Department of Nursing
Bachelor of Science in Nursing Program (Undergraduate)
APPLICATION
15/FA for 16/WI admission
You must apply to SVSU and obtain a student identification number and SVSU email address before applying to the nursing
program. Admission to SVSU does not guarantee admission to the nursing program.
Date:
Are you entering SVSU as part of the Freshman Admission Program?
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Yes
No
Have you ever been admitted to a nursing program at another
Have you ever applied to SVSU's Nursing Program?
college/university?
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Yes if yes, where? Click here to enter text.
No
Last Name:
Yes if yes, what semester/year? Click here to enter text.
No
First Name:
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Initial:
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text.
Previous Married/Maiden/Other Name:
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Date of Birth:
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text.
Permanent Address:
City:
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Male
Female
Other ___________________
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State
Zip Code
County
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text.
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Local Phone Number #
Home Telephone #
Mobile Phone #
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enter text.
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SVSU E-mail Address (Note: we will only use SVSU email address)
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Are you a citizen of the U.S.A.?
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Yes
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No
Are you a U.S. Veteran?
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Yes
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No
Name and telephone number of a person we can
Have you ever been convicted of a felony or misdemeanor?
contact if you cannot be reached by any of the
above numbers?
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If yes, attach materials indicating the crime for which you were convicted, the court in which you were convicted, dates and
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No
sentences imposed. PLEASE NOTE: Background checks are required of all students progressing to the interview round, and
fingerprinting is required of all admitted students. Additional checks may be required during the program.
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ETHNIC ORIGIN: Please mark ONE CATEGORY TO INDICATE WHICH YOU THINK BEST APPLIES TO YOU:
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(01)
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American Indian, Eskimo or Aleut (AIEA)
Asian or Pacific Islander (API)
Black, excluding Hispanic
Hispanic
White, excluding Hispanic
Prefer not to answer
International, not a U.S. Citizen
Multiracial*
If you answered "Multiracial," please mark all of the races that apply to you based on the list above:
☐ API ☐ AIEA ☐ White
☐ Black ☐ Hispanic
*For purposes of this question, you are multiracial if you have parents from more than one of the broad race categories listed above. Although optional, this
information is requested to fulfill reporting obligations to the U.S. Department of Education.
ACADEMIC RECORD
An official transcript must be on file in the Registrar's office from each institution attended, even if no credit was earned. Failure to list all schools and provide the appropriate information
may make you ineligible for admission. An application will not be processed if all transcripts have not been attached to this application.
ASSOCIATE DEGREE(S) EARNED
Degree:
Degree:
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Institution:
Institution:
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Date:
Date:
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GPA:
GPA:
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BACHELOR'S DEGREE(S) EARNED
Degree:
Degree:
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Institution:
Institution:
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Date:
Date:
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GPA:
GPA:
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CREDITS EARNED – Name other colleges which you have attended, regardless of grades and/or hours earned.
Institution:
Dates of Attendance:
Date:
GPA:
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PREREQUISITE COURSES FOR UNDERGRADUATE NURSING STUDENTS
Prerequisite courses required to be completed before entering (and not by the deadline date) are the following:
BIOL 111A (Principles of Biology)
BIOL 232/233 (or approved Anatomy Physiology)
BIOL 236 (Human Nutrition)
BIOL 237 (Microbiology)
CHEM 111 and CHEM 111L lecture & laboratory (General Chemistry)
Statistics (MATH 132A or MATH 132B or PSYC 299 or PS 225!)
PSYC 100 (General Psychology)
SOC 111 (Introduction to Sociology)
General Education Category 9 – any course approved for the Oral Communication category
General Education Category 10 – any course approved for the Written Communication category
Students may be enrolled in one or more of the above courses and apply to the program. Students must have a C (2.0) or
better in completed prerequisite courses to apply and a minimum 2.8 in both overall GPA and science/math GPA of
completed prerequisite nursing courses BY THE APPLICATION DEADLINE for October applications and BY THE END OF
WINTER SEMESTER for April applications. My signature below indicates that I have read and understand the “NURSING
PROGRAM TECHNICAL STANDARDS” and I am able to meet the Technical Standards of the Nursing Program with or
without reasonable accommodations.
