School of Nursing
Baccalaureate Nursing Program
Application for
Fall 2016 Admission
Personal Information
First Name
Middle Name
Last Name
Maiden Name
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email address
GFU Student ID #
Primary Phone
Secondary Phone
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Permanent Mailing Address
City
State
Zip
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Local Mailing Address
City
State
Zip
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Mail the Letter of Decision to the following address:
Ethnicity:
Permanent ☐
☐ American Indian/Alaska Native
☐ Black/African American
☐ Non-Resident Alien
☐ Native Hawaiian/Other Pacific Islander
☐ White
Local ☐
☐ Asian
☐ Hispanic
☐ Not Hispanic
☐ Two or More Races
Have you been arrested, charged with, entered a plea of guilty, no contest, convicted of or been sentenced for any criminal
offense either misdemeanor or felony, including driving under the influence, in any state? (The fact that a conviction has
been pardoned, expunged, dismissed or that your civil rights have been restored does not mean that you answer this
question “NO”; you would answer “YES” and give details on the charge).
☐ Yes
☐ No
If yes, please explain: Click here to enter text.
Education
High School
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College
City
State
Graduation (MM, YYYY)
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Start Date (MM, YYYY)
End Date (MM, YYYY)
Degree Earned
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Pre-requisite Course Work: Indicate below all courses you have taken to meet the George Fox University School of Nursing pre-requisite course
requirements. Course grades must be on transcripts.
Transfer credit evaluation must be done with the University Registrar and on file before the application is submitted.
Enter CT in Grade column for classes currently in progress.
Pre-requisite Course Requirements
Course Title
Credit
Hours
Human Anatomy
and Physiology I
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Human Anatomy
and Physiology II
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Human Anatomy
and Physiology III
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General, Organic and
Biological Chemistry I
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General, Organic and
Biological Chemistry II
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General, Organic and
Biological Chemistry III
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Principles of Sociology
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General Psychology
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Intro to Communication
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College Algebra (or higher)
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College Writing
(Freshman Composition)
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Course
Pre-fix
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Course
Number
Institution where
course completed
Semester/Quarter Taken
Grade
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Essay
In a 300 word maximum essay, answer the following two questions:
1) Why do you want to pursue nursing as a profession?
2) Why are you choosing George Fox University for your nursing education?
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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 all statements in my application are
true.
Signature: Click here to enter text.
Date: Click here to enter text.
George Fox University School of Nursing use only
☐
Application Received by May 6, 2016
☐
Email sent to applicant confirming receipt of application and any other materials
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GPA Evaluation completed
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Applicant Evaluation Form completed
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GFU Unofficial Transcript printed for completing Applicant Evaluation
☐
GFU Official Transcript printed and included in Applicant file
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Transfer Transcripts printed and included in Applicant file
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Transcripts for CT courses received, verified, printed and included in Applicant file
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HESI A2 Exam results processed
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Recommendation & Appraisal Form (1) received and processed
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Recommendation & Appraisal Form (2) received and processed
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Additional Information Provided
☐
Final letter sent by May 27, 2016
GFU SON Comments:
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