Western Illinois University
School of Nursing
APPLICATION FOR ADMISSION
Baccalaureate of Science in Nursing
RETU
RN THIS
FORM
WITH
$30 APPLICATION FEE TO
RETURN
THIS
FORM
TO
Western Illinois University
School of Nursing
Waggoner Hall 339
1 University Circle
Macomb, IL 61455-1390
(309) 298-2571 Fax: (309) 298-2270
Baccalaureate of Science in Nursing
Western Illinois University
ADMISSION CHECKLIST
Submit the BSN admission packet containing the following documents:
______ 1. BSN Application for Admission and the application fee of $30
______ 2. Educational and Professional Goals Statement
______ 3. Documentation of Community Service
______ 4. Documentation of veteran status
______ 5. Two Confidential Recommendation forms (see enclosed) from professional colleagues who have worked with you a minimum
of three years — Confidential Recommendations should be requested from individuals who have worked closely with you and
are able to give specific information about your abilities and potential. These will be returned to you in a sealed envelope by
each of the individuals. Submit the sealed envelopes with the Confidential Recommendations or have the person send the
Confidential Recommendation directly to the School of Nursing.
______ 6. Send Transcript Request Form to the college or university that you attended. Institutions must be regionally accredited,
NLNAC, and/or CCNE. WIU will only accept official transcripts from the college or university’s registrar’s office in a
sealed envelope. (Schools generally charge $1 to $5 for this service.)
______ 7. Copy of current Illinois Registered Nurse License, if applicable
______ 8. Transfer of Credit request form
ADMISSION REQUIREMENTS FOR PRE-LICENSURE STUDENTS
Students who wish to apply to the School of Nursing for admission to the major as a Basic Nursing student must
1.
2.
3.
4.
5.
6.
7.
8.
Have a complete application on file in the School of Nursing no later than March 1 for admission for the next Fall Semester.
Completion of the Test of Essential Academic Skills® (TEAS). Scores on the exam must be received in the Nursing Office by
March 1 for Fall Semester admission.
Students must complete all general education and support course requirements by July 1 for Fall Semester admission.
Have a minimum cumulative GPA of 2.33 on a 4.0 scale for all postsecondary work. The following courses must have a grade of
C+ (2.33) or better:
a.
Zool 230: Human A&P I
b.
Zool 231: Human A&P II
c.
Chem 101: Gen Chemistry I
d.
Chem 102: Gen Chemistry II
e.
FCS 109: Intro to Nutrition
f.
FCS 121: Intro Life Span Dev
g.
Micro 200: Intro Micro
h.
Stat 171: Gen Element Stats
In addition, only one of these courses may be repeated if a grade of C+ (2.33) is not achieved. A student may
repeat one course one time. Admission will be denied to any student who receives a second grade of less than
C+ (2.33) for any nursing support course.
Submit an official transcript with the Application for Admission. WARD reports are acceptable for WIU students.
Secure letters of reference from two (2) professional references: one academic (i.e., instructor or professor) and one employer (i.e.,
supervisor). If there has been no employment, students may submit letters from two instructors/professors.
Provide documentation to Beu Health Center that all health requirements for the School of Nursing have been met by August 1
before Fall Semester admission. Health requirements may be different from the standard University requirements. (Students are
responsible for all costs incurred for admission as well as ongoing health requirements.)
Provide documentation to the School of Nursing that all safety requirements have been met by August 1 before Fall Semester
admission. (Students are responsible for all costs incurred for admission as well as ongoing safety requirements.)
a.
Criminal Background Check
All applicants are required to submit a criminal background check. Details will be given to the student upon admission
to the program.
b.
Drug Screen
All applicants are required to be drug tested on admission with random drug screens thereafter. Applicants with a felony
conviction or a positive drug screen may be denied entry into the clinical facility for clinical practice.
ADMISSION REQUIREMENTS FOR REGISTERED NURSES
Students who wish to apply to the School of Nursing for admission to the major as an RN-BSN Completion nursing student must
1.
2.
3.
4.
5.
6.
7.
8.
Have a completed application on file in the School of Nursing no later than July 1 for admission for the next Fall Semester or
October 1 for Spring Semester admission. Students will be considered pre-nursing until all the general education and support
course requirements are met. Admission to pre-nursing does not guarantee admission to the major.
Submit a current copy of the Illinois License as a Registered Nurse.
Students must complete (or transfer in) all general education and support course requirements by July 1 for Fall Semester
admission and January 1 for Spring Semester admission. There are 60 semester hours of general education and support courses.
