ADN Program Application Packet New Associate Degree Nursing (ADN) students are admitted each Spring and Fall semester. Space in the ADN program is limited; therefore, admission is competitive and applicants will be scored on an objective point procedure that has been strategically set up to predict student success. Students are admitted into all Dixie State University programs without discrimination in regards to race, color, ethnic background, national origin, religion, creed, age, lack of American citizenship, disability, status of veteran, or gender. Application Packet Includes: Student Application Checklist o Page 2 of this packet Official Application o Pages 3-4 of this packet Acknowledgement of Program Requirements for Personal Effort and Commitment o Page 5 of this packet Accepted Applicants Information o Page 6 of this packet ADN Admissions Timeline SPRING FALL Application Due September 10 th May 10 th Notification of Acceptance to Program** September 25 th May 25 th Student Acceptance / All Health Requirements Due November 20 th July 20 th **Notification of acceptance to ADN program will be sent to your Dmail account How to Submit Your Application Packet: Submit all documents in a single packet. You may submit signed documents as email attachments to nursing@dixie.edu or fax to 435-879-4829. You may also submit documents via mail (certified recommended): DSU Nursing Department Taylor Building, Office #302 225 South University Ave St George, UT 84770 Direct any questions to: o Alice Clegg, Nursing Advisor Last Names A-J clegg@dixie.edu 435.879.4813 o Kaylie Romney, Nursing Advisor Last Names K-Z romney@dixie.edu 435.879.4803 o Department Secretary nursing@dixie.edu 435.879.4810 Revised 201630 ADN Application Page 1
Applicants must: Application Checklist: Do not submit this form with your application Be admitted to Dixie State University o Pay $35 DSU admission fee at http://admissions.dixie.edu/ Meet the Minimum Eligibility requirements o Students who do not meet minimum eligibility will be disqualified o Listed at http://health.dixie.edu/nursing/nursing-admissions/ Pay the ADN Application Fee o Pay ADN Application Fee at http://dixie.edu/onlinepayments/ Click on All Other Payments and select ADN Nursing Application Include copy of payment receipt with submitted application Submit Official Transcripts to DSU o Send official transcripts from all other colleges/universities attended o DSU Registrar s Office, 225 S University Ave, St George UT 84770 Complete the Kaplan Nursing School Entrance Exam o For more information about the entrance exam, visit http://health.dixie.edu/nursing/nursing-admissions/#adn_exam Collect Documents for Application Packet (staple or paper clip only; emailed applications are accepted) o Filled out, signed two-page application o Official transcripts from all other colleges/universities Do not submit Dixie State University transcripts as they will be electronically evaluated o Filled out, signed Acknowledgement of Program Requirements document o Printed results of Kaplan Entrance exam o Receipt of ADN Application Fee payment o Do not submit any additional documents, letters, or forms Submit completed applications by 3:00 pm on the due date o See Page 1 of this packet for mailing address and other contact information o Mailed applications must be postmarked FIVE days prior to due date Late applications will not be accepted but may be considered for the next semester o If due date falls on a weekend or holiday, the deadline will be extended to the next business day Please note: In order to be licensed as a nurse in the State of Utah, applicants must conform to the Utah Nurse Practice Act. Applicants who have been convicted of a felony, treated for mental illness or substance abuse should discuss their eligibility status for licensure with the Utah State Board of Nursing. Acceptance and completion of the nursing program does not assure eligibility to take the licensure examination. The Utah State Board of Nursing makes the final decision as to whether a license will be issued to practice nursing in this state. If you have questions, contact the State Board of Nursing, P.O. Box 45802, Salt Lake City, UT 84145; Phone number 801.530.6789. Revised 201630 ADN Application Page 2
ADN Program Application Application for: Spring Admission Due by 3:00 pm on September 10 th Fall Admission Due by 3:00 pm on May 10 th Date Submitted DIRECTIONS: Please type or print. Incomplete applications will not be processed. 1. Personal Information First Name MI Last Name DixieID (Student Number) Birthdate Prefer to be Called Address City State Zip Cell Phone Other Phone Personal Email 2. Emergency Contact Name Relationship Address City State Zip Primary Phone Secondary Phone 3. Program Application Requirements By submitting this application packet, I agree to the following: I have read and understand the ADN Program Application Packet I will abide by all program requirements listed By the due dates listed in this packet: I will have met the Minimum Eligibility guidelines (page 2) I will hold a CNA Certificate or LPN License I will have completed all mandatory vaccinations and/or titers Revised 201630 ADN Application Page 3
