5 Additional Elective Credits in College Level Coursework, list below: Course Status Institution

4 Health Care Experience Verification Form I have a license, certification, or registration to practice. Check one: CNA, EMT, LPN, MLT, Navy HM, Army Medic, Other A copy of your license or certification must be attached to this form. I do not have a license but I was trained on the job or have volunteer experience at as a I verify that I have worked hours in this capacity. My job responsibilities included: Supervisor s title Supervisor s Phone Number Supervisor s Address Supervisor s Signature

5 Application Checklist Please affirm the following with a check mark beside each item: I have been admitted to Old Dominion University as a degree seeking student. I have sent official transcripts to the ODU Office of Admissions. I have attached my unofficial or official transcripts from any previous institutions to this application. I have attached my HESI A2 Score/Transcript this application. See testing center website for test dates for the HESI A2.Test dates are limited. Be sure to schedule early. The HESI transcript must be attached to your application otherwise it will not be considered and a zero will be scored. Preference is given to students with a minimal score of 80. If applicable, proof of health care related certifications and/or experience and are attached. I am aware that all of the prerequisite courses must be completed at the time of the application. My application indicates a grade for each of those completed prerequisite courses. I am aware that all required remaining non-nursing courses must be completed prior to entry into the Prelicensure Nursing Program. Signature of Applicant Date Return application with documentation of health care certifications and photocopies of transcripts attached to: Undergraduate Program Coordinator Old Dominion University, School of Nursing 4608 Hampton Boulevard Health Sciences Building, Room 2134 Norfolk, VA Applicants are notified of the admission decision in April. ODU s Nursing program begins in the fall.

RN-BSN TRANSFER PLANNING GUIDE Black Hawk College

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