Have a minimum of a cumulative GPA of 2.33 on a 4.0 scale for all postsecondary work except those listed below. The
following courses (or comparable courses) must have a grade of C+ (2.33) or better:
a.
All nursing courses taken for the Associate Degree in Nursing or Diploma in Nursing
b.
The following courses are listed as nursing support courses. These courses or their equivalents will be transferred in>
i.
Zool 230: Human A&P I
ii.
Zool 231: Human A&P II
iii.
Chem 101: Gen Chemistry I
iv.
Chem 102: Gen Chemistry II
1.
Chem 101 and Chem 102 requirements may be waived if the chemistry course the student completed
(at least C+ [2.33]) was at the college level and included organic chemistry. The semester hour
requirement is not waived; the student must complete the 125 semester hours required for the degree.
v.
FCS 109: Intro to Nutrition
vi.
FCS 121: Intro Life Span Dev
vii.
Micro 200: Intro Micro
viii.
Stat 171: Gen Element Stats
In addition, only one of these courses may be repeated if a grade of C+ (2.33) was not achieved. A student may
repeat one course one time. Admission will be denied to any student who received a second grade of less than
C+ (2.33).
Submit all official transcripts with the Application for Admission. Failure to submit all postsecondary transcripts will result in a
denial of admission.
Secure letters of reference from two (2) professional references: one academic (i.e., instructor or professor) and one clinical (i.e.,
supervisor).
Provide documentation to Beu Health Center that all health requirements have been met by August 1 for Fall Semester admission
or January 1 for Spring Semester admission. Health requirements may be different from the standard University requirements.
(Students are responsible for all costs incurred for admission as well as ongoing health requirements.) See form for a complete list
of requirements.
Provide documentation to the School of Nursing that all safety requirements have been met by July 1 for Fall Semester admission
and January 1 for Spring Semester admission. (Students are responsible for all costs incurred for admission as well as ongoing
safety requirements.) See form for a complete list of requirements.
a.
Criminal Background Check
All applicants are required to submit a criminal background check. Details will be given to the student upon admission
to the program.
b.
Drug Screen
All applicants are required to be drug tested on admission with a random drug screen every semester thereafter.
Applicants with a felony conviction or a positive drug screen may be denied entry into the clinical facility for clinical
practice.
Baccalaureate of Science in Nursing
APPLICATION FOR ADMISSION
PERSONAL INFORMATION
Name:______________________________________________________________________________________________________
Last
First
Middle Initial
Social Security Number:________________________________________________________________________________________
Maiden or Previous Name:__________________________________________ Preferred Name:_______________________________
Permanent Address:____________________________________________________________________________________________
City:_______________________________________________ State:_________________________________ ZIP:_______________
Home Phone: (______)________________________________ County:__________________________________________________
Employer:___________________________________________ Position:________________________________________________
Employer’s Address:___________________________________ City:_________________ State:____________ ZIP:______________
Work Phone: (______)_________________________________ Ext:_________________ Fax: (______)________________________
E-Mail Address:_____________________________________________ Country of Citizenship:_______________________________
CITIZEN STATUS
U.S. Citizen
Non U.S. Citizen (specify country)______________________________ U.S. Permanent Resident?
Yes
No
VETERAN STATUS
Will you have completed a minimum of one year active duty in the U.S. military (check one)? Yes
No
If yes, submit copy of DD214 form with status of discharge. Dates of Service: From __________________ To __________________
National Guard or Reserve Duty?
Yes
No Start Date of Basic Training ____________________________________________
DEGREE FOCUS – Please indicate your focus of study.
Pre-Licensure Nursing
RN-BSN Completion
CLASS SITE – Please rank by order of preference.
Macomb
Quad Cities (RN-BSN Completion Only)
REGISTERED NURSE LICENSURE
Please include a copy of your current RN license with this application, if applicable. All students must maintain current Illinois licensure
while enrolled in the program.
Illinois License Number: _________________________________________
Expiration Date:______________________________
PREVIOUS EDUCATION – List all institutions from which degree(s) were granted.
Name of Institution
Location
Dates Attended
Degree Earned
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
OFFICIAL TRANSCRIPT must be sent to Western Illinois University from all regionally accredited NLNAC, CCNE, or accredited
college or university programs that you have attended since high school graduation.
TRANSFER OF CREDIT*
This section must be completed for coursework from other institutions to be considered for transfer in lieu of bachelor’s degree
requirements at Western Illinois University. Credits earned prior to admission but not reported on this form will not be considered for
transfer after admission. Official syllabi/course descriptions must be provided upon request. Not more than 9 semester credits will be
accepted in transfer. Transfer credits must meet these criteria: (1) completed less than five years ago (however, the school reserves the
right to deny transfer of credit for courses in which the content or practice has significantly changed in the last three years), (2) graded C+
or above, (3) pass/fail courses are not acceptable, (4) earned at NLNAC or CCNE accredited institutions, (5) accepted as bachelor’s degree
credit at granting institution, (6) equivalent to Western Illinois University course, and (7) appropriate for the student’s proposed program.