Revised 201630 ADN Application Page 4 4. Prerequisite Course Completion Required Courses List ALL attempts for ALL prerequisites. Use additional line if necessary. Do NOT use midterm grades. DSU Course Number HIGHEST GRADE - (USED IN SCORING) ALL OTHER ATTEMPTS - (NOT USED IN SCORING) NOTES (Retake in Progress, etc.) Semester Grade College or University Repeated Semester Grade College or University Human Anatomy BIOL 2320 Human Anatomy Lab BIOL 2325 Human Physiology BIOL 2420 Human Physiology Lab BIOL 2425 Elem Gen / Organic Chemistry CHEM 1110 Elem Gen / Org Chem Lab CHEM 1115 Intro to Writing ENGL 1010 Intermediate Writing ENGL 2010 College Algebra, or Intro to Statistics, or Quantitative Reasoning MATH 1030 MATH 1040 MATH 1050 PSYC 1010* Human Development/ Lifespan PSYC 1100 FCS 1500 **Higher level Math or Chemistry may be used *PSYC 1010 for Spring 2017 applicants only
Acknowledgement of Program Requirements for Personal Effort and Commitment The nature of the Dixie State University Nursing Programs, as with most nursing programs, requires a substantial time commitment to fulfill the intensive requirements of the program in the classroom, nursing arts laboratory, and clinical settings. Student success in the nursing program is dependent upon the creation and maintenance of a collaborative, working partnership between students and faculty. The nursing program faculty recognizes its responsibility as facilitators of your learning and is committed to helping you succeed in the program. However, it is important that you are aware of the responsibilities you will hold for your own learning while in the nursing program. As part of your application to the program, please read the following and sign below. Your signature is an acknowledgement of your understanding of the expectations of the program. 1. There is a minimal study expectation of two hours of study per week for each credit enrolled. For example, a 5 credit nursing course requires a minimal expectation of 10 hours of study per week. Most students spend more time than the minimal study expectation. 2. Although we hold an appreciation for your possible need to work to support yourself and/or a family, most students find it difficult to work full time and still achieve the grades they may have earned in non-nursing courses. Reducing your work schedule to part-time, if possible, will be helpful for success in the nursing program. 3. In general and given the same amount of student effort, nursing students may not achieve the high grades they earned in non-nursing courses. You will be learning a new language in the first semester of your program. Additionally, you will be exposed to in-depth, comprehensive nursing concepts and principles that may require more effort on your part to learn and understand. 4. You are expected to be prepared for class, lab, and clinical. This may include extensive reading and completion of concept maps or other assignments prior to your attendance. 5. Most exams given in nursing courses are structured similarly to the nurse licensing exam. This means that most of the items on the exams are application type questions rather than simple knowledge and recall. These questions require a higher-order of thinking to answer correctly. We provide you with strategies for learning and test-taking that help you take the nursing course exams. 6. You will find the nursing program different and more difficult than your past educational experiences. The nursing program is designed this way to facilitate the quality of the program, prepare you to pass your licensing exam, and ensure you become a safe and competent nurse. I certify that all of the statements in this application and all of the documents submitted with this application are true and accurate to the best of my knowledge. I acknowledge that I have read and understand the above statements and, if I am accepted into Dixie State University s Nursing Program, I agree to manage my time and personal affairs in order to meet the commitment necessary to succeed. Print name of Applicant Date Signature of Applicant Print Application Start Over Revised 201630 ADN Application Page 5
Accepted Applicants Once accepted into the program, you will submit documentation for: Mandatory Immunizations: Negative 2-Step TB test Proof of two separate skin tests (PPD) within any 12 month period Chest x-ray or TB medication series is acceptable Blood test with negative result QuantiFERON Gold or T-SPOT.TB MMR (Measles, Mumps, Rubella): Series of 2 Proof of two vaccinations, or Titer showing immunity to measles, mumps and rubella is acceptable Hepatitis B vaccination: Reactive Titer Titer showing immunity/reactivity Series of 3 vaccinations and reactive titer is needed to start clinical rotation TDaP: Must include Pertussis Must have 1 vaccination after age 10 Childhood DPT or DTaP not acceptable Tetanus/TD alone not acceptable Varicella (Chicken Pox) Proof of two vaccinations, or Titer showing immunity Physician report is no longer acceptable Annual Flu Vaccination Verification of current season vaccination Fall admission: Due after the start of your 1 st ADN Semester Spring admission: Due by November 20 th Additional Requirements: CNA Certification Proof of current CNA certification (or LPN license) CPR Certification Classes are scheduled for you during the first week of the semester Prerequisite Course Completion Successful completion of ALL prerequisite courses is required for entrance into the ADN Program. Transfer students must submit an OFFICIAL transcript with final grades ( C or better) to the nursing department and to the registrar s office for courses completed after application deadline. The following are only required if you are formally admitted into the ADN Program. More information on these requirements will be given with your program acceptance packet: Drug Screen Background Screen Revised 201630 ADN Application Page 6