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Signature: Click here to enter text.
Date: Click here to enter text.
Please contact the SVSU Office of Disability Services for further clarification of reasonable accommodations available.
My signature below indicates that I have read and understand the "HEALTH AND OTHER REQUIREMENTS FOR
NURSING PROGRAM” and am able to meet the requirements. I verify that my immunizations as listed of this application
are complete or will be complete by January 1, 2016. I understand that if I am admitted and my immunizations are found
to be not current my seat may be forfeited.
Signature: Click here to enter text.
Date: Click here to enter text.
STATEMENT OF PERMISSION AND AFFIRMATION
I am certain that I have met the requirements to be eligible to apply to the Bachelor of Science in Nursing Program at this
time.
My cumulative GPA from ALL colleges/universities ever attended is a minimum of 2.8 or better; it is: Click here to enter
text.
My science/math GPA is a minimum of 2.8 or better; it is: Click here to enter text.
(using BIOL 111A, CHEM 111, 111L, STATISTICS, BIOL 232/233, BIOL 237 and BIOL 236).
To calculate the GPA , multiply the number of credits for each
course completed by the value for the course grade received
(A = 4.0, A- = 3.7, B+ = 3.3, B = 3.0, B- = 2.7, C+ = 2.3, C = 2.0,
D = 1.0)
add the answers and divide by the total number of credits
completed. See example below.
CHEM 111CHEM 111LBIOL 111A BIOL 232 STATS -
C
A
B+
A
B
4 credits x 2.0 GPA =
1 credit x 4.0 GPA =
4 credits x 3.3 GPA =
4 credits x 4.0 GPA =
4 credits x 3.0 GPA =
8 pts
4 pts
13.2 pts
16 pts
12 pts
(sum of totals) = 53.2 (grade points) / 17 (credits) = 3.129 GPA for
Science/Math
I hereby affirm that the statements I have made on this application form are complete, accurate, and truthful to the best of
my knowledge. I understand that the Department of Nursing reserves the right to use this information, my student
records, and credentials in the selection process. Hence, I permit this application and my student record, which contains
my credentials, to be submitted to the Nursing Selection Committee.
I understand that withholding information requested on this application or giving false information may make me ineligible
for admission to the University or subject to dismissal. I have read this application and certify that the statements I have
made on this application are correct and complete.
I hereby consent to disclosure of any information regarding any criminal convictions I have described in this application,
by the Department of Nursing, in its discretion, to (i) university officials, including, without limitation, faculty (whether fulltime or part-time), who have a legitimate educational interest in such information and/or (ii) employees and agents of
health care facilities at which I may be placed to do my clinical learning, in order for such persons to determine my
eligibility for placement at such facility.
I understand the requirement for the background check and will comply willingly if my application moves to the interview
round. I understand that I must submit all materials with my application and if I fail to do so, my application will not be
scored.
Signature: Click here to enter text.
Date: Click here to enter text.
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Documentation to be submitted with your application:
 Completed nursing program application with your signatures and dates.
 Current class schedule, whether you are taking classes at SVSU or another institution.
 If you are taking a required course during spring/summer, attach proof of registration for that course.
 Your degree audits (go to Cardinal Direct and print it).
 Transcript(s) (unofficial is acceptable) from all colleges and/or universities ever attended,
including SVSU transcript from Cardinal Direct. The SVSU Registrar also must have an official transcript
on file.
 Copy of signed course petition form(s) if you have petitioned the Nursing Department Chair or SVSU
Registrar regarding a course.
 Transfer Evaluation Report (TER) from each college and/or university attended; you
received this report from SVSU’s Registrar’s Office after you applied to SVSU and sent official transcripts.
It is the policy of Saginaw Valley State University that no unlawful discrimination will be practiced or tolerated in the provision of
employment, education, organizations, athletics, housing, public accommodations and other services to the public. Equal opportunity will
be provided regardless of race, religion, sex, sexual orientation, national origin, age, marital or familial status, color, height, weight,
handicap or disability.
Revised: 9/1/15jn
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