I am requesting the following courses be accepted in transfer and have requested official transcripts to be sent directly to Western Illinois
University. I understand that I may be required to provide course syllabi/description as needed.
Transfer for
Proposed Course #/Title
Institution
Credits Grade
Date Completed
___________________________________ ________________________
______
______
_______________
WIU Course
______________
Office Use Only
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____________________________ ___________________
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Total Number of Credits Proposed to Transfer: _____________ (A maximum of nine credits may be accepted.)
Reviewed by:_______________
Date Reviewed:_____________
Name__________________________________________________________
Last
First
Middle Initial
_________________________________________
Date Submitted
*A total of 32 credits will be transferred for licensed nurses from their associate’s degree or diploma and do not need to be documented on
this form. All additional courses must be cited on this form.
WORK EXPERIENCE
Starting with your current position, please list your three most recent positions. Show full-time employment, including military service,
summer employment, and significant part-time employment. (Even though you may attach a résumé, please complete the information on
this application form.)
Employer:__________________________________________ Type of Healthcare Facility:_______________________________
Address:___________________________________________ City:______________________ State:____________ ZIP:______
Position:___________________________________________ Dates Employed: From_________________ To______________
Responsibilities:___________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
----------------------------------------------------------------------------------------------------------------------------------------------------------------------Employer:__________________________________________ Type of Healthcare Facility:_______________________________
Address:___________________________________________ City:______________________ State:____________ ZIP:______
Position:___________________________________________ Dates Employed: From_________________ To______________
Responsibilities:___________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
---------------------------------------------------------------------------------------------------------------------------------------------------------------------Employer:__________________________________________ Type of Healthcare Facility:_______________________________
Address:___________________________________________ City:______________________ State:____________ ZIP:______
Position:___________________________________________ Dates Employed: From_________________ To_______________
Responsibilities:___________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
COMMUNITY EXPERIENCE
Indicate the nonprofit, community, business, and professional organizations in which you have been actively involved. List by order of
personal significance. You must provide written documentation from your supervisor for service performed.
Organization
Dates
Role/Position
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
ADMISSION ESSAY
As you complete the Educational and Professional Goals Statement, please be aware that our questions are meant to help you distinguish yourself from other
applicants. The Admission, Progression, and Retention Committee reviews all applications to consider two specific areas:
1.
Does the application demonstrate college-level written communication skills? Particular attention is paid to grammar, mechanics
(i.e. punctuation and spelling), the logical organization of material, analysis of issues, support of positions, and clarity of thought.
2.
Has the applicant participated in community service activities? Has the community service positively contributed to the well-being
of others in need?
We encourage you to share with us some personal insights about experiences that have influenced your professional life. We consider it a
privilege to read your essay and want you to know that we respect your confidentiality.
Thank you.
School of Nursing Admission, Progression, and Retention Committee
INSTRUCTIONS
Please conform to the Publication Manual of the American Psychological Association (APA) (5th ed.) guidelines for written materials.
EDUCATIONAL AND PROFESSIONAL GOALS STATEMENT
Write a personal statement indicating what you expect to learn and achieve from the Bachelor of Science in Nursing Program.
List educational and professional goals. Describe how the BSN degree will enhance your career plans. Project the kind of
position you anticipate having five years after you earn this degree. Describe experiences you have had that form the
foundation for your goals.
Be specific in answering the above questions. Approximately 500 words.
RECOMMENDATIONS
List the name, title, and address of the individuals from whom you have requested professional recommendations:
Name:_____________________________________________ Title:_____________________________________________________
Address:___________________________________________ City:_____________________ State:________________ ZIP:_______
Name:_____________________________________________ Title:_____________________________________________________
Address:___________________________________________ City:_____________________ State:________________ ZIP:_______
OTHER INFORMATION
How did you first hear about the Western Illinois University School of Nursing Program?
Alumni (name/s):_____________________________________
Friend (name/s):_____________________________________
Relative (name/s):____________________________________
Student (name/s):_____________________________________
Employer (name/s):__________________________________
Radio commercial (station/s):____________________________
Coworker (name/s):_________________________________
Newspaper advertisement (name/s):_______________________
Other:____________________________________________________________________________________________________
Technical College
Western Illinois University Representative
Internet
OPTIONAL INFORMATION
The following information is optional. Refusal to provide it will not subject the applicant to any adverse treatment and will not affect
admission in any way. The information is requested to best meet your needs.
