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-266700-228600 Date Received in Office:____ ___ Tarleton State University Department of NursingBachelor of Science Program in Nursing - RN to BSN & RN to MSN EntryAlternate Entry Application for Admission to Upper Division Nursing Coursestarleton.edu/nursing Name: ________________________________ Tarleton ID #________________________ (Last) (First) (Tarleton ID available after admission to the University) Address: ______________________________ Telephone ________________________ (Area Code) HomeCity/ST/Zip:_____________________________ ________________________ (Area Code) Work E Mail: ______________________________ ________________________ (Area Code) Cell Applying For (check one): RN to BSN entry ____________ RN to MSN entry ____________ (Offered only in Fort Worth) (Offered in Ft. Worth & Main Campus) Campus Applying For (check one): Ft. Worth __________ Stephenville ________ (RN to MSN Only) Semester/Year applying to the Tarleton Nursing Program: ____________________ _______ (Semester Fall or Spring) (Year) Do you have an associate degree or diploma in nursing? _____ Yes ____ No If yes, Year awarded ___________ If yes, Name of institution granting associate degree or diploma in nursing? _______________________RN in Texas? ____ Yes ___ No If yes, license # ______________ If no, explain _________________________ (i.e., New graduate/out of state license)Do you have a Non Nursing Bachelor’s Degree? ____________ Yes ____________No If yes, year awarded ____________ If yes, awarding University/College ______________________________________________ _____ What is the Non Nursing Bachelor’s Degree?_________________________________________________Have you taken course work at Tarleton? ____________ Yes ____________ No If yes, what year(s)? __________________ Colleges and/or universities and the year(s) attended: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Course(s) in which currently enrolled: Semester/Yr Additional courses to be completed Semester/Yr (Submit proof of enrollment) prior to starting nursing courses: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I attest that by signing this application all information above is true and correct and that I have read and followed the Tarleton Department of Nursing and Admission Program Requirements for the semester to which I am applying. ______________________________________________________ ________________________ Student Signature Date Submit this application, resume, 3 letters of recommendation, and the $35 application fee (cashier’s check or money order only) to: RN to BSN Admission OR RN to MSN Admission, Tarleton State University, Department of Nursing, P.O. Box T--0500, Stephenville, TX 76402 10/9/2013 ................
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