Date Received in Office:____
___
Tarleton State University Department of Nursing
Bachelor of Science Program in Nursing - RN to BSN & RN to MSN Entry
Alternate Entry Application for Admission to Upper Division Nursing Courses
www.tarleton.edu/nursing
Name: ________________________________ Tarleton ID #________________________
(Last) (First)
(Tarleton ID available after admission to the University)
Address: ______________________________ Telephone ________________________
(Area Code) Home
City/ST/Zip:_____________________________
________________________
E Mail: ______________________________
________________________
(Area Code) Work
(Area Code) Cell
Applying For (check one): RN to BSN entry ____________
(Offered only in Fort Worth)
Campus Applying For (check one): Ft. Worth __________
RN to MSN entry ____________
(Offered in Ft. Worth & Main Campus)
Stephenville ________ (RN to MSN Only)
Semester/Year applying to the Tarleton Nursing Program: ____________________ _______
(Semester Fall or Spring)
Do you have an associate degree or diploma in nursing? _____ Yes
____ No
(Year)
If yes, Year awarded ___________
If yes, Name of institution granting associate degree or diploma in nursing? _______________________
RN in Texas? ____ Yes
___ No
If yes, license # ______________ If no, explain _________________________
(i.e., New graduate/out of state license)
Do you have a Non Nursing Bachelor’s Degree? ____________ Yes ____________No If yes, year awarded ____________
If yes, awarding University/College ______________________________________________
_____
What is the Non Nursing Bachelor’s Degree?_________________________________________________
Have you taken course work at Tarleton? ____________ Yes ____________ No If yes, what year(s)? __________________
Colleges and/or universities and the year(s) attended:
____________________________________________________
________________________________________________
____________________________________________________
________________________________________________
Course(s) in which currently enrolled:
(Submit proof of enrollment)
Semester/Yr
Additional courses to be completed
prior to starting nursing courses:
Semester/Yr
____________________________________________________
________________________________________________
____________________________________________________
________________________________________________
____________________________________________________
________________________________________________
____________________________________________________
________________________________________________
I attest that by signing this application all information above is true and correct and that I have read and followed the
Tarleton Department of Nursing and Admission Program Requirements for the semester to which I am applying.
______________________________________________________ ________________________
Student Signature
Date
Submit this application, resume, 3 letters of recommendation, and the $35 application fee (cashier’s check or
money order only) to: RN to BSN Admission OR RN to MSN Admission, Tarleton State University, Department of
Nursing, P.O. Box T--0500, Stephenville, TX 76402
10/9/2013