Sex/Marital Status:
Single Male
Married Male
Single Female
Married Female
Date of Birth:_________________________ Place of Birth:_________________________ Religious Affiliation:___________________
Ethnic Background:
White Caucasian
African American
Native American
Hispanic
Asian/Pacific Islander
Other__________________________
………………………………………………………………………………………………………………………………………………
I understand that I am responsible for the submission and receipt of my official degree-bearing transcripts and that Western Illinois
University will accept for its permanent file only those transcripts issued directly by the registrar of institutions I have attended. Formal
admission to Western Illinois University as a Bachelor of Science in Nursing degree candidate is granted only after all admission materials
have been received.
I certify that the information contained in this application is a true and accurate account. The essays were written solely by me, without
assistance (this includes editing) from other individuals. I further authorize Western Illinois University to make appropriate inquiries when
necessary to certify the accuracy of my records. I understand that falsification may result in denial of admission or dismissal from the
University.
If I am accepted by the Western Illinois University School of Nursing, I understand that I will be expected to abide by all University and
School of Nursing rules and regulations.
______________________________________________________________
Signature
__________________________________________
Date
Baccalaureate of Science in Nursing
CONFIDENTIAL RECOMMENDATION
APPLICANT: Please print or type your name.
____________________________________________________________________________________________________________
Last
First
Middle Initial
TO THE PERSON COMPLETING THIS EVALUATION:
The person whose name appears above is applying for admission to the Bachelor of Science in Nursing Program at Western Illinois
University. In our consideration of each applicant, we place particular emphasis on comments from individuals who the applicant has
chosen to assess him or her. This recommendation will be used only for admission purposes; it will not be made a part of the student’s
educational record, and no reference will be made to it for educational purposes after a decision is final on the applicant’s admissibility.
Therefore, this recommendation is not subject to the provisions of the Family Educational Rights and Privacy Act of 1974. The applicant
will not have access to this recommendation under that law.
Name of Person Completing This Form:___________________________________________________________________________
Organization:___________________________________________________Position/Title:__________________________________
Address:____________________________________________________________________________________________________
Work Phone: (______) ________________________________________ Home Phone: (______)_____________________________
How long have you known the applicant?__________________________ Years: ____________________ Months:________________
During which period of time have you had the most contact with the applicant?
From (month/year):______________________________ To (month/year):________________________________________
Under what circumstances have you worked with the applicant?__________________________________________________________
___________________________________________________________________________________________________________
May we contact you regarding this applicant?
Yes
No
DESCRIBE THE APPLICANT’S ABILITY TO COMMUNICATE ORALLY AND IN WRITING.
If the applicant is from a non-English-speaking country, how well does he or she understand, write, and speak English?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Rate the applicant as compared to his or her peers and note the reference group with which you are making your comparisons:
ATTRIBUTES AND
ABILITIES
FAIR
GOOD
EXCELLENT
UNABLE TO RATE
Flexibility/adaptability
Initiative
Leadership potential
Integrity
Ability to overcome
obstacles
Openness to new ideas
Self-confidence
Analytical skills
Able to work with others
Goal oriented
Comments:_________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Of the attributes and abilities evaluated above, please comment on the following:
1) Applicant’s area of greatest strength.
2) Areas in which applicant could use greatest development.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Please indicate your overall evaluation of this applicant?
Strongly Recommend
Recommend
Recommend with Reservation
Do Not Recommend
Comments:___________________________________________________________________________________________________
____________________________________________________________________________________________________________
We realize that considerable time and effort is involved in preparing this evaluation, and we greatly appreciate your help. Please return this
form to the applicant in a sealed envelope with your signature across the seal. The applicant will then submit the sealed, signed envelope
as part of the completed application packet to the Western Illinois University School of Nursing.
_______________________________________________________
Signature
_________________________________________________
Date
Baccalaureate of Science in Nursing
CONFIDENTIAL RECOMMENDATION
APPLICANT: Please print or type your name.
____________________________________________________________________________________________________________
Last
First
Middle Initial
TO THE PERSON COMPLETING THIS EVALUATION:
The person whose name appears above is applying for admission to the Bachelor of Science in Nursing Program at Western Illinois
University. In our consideration of each applicant, we place particular emphasis on comments from individuals who the applicant has
chosen to assess him or her. This recommendation will be used only for admission purposes; it will not be made a part of the student’s
educational record, and no reference will be made to it for educational purposes after a decision is final on the applicant’s admissibility.
