Washington State University College of Nursing
Nursing Pathways program
New Student Application
For questions please contact:
Robert Garza, M.Ed.
Student Services Manager
Creating a Nursing Path, HRSA WFD Grant
Washington State University Tri-Cities College of Nursing
2710 Crimson Way Richland, WA 99354-1671
509-372-7181 (Office) * 509-372-7116 (Fax)
Student Application Checklist
Completed Application
(2) Recommendation and Evaluation Forms
Student Questions (Typed answers)
Unofficial high school or college transcript (not needed for HS & College Freshmen)
Reviewed & Signed Participation Requirement Form
______ Complete and Submit to: Elaine Myers, Guidance Specialist by November 7th
Office Use Only (2013-14)
Accept
Waitlist_____
Declined
____
Robert Garza
__
Cindy Mackay-Neorr
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Program Application
Personal Information
Name
Date of Birth
Mailing Address
Home Phone
Cell Phone
What is your residency status?
U.S. Citizen
Email
Permanent Resident
Other
Social Security or Tax ID # required to process student financial stipends:__________________
Ethnicity
Asian American
African American
Native Hawaiian/Pacific Islander
More than one race
Native American/Alaskan Native
Enrolled: ___Yes ____NO
Tribal Affiliation_________
Hispanic, Latino/a
White/Caucasian
Other_________________(please indicate)
Education
Name of High School/College
Grade/Year Level
Expected Graduation Date
Counselor Name
College/University SID#
Current Transcript Cumulative GPA
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- Student Questions Please type the answers to the following questions on a separate sheet of paper.
Describe your reason for wanting to pursue a career in nursing?
What is your motivation to complete your educational and career goals?
How do you feel you would benefit from being in the Washington State University
Nursing Pathways program?
Why should you be selected as one of the Nursing Pathways scholars?
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Participation Requirements
Please review all the items listed below. Place your initials next to all of the requirements you are
able to meet. In order to participate in or qualify for the Nursing Pathways program, you must be
able to meet all program requirements.
All Participants:
* _____ (Initial) During the school year, students will attend up to 8 program workshops and 2
community service learning projects.
*_____ (Initial) I certify that I currently have a Cumulative GPA of 2.0 or above.

If Cumulative GPA is below 2.0, please attach a letter of support from your
counselor.
High School Students Only:
During summer, students will be eligible to submit a competitive application to attend a 12 day
Summer Nursing Career Institute in Spokane.
I authorize to the best of my knowledge, statements I have provided on this application are
complete and true. Failure to disclose and submit complete and accurate information may result
in the denial of acceptance to the WSU Nursing Pathways program.
I understand that one of the major purposes for Nursing Pathways program is to assist me in
strengthening my academic and communication skills. I also understand that participation in the
Nursing Pathways program does NOT guarantee my acceptance into any college/university, or
the WSU College of Nursing.
Student Signature
Date
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Recommendation Form
This form is to be completed by a school counselor, teacher, coach, mentor, or supervisor. (2)
recommendations are required. At least one recommendation form must be completed by a
teacher. Upon completion of the recommendation form, the document is to be returned to the
student in a sealed envelope. Attention to: Robert Garza, WSU Tri-Cities Nursing
Name of person providing the recommendation:
Applicants Name:
In what capacity have you known the student? (Check all that apply)
Teacher
Counselor
Mentor
Coach
Supervisor
Other (specify)
What barriers could stop the student from attending college and pursuing a career in nursing?
(In 2-3 sentences)
Why would the student benefit from participating in the Nursing Pathways program?
(In 2-3 sentences)
Signature
Date
Title
Email
Phone #
For further questions or inquiries please contact:
Robert Garza, M.Ed.
Student Services Manager, 509-372-7181
Washington State University College of Nursing
2710 Crimson Way Richland, WA 99354-1671
Email: roberto_garza@tricity.wsu.edu
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Recommendation Form
This form is to be completed by a school counselor, teacher, coach, mentor, or supervisor. (2)
recommendations are required. At least one recommendation form must be completed by a
teacher. Upon completion of the recommendation form, the document is to be returned to the
student in a sealed envelope. Attention to: Robert Garza, WSU Tri-Cities Nursing
Name of person providing the recommendation:
Applicants Name:
In what capacity have you known the student? (Check all that apply)
Teacher
Counselor
Mentor
Coach
Supervisor
Other (specify)
What barriers could stop the student from attending college and pursuing a career in nursing?
(In 2-3 sentences)
Why would the student benefit from participating in the Nursing Pathways program?
(In 2-3 sentences)
Signature
Date
Title
Email
Phone #
For further questions or inquiries please contact:
Robert Garza, M.Ed.
Student Services Manager, 509-372-7181
Washington State University College of Nursing
2710 Crimson Way Richland, WA 99354-1671
Email: roberto_garza@tricity.wsu.edu
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