Department of Nursing Supplemental Application
CNECM/POST-LICENSURE BSN PROGRAM APPLICATION FOR SUMMER 2015 START
IMPORTANT: The Collaborative Nursing Education Continuum Model (CNECM) allows the current
ADN student to begin upper division nursing coursework for the BSN at SSU while in their ADN [prelicensure] program. If you will graduate from your ADN program mid-academic year (DecemberJanuary) you are not eligible for the CNECM; you may apply to the Post-Licensure BSN Program as
described on the website. Read all instructions carefully. An incomplete application or unmet criteria
will render you ineligible for admission consideration. Keep this page of directions and a copy of your
application for your records.
Admission to the CNECM Post-Licensure BSN Program requires:

Current enrollment and good standing in one of the CNECM partner ADN Programs (NVC,
COM, SRJC, SCC, or MC) confirmed by ADN Program Faculty and Director
DO NOT request letters of reference from your Director or Faculty.

Submission of all official college transcripts (including Fall 2014 semester) reflecting a
minimum overall college GPA of 3.0.
Submit all official college transcripts ONLY TO the SSU Department of Nursing at the address
below. DO NOT send official or unofficial transcripts to the university at this time.

Submission of completed Post-Licensure BSN Degree Worksheet.
Submit completed Post-Licensure BSN Degree Worksheet with your application. Using the
information supplied on the SSU Post-Licensure BSN website “Resources” (see Post-Licensure
BSN Students list) complete the Worksheet to the best of your ability. All of the information
needed to evaluate progress toward the BSN is included on the website. It is not possible for the
SSU Nursing Faculty to provide individual advising meetings prior to admission and we are not
authorized to “evaluate transcripts.” An application submitted without a completed Worksheet will
be considered incomplete and not eligible for admission.
EXCEPTION: If you already possess a baccalaureate degree in another discipline, you DO NOT
need to submit the Worksheet with your application and the requirement for a specific course in
Critical Thinking (GE Area A3) is considered met.
Priority admission will be given in the following order to applicants who have:
1. Completed all of the CSU System Wide Requirements for Admission to BSN Program (see page 3).
2. Have the least number of SSU/CSU GE requirements remaining to be completed (6 units of GE can be
outstanding and completed at SSU after ADN graduation and full admission to the university).
Application is due postmarked March 15, 2015
Sent To:
SSU
Nursing
Department
1.
2.
3.
4.
Checklist
Completed CNECM/Post-Licensure BSN Application (this document)
Completed Post-Licensure BSN Degree Worksheet
$50.00 non-refundable qualification assessment fee made payable to SSU
Official college transcripts
Date Sent
Sonoma State University Department of Nursing
1801 E. Cotati Ave.
Rohnert Park, CA 94928-3609
The Nursing Department will notify you of admission status by email no later than Fri, April 17, 2015
01-12-15
CNECM Application: Post-Licensure BSN PROGRAM APPLICATION for Summer 2015 Start
Department of Nursing Supplemental Application
CNECM/POST-LICENSURE BSN PROGRAM APPLICATION FOR SUMMER 2015 START
First Name:
Last Name:
CHECK that you anticipate completing your ADN in Spring 2016
CHECK IF YOU hold a baccalaureate degree in another discipline
CHECK if you are a veteran with DD214 papers or current member of US armed services
CHECK that you have completed and included the BSN Degree Worksheet with this application
CHECK that you have included the $50.00 qualification assessment fee with this application
CHECK that you have had all official transcripts sent to the SSU NURSING DEPARTMENT
CONTACT INFORMATION
Address:
____________________________________________________________________________
____________________________________________________________________________
Telephone:
___________________________ (home)
____________________________ (cell)
Email:
_________________________________________________________________
(Note: all correspondence, including nursing admission decision, will be sent to this e-mail address)
Circle the ADN program in which you are enrolled in second semester and in good standing:
COM
MC
NVC
SRJC
SCC
Use the “Overall College GPA Calculator” located in
Potential Student Resources section of webpage at
http://www.sonoma.edu/nursing/resources/
Current Overall College GPA:
Colleges and Universities Attended (begin with current)*
Institution Name
City, ST
Dates Attended
No. of units
completed
GPA
Degree or
Diploma
Date
Completed
*You must record all of the information requested here
or your application will NOT be considered!
01-12-15
CNECM Application: Post-Licensure BSN PROGRAM APPLICATION for Summer 2015 Start
Department of Nursing Supplemental Application
CNECM/POST-LICENSURE BSN PROGRAM APPLICATION FOR SUMMER 2015 START
CSU System Wide Requirements for Admission to BSN Program
(CSU Chancellor’s Office Executive Order 1084, January 10, 2013)
Record the course information requested below (DO NOT state “refer to transcripts”)
Course Requirement
(CSU GE Area)
Course Name & No.
(e.g., “Engl 101”)
College/University
Term/Year
Grade
English Composition (A1)
Speech (A2)
Critical Thinking (A3)
Chemistry (B1)
Anatomy (B2)
Physiology (B3)
Microbiology (B3)
Statistics (B4)
Please note that ALL of these (8) courses are required for admission and that, due to the nature of the
nursing major, there are more science units(GE Area B) required than the minimum number needed
to meet the SSU/CSU General Education requirements.
If you are a second baccalaureate applicant, please mark “2nd bacc” for the Critical Thinking
requirement (if you have not taken a specific Critical Thinking course, your baccalaureate degree will
meet this requirement).
CERTIFICATION
To be read and signed by all applicants to certify the accuracy of the information provided
I certify under penalty of perjury, or after first being duly sworn, that I have provided complete and accurate
responses to the items on this application. I further certify (swear) all official documents submitted in support of
this application are authentic and unaltered records that pertain to me. I authorize release of any information
submitted by me in connection with my application to any person, firm, corporation, association or government
agency, but only to verify or explain the information, obtain pertinent records, or in connection with perjury
proceedings. My signature certifies the accuracy and completeness of the information provided. I understand
that any misrepresentation may be cause for denial or cancellation of admission.
Applicant’s signature _____________________________________________ Date __________________
01-12-15
CNECM Application: Post-Licensure BSN PROGRAM APPLICATION for Summer 2015 Start
Department of Nursing Supplemental Application
CNECM/POST-LICENSURE BSN PROGRAM APPLICATION FOR SUMMER 2015 START
The following information is completely voluntary and will not be considered in the application
process. Please submit with your Department of Nursing application. This sheet is separated from
your application upon receipt by the Department and used only for state and national data reporting
requirements to licensing and accreditation agencies.
Gender:
Birthdate:
Citizenship:
Male
Female
Transgender
____ / ____ / __________
(mm) (dd)
(yyyy)
U.S. Citizen or Resident Alien
on Foreign Student Visa
Ethnicity:
White/ Caucasian
Black Non-Hispanic
American Indian or Alaskan Native
Filipino
Asian
Hawaiian/ Pacific Islander
Hispanic
Other (specify):
01-12-15
CNECM Application: Post-Licensure BSN PROGRAM APPLICATION for Summer 2015 Start