Therefore, this recommendation is not subject to the provisions of the Family Educational Rights and Privacy Act of 1974. The applicant
will not have access to this recommendation under that law.
Name of Person Completing This Form:___________________________________________________________________________
Organization:___________________________________________________Position/Title:__________________________________
Address:____________________________________________________________________________________________________
Work Phone: (______) _______________________________________ Home phone: (______)______________________________
How long have you known the applicant?__________________________Years: ____________________ Months:________________
During which period of time have you had the most contact with the applicant?
From (month/year):______________________________ To (month/year):________________________________________
Under what circumstances have you worked with the applicant?__________________________________________________________
____________________________________________________________________________________________________________
May we contact you regarding this applicant?
Yes
No
DESCRIBE THE APPLICANT’S ABILITY TO COMMUNICATE ORALLY AND IN WRITING.
If the applicant is from a non-English-speaking country, how well does he or she understand, write, and speak English?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Rate the applicant as compared to his or her peers and note the reference group with which you are making your comparisons:
ATTRIBUTES AND
ABILITIES
FAIR
GOOD
EXCELLENT
UNABLE TO RATE
Flexibility/adaptability
Initiative
Leadership potential
Integrity
Ability to overcome
obstacles
Openness to new ideas
Self-confidence
Analytical skills
Able to work with others
Goal oriented
Comments:_________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Of the attributes and abilities evaluated above, please comment on the following:
1) Applicant’s area of greatest strength.
2) Areas where applicant could use greatest development.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Please indicate your overall evaluation of this applicant?
Strongly Recommend
Recommend
Recommend with Reservation
Do Not Recommend
Comments:___________________________________________________________________________________________________
____________________________________________________________________________________________________________
We realize that considerable time and effort is involved in preparing this evaluation, and we greatly appreciate your help. Please return this
form to the applicant in a sealed envelope with your signature across the seal. The applicant will then submit the sealed, signed envelope
as part of the completed application packet to the Western Illinois University School of Nursing.
_______________________________________________________
Signature
_________________________________________________
Date
Baccalaureate of Science in Nursing
TRANSCRIPT REQUEST FORM
Please send one (1) official transcript to
Western Illinois University
School of Nursing
Waggoner Hall 339
1 University Circle
Macomb, IL 61455-1390
Please send additional copies to student:
Yes
No
Number of Copies: ____________
Name:_____________________________________________________________________________________________________
Address:____________________________________________________________________________________________________
City:____________________________________________________State:_______________________ ZIP:____________________
Social Security Number:_____________________________________ Date of Birth:________________________________________
Last Year of Attendance:___________________________ Name on Transcript If Different from Above________________________
I have enclosed a processing fee of $_________________ per transcript.
____________________________________________________
Signature
_________________________________________________
Date
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
Baccalaureate of Science in Nursing
TRANSCRIPT REQUEST FORM
Please send one (1) official transcript to
Western Illinois University
School of Nursing
Waggoner Hall 339
1 University Circle
Macomb, IL 61455-1390
Please send additional copies to student:
Yes
No
Number of Copies: ____________
Name:_____________________________________________________________________________________________________
Address:____________________________________________________________________________________________________
City:____________________________________________________State:_______________________ ZIP:____________________
Social Security Number:_____________________________________ Date of Birth:________________________________________
Last Year of Attendance____________________________ Name on Transcript If Different from Above:_______________________
I have enclosed a processing fee of $_________________ per transcript.
____________________________________________________
Signature
_________________________________________________
Date
Baccalaureate of Science in Nursing
TEAS®
TEAS® INSTRUCTIONS
Each applicant to the School of Nursing must take the Test of Essential Academic Skills (TEAS®).
The TEAS® consists of four sections: mathematics, reading, science, English and language usage. A review of basic concepts and theories
in each area is recommended. ATI has two products, the TEAS® Study Manual and a TEAS® Online Practice Assessment, available to guide
your review and provide feedback about your study progress. Order online at atitesting.com.
There is no set passing score for the TEAS® at WIU; applicants will be awarded points based on their score. These points will be used with
other points to determine admission. Only the first TEAS® score will be used to determine the number of points for each student.
The TEAS® will be offered at WIU. Please call (309) 298-2571 to schedule your TEAS® testing. This test fee is about $30 and will be paid
directly to ATI (Assessment Technologies Institute). Bring a current credit card to the test session. Check our website for possible test
dates and times at www.wiu.edu/nursing/admissions.
If you have taken the TEAS® at another location, your TEAS® results can be sent to any nursing school. You can request that ATI
electronically transmit your results to a school for a small fee. Just go on the ATI website and have them sent to Western Illinois
University.