CALIFORNIA STATE UNIVERSITY, LONG BEACH
College of Health and Human Services, School of Nursing
Masters of Science – Pediatric Nurse Practitioner
Certificate: Nurse Practitioner: Yes ___ No___
Student Number: _______________________________________________
Email: ______________________________
Name: ________________________________________________________
Phone: (_______)_____________________
(Last)
(First)
(Middle)
Address: _____________________________________________________________________________________________
(Street and Number)
(City)
(State)
(Zip)
Bachelor Degree Major: _____________________ Institution: _____________________ Graduation Date: _______________
Program Entry Date: ________________________ Mandatory Completion Date: _____________WPE Date:______________
Dept.
No.
Units
300
500
400
600
Course Title
Completed
Grade
Sem/Year
CORE COURSES
NRSG
NRSG
NRSG
NRSG
NRSG
NRSG
NRSG
NRSG
510
520
535
535L
540
550
560
596
Advanced Pathophysiology for Adv.Practice
Advanced Pharmacology for Advanced Practice
Advanced Physical Assessment for Adv.Practice
Advanced Physical Assessment Lab
Health Care Economics, Policy & Management
Human Diversity & Psychosocial Issues
Theoretical Professional Roles for Adv.Practice
Research Methods in Nursing
2
3
2
1
2
2
2
3
CLINICAL SPECIALIZATION COURSES
N RSG
NRSG
NRSG
NRSG
NRSG
NRSG
NRSG
NRSG
NRSG
NRSG
NRSG
650
650A
650B
651
651A
651B
652
652A
695
698
692
Pediatric Theory Advanced Practice Nursing I
Pediatric Clinical Advanced Practice Nursing I
Pediatric Clinical Advanced Practice Nursing II
Pediatric Theory Advanced Practice Nursing II
Pediatric Clinical Advanced Practice Nursing III
Pediatric Clinical Advanced Practice Nursing IV
Pediatric Theory Advanced Practice Nursing III
Pediatric Clinical Advanced Practice Nursing V
Professional Literature (Comps) or
Thesis
or
Nursing Directed Project
Total Units Earned in Program
3
3
3
3
3
3
3
3
3
1-3
1-3
44
____________________________________________
Student Signature
Date
____________________________________________
Graduate Advisor or Dept. Chair
Date
____________________________________________
Associate Dean of CHHS
Date
CALIFORNIA STATE UNIVERSITY, LONG BEACH
SCHOOL OF NURSING
PREREQUISITES
________________________________
Student Number
Date_______________________
Name__________________________________________________________________________
Address:_______________________________________________________________________
(Street and Number)
(City)
(State)
(Zip)
Bachelor’s Degree_____________________________________Year________________________
Institution_____________________________________________________________
Were prerequisites completely satisfied by Undergraduate degree? ___Yes or No___
If not, list prerequisites taken after your BSN:
Prerequisite subject
(Stats, Patho, Phy. Ass.
etc.)
Course name/# taken to
satisfy prerequisites
Institution
Semester
taken
Grade
received