CALIFORNIA STATE UNIVERSITY, LOS ANGELES



CALIFORNIA STATE UNIVERSITY, LOS ANGELES

Patricia A. Chin School of Nursing

Accelerated Bachelor of Science in Nursing - ABSN

Application for Summer 2021

General Information: Word process or print in black ink

Name: ______________________________________________________________________________

Last First Middle

Address: ______________________________________________________________________________

Street City State Zip

Contact #s: Cell ( ) _ ___________

Work ( ) ________________________ _ Home ( ) _________________________

DOB: (required) _____________

E-mail address: (required) ______________________________________________________

Ethnic/racial background :(optional) _____________________________________________

Languages spoken fluently: _____________________________________________________

How you self-identify: (optional)

_Woman __Man ____Transgender Woman ____Transgender Man

____Gender Queer ____Gender non-conforming ____Another identity

Additional degree(s) you are considering in the future:

_____None at this time

_ MSN

____ DNP

____ PhD

Education: List all colleges and universities attended, indicate degrees earned if applicable, beginning with most recent (You may submit a resume if you prefer).

|Institution |State/Country |Major |Degree |GPA |Year |

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Work Experience: List all work experience over the past 7 years beginning with your current or most recent work (You may submit a resume if you prefer).

|Position |Employer |City and State |Dates |

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Professional or Community Involvement: List recent professional or community activities and any honors or awards earned (You may submit a resume if you prefer).

Include your word-processed essay (no more than two pages, double-spaced) that address your reasons for entering the nursing profession, long term professional goals, and any characteristics or life experiences that you believe prepares you for success in this program.

If possible, include all of the following in your application packet, as it will expedite the review of your file:

● ABSN Application for Summer 2021 form

● Personal essay

● Two copies of official (sealed) transcripts from all colleges attended

● Two recent academic or work-related letters of recommendation on official letterhead. Letters should address your academic ability and characteristics that the writer feels qualify you for the program and the nursing profession. (e.g. college professor, employer, supervisor.)

● Completed Prerequisite Check List

● ATI TEAS scores – individual performance profile (if available)

Applicant signature: _____________________________ Date: ________________

Please address all correspondence to: Patricia A. Chin School of Nursing

Attention: ABSN Program

California State University, Los Angeles

5151 State University Drive

Los Angeles, CA 90032

ABSN - Prerequisite Check List

Your Name: ______________________________________________________

|Course Number & |College |Semester/ |Grade |Office Use Only |

|Course Title | |Quarter & Year | | |

| EXAMPLE |EXAMPLE |EXAMPLE | A | |

|Human Growth &Development: | | | | |

|PSYC 24: Life-Span Developmental Psychology |Pasadena City College |Fall 2018 | | |

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|Human Anatomy with lab: | | | | |

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|Human Physiology with lab: | | | | |

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|Chemistry with lab: | | | | |

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|Microbiology with lab: | | | | |

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|Life span psychology: | | | | |

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|Principles of Sociology or Cultural Anthropology: | | | | |

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|Human Nutrition: | | | | |

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|Statistics (inferential): | | | | |

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|Critical Thinking: | | | | |

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Fill out this portion as demonstrated by the example shown below (you may add another page if needed)

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