1 - University of Wyoming



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BRAND (“Bachelors Reach for Accelerated Nursing Degree”) PROGRAM

ADMISSION APPLICATION for SUMMER 2014

|Personal Data |

|Full Legal |Last Name |First Name |Middle Name |Social Security Number |

|Name | | | | |

| | | | | |

|Other names used if different than above |UW Email Address |University of Wyo. ID #, if known |

| | | |

|Date of Birth |Gender |Non-UW Email Address |Current (home) Phone |

| | | | |

|Current |Street/Box |Cell Phone |

|Address | | |

| | | |

| |City |State |Zip Code |Work Phone |

| | | | | |

|Permanent |Street/Box |Permanent Phone |

|Address | | |

| | | |

| |City |State |Zip Code |State of Legal Residence |

| | | | | |

|Other Personal Information |

|High School from which you graduated (Name of school, city and state): |

| |

|Education Data |

|If your transcripts were sent to the UW Admissions Office instead of to the School of Nursing, please note: |

|Complete the following information for all colleges/universities previously attended and currently attending including the University of Wyoming, in order of |

|attendance. Official transcripts must be on file with the School of Nursing from each individual school attended with the exception of UW, since we have access to|

|that record. Request official transcripts from all schools attended to be sent directly to the School of Nursing in order to be accepted as official. Our office |

|copies all transcripts received, forwarding originals to the UW Admission Office. |

| | |Degree Received or Anticipated & GPA |

|Colleges/Universities |City/State |Dates Attended |Degree |Mo / Yr |GPA at graduation | |

| | | | | |(if applicable) | |

|1 |

|Prerequisite Course Data |

|Courses to be completed by application due date – November 1 |

|MICROBIOLOGY / 4 CREDIT HOURS |

| |Identify course completed or to be completed that fulfills the requirement |

| |Semester and year course completed or to be completed (flag any repeats) |

| |Identify school where the course was/will be completed |

|Anatomy & Physiology / 8 CREDIT HOURS |

| |Identify course completed or to be completed that fulfills the requirement |

| |Semester and year course completed or to be completed (flag any repeats) |

| |Identify school where the course was/will be completed |

|PSYCHOLOGY / 3-4 CREDIT HOURS |

| |Identify course completed or to be completed that fulfills the requirement |

| |Semester and year course completed or to be completed (flag any repeats) |

| |Identify school where the course was/will be completed |

|NUTRITION / 3 CREDIT HOURS |

| |Identify course completed or to be completed that fulfills the requirement |

| |Semester and year course completed or to be completed (flag any repeats) |

| |Identify school where the course was/will be completed |

|PATHOPHYSIOLOGY / 4 CREDIT HOURS |

| |Identify course completed or to be completed that fulfills the requirement |

| |Semester and year course completed or to be completed (flag any repeats) |

| |Identify school where the course was/will be completed |

|Prerequisite Certification/Licensure |

|CNA Certification or LPN Licensure must be received by our school no later than May 1, 2014. |

|CNA Certification / LPN Licensure Information |

|Expiration Date |Plans for completing certification/licensure if not already completed |

| | |

Honesty Statement / Signature

The University of Wyoming is built upon a strong foundation of integrity, respect, and trust. All members of the University community have a responsibility to be honest and the right to expect honesty from others. Any form of academic dishonesty is unacceptable to our community and will not be tolerated.

I understand that any attempt on my part to falsify answers or exclude pertinent data is cause for rejection of my application and/or dismissal from the program. I hereby certify that the above statements are true to the best of my knowledge.

Part of the application packet includes 2 essays. I certify that the essays I will be mailing in as part of my application packet are my own work.

Sign and date below to agree with the above statements. Your signature is required for your application to be considered complete.

Signature: Date:

UW is an affirmative action/equal opportunity educational institution.

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