Dear Candidate: - Ohio State University



Dear Candidate:

Our Honor Code represents exemplary values that are deeply rooted in the culture of OSU College of Nursing. We – the faculty, students, and staff – embrace these values in our professional, as well as our personal lives.

The College of Nursing Honor Council at OSU is an organization designed to promote altruism, integrity, respect, responsibility, and excellence within the College of Nursing and the Ohio State University. Members of the CON Honor Council also provide a good academic and professional example, uphold procedures during questionable breeches, and select new members each academic year.

The expected length of term on the Honor Code is one academic year, which may be renewed every year until graduation as long as the student fulfills his/her committee responsibilities and remains in good standing in the College of Nursing. Membership on the Members are expected to attend all meetings that do not interfere with other academic duties of Ohio State University, employment responsibilities, and/ or personal emergencies.

The Honor Code Selection Committee and faculty members will select applicants based on their answers to application questions, resume, and recommendation form. Selected applicants will be contacted for an interview within 2-3 weeks after the submission deadline.

Please return completed application to:

Sandy Cody

Assistant Dean for Student Affairs

OSU College of Nursing

240 Newton Hall

1585 Neil Avenue

Columbus, OH 43210-1289

Application due by:

June 30, 2010

Application Checklist/ Sections Completed:

___ General Information

___ Academic Background

___ Questions and Experience

___ Ethical Questions

___ 2 Recommendations in sealed envelopes:

1 from a faculty member or work supervisor

1 from a student peer or co-worker

References:

Moritz College of Law Admissions Application Process. (2007). Application portfolio for

admission and financial aid. Retrieved April 16, 2007, from

admissions/docs/application.pdf

The Ohio State University Fisher College of Business Online Application. (2007). MBA full-

time program reference form. Retrieved April 16, 2007, from



University of Colorado at Boulder Honor Code (2007). Honor council application. Retrieved

April 16, 2007 from

honor%20council%20application.pdf

General Information:

Title First Name Middle Initial Last Name

/ /

Current Address (including City/State/Zip) Date Valid Through

Permanent Address (including City/ State/ Zip)

Telephone Number Email Address

Gender Ethnicity (Optional) Date of Birth

Optional:

Are you currently, or, within the last 12 months were you, on active military duty? Y / N

Dates of Military Service (if applicable)

Academic Background:

For the next academic year, will you be a:

___Sophomore

___Junior

___Senior

___RN to BSN

___Graduate: Please specify: __________________ Projected Date of Graduation:___/____/____

Please list the colleges or universities you have previously attended:

|College or University |City/ State |Dates Attended |Degree Earned |Graduation Date |

|  |  |  |  |  |

|  |  |  |  |  |

|  |  |  |  |  |

|  |  |  |  |  |

Questions and Experience:

Please briefly answer the following questions (1-3 sentences maximum):

1. Why do you want to be on the Honor Code Committee?

2. What is the importance of promoting professional integrity in the College of Nursing?

3. Why do you feel a student run Honor Code is an important outlet for students to have and how does it differ from decisions made by faculty?

Ethical Questions:

▪ Are there any academic or disciplinary charges from any educational institution against you?

Y / N

▪ Have you ever been the subject of a court martial hearing, dishonorably discharged from the military, or administratively separated from the military with other than an honorable discharge?

Y / N

▪ Have you ever been involuntarily separated from a job as a result of an accusation that involved dishonesty?

Y / N

▪ Have you ever been sued for a non-criminal act that was alleged to have been intentional?

Y / N

▪ Were you ever on academic or disciplinary probation?

Y / N

▪ Have you ever been charged with, penalized for, or adjudicated guilty of, a violation of a college or university honor code, or have you ever been suspended or dismissed from any educational institution?

Y / N

▪ Have you ever been the subject to disciplinary action by a professional association or state licensing board, or had a professional license suspended or revoked?

Y / N

▪ Have you ever been accused of sexual assault or sexual harassment?

Y / N

▪ Have you ever been convicted of an alcohol or drug related crime? Please attach a brief explanation of any convictions if you mark “Yes”.

Y / N

By signing this form I verify that the above information is honest and correct to the best of my knowledge and that I am in good academic standing within Ohio State University and the College of Nursing:

Signature Date

Recommendation Form #1 (Student Peer or Co-Worker): Please return in a sealed envelope with application

1. What is your relationship with this applicant? ____________________________

2. How long have you known this applicant? ____________________________

Please compare the applicant with students similar in education and experience in the same field:

3. How would you rate the applicant on general critical thinking skills?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

4. How would you rate the applicant on respect and equal treatment of customers/ patrons/ patients/ or clients?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

5. How would you rate the applicant on initiative?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

6. How would you rate the applicant on leadership ability?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

7. How would you rate the applicant on teamwork?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

Recommendation Form #1 – cont. (Student Peer or Co-Worker): Please return in a sealed envelope with application

8. How would you rate the applicant on fairness and consistency?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

9. How would you rate the applicant on responsibility?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

Why do you think this applicant would be a good selection for the Honor Code Committee?

Please write any additional comments here:

By signing this form I indicate that I have filled out this reference honestly and to the best of my knowledge:

Printed Name and Credentials/ Position

Contact Information (e.g. phone number or email address)

Signature Date

Recommendation Form #2 (Faculty or Work Supervisor): Please return in a sealed envelope with application

1. What is your relationship with this applicant? ____________________________

2. How long have you known this applicant? ____________________________

Please compare the applicant with students similar in education and experience in the same field:

3. How would you rate the applicant on general critical thinking skills?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

4. How would you rate the applicant on respect and equal treatment of customers/ patrons/ patients/ or clients?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

5. How would you rate the applicant on initiative?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

6. How would you rate the applicant on leadership ability?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

7. How would you rate the applicant on teamwork?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

Recommendation Form #2 – cont. (Faculty or Work Supervisor): Please return in a sealed envelope with application

8. How would you rate the applicant on fairness and consistency?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

9. How would you rate the applicant on responsibility?

___ Outstanding (highest 5% - comparable to best students)

___ Very Good (highest 10%)

___ Good (upper 25% - ability easy to identify)

___ Average (Upper 50%)

___ Below Average

Why do you think this applicant would be a good selection for the Honor Code Committee?

Please write any additional comments here:

By signing this form I indicate that I have filled out this reference honestly and to the best of my knowledge:

Printed Name and Credentials/ Position

Contact Information (e.g. phone number or email address)

Signature Date

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