AUBURN MONTGOMERY
SCHOOL OF NURSING
APPLICATION FOR ADMISSION TO THE
EARN PROGRAM
(Educational Advancement for Registered Nurses)
Selection for admission to the EARN Program is based on academic performance in the lower
division pre-nursing courses. A minimum grade of “C” is required for each course, and a minimum
overall GPA of 2.5 based solely on these courses is required. These courses do not have to all be
completed prior to entry to the EARN program, but must all be completed to qualify for graduation.
Applicants not currently enrolled at Auburn Montgomery must attain university admission
prior to applying to the EARN program. The university application is online at www.aum.edu,
click “Admissions” then “Apply to AUM.” Official transcripts from each college or university
attended must be sent directly from their Records Office to the Auburn Montgomery Admissions
Processing Office to be considered for admission.
Please attach a copy of your university admission letter to this application and submit to:
Auburn Montgomery School of Nursing
P.O. Box 244023
Montgomery, AL 36124-4023
Attn: Lorinda Stutheit RNC, MSN
Admission Coordinator
Lorinda.Stutheit@aum.edu for questions
I plan to complete the EARN program:
_____ Full time
_____ Part time
____________________________________
SIGNATURE
_______________________________
DATE
AUBURN MONTGOMERY
SCHOOL OF NURSING
ADMISSION APPLICATION
Name:
(Last)
(First)
(Middle/Maiden)
Present Address:
(Number)
(Street)
(City)
(State)
(Home Phone)
(Zip)
(Business)
(Mobile/cell)
Permanent Address:
(Number)
(Street)
(City)
(State)
(Zip)
RN License Number ___________________ Home E-mail address_______________________
(required)
Specify address to which you want correspondence sent: Present ________ Permanent ________
Next of Kin __________________________________ Phone: ___________________________
(Last)
(First)
AUM Student ID number S00_______________ (required)
COLLEGES, UNIVERSITIES ATTENDED:
Name of Institution
City, State
Dates Attended
(Month, Year)
Previous Bachelor’s
Degree?
Date Conferred:
Plan for Completion of
Prerequisite Requirements
Course
School
Semester
EARN
DEMOGRAPHIC INFORMATION
Name:__________________________________________ Date: _______________________
The School of Nursing considers applicants on the basis of their academic qualifications and does not
discriminate in regard to age, sex, race, creed, marital status, or ethnic origin. The information requested
below is for the purpose of compiling data for reports to federal and state agencies and for accrediting
associations.
CIRCLE AND/OR FILL IN THE CORRECT INFORMATION
1. Date of Birth:_______________________
Month/Day/Year
2. Gender
a. Male
b. Female
3. Marital Status:
a.
Never Married
b.
Married
c.
Widowed
d.
Divorced
e.
Separated
8. Prior Nursing Education:
a. LPN
b. R.N., Diploma-Yr. Grad._________
c. R.N., A.D.N.-Yr. Grad.__________
d. Armed Services:
_____________________________
(specify)
e. Other:________________________
(specify)
9. Other Degree (BA/BS):________________
Other degree major: ___________________
(specify)
4. Children: ______ Ages: ___________
10. Place of Birth:
a. Alabama_____________________
5. Race/Ethnic Background:
(county)
a.
American Indian or Alaskan native
b. Out of State___________________
b.
Asian (not Hispanic origin)
(state)
c.
Black or African American (not Hispanic origin)
c.
Out
of
Country________________
d.
Hispanic or Latino
(country)
e.
Native Hawaiian or Other Pacific Islander
11. Citizenship Status
f.
White (not Hispanic origin)
a. Native born U.S. Citizen
g.
Two or more races
b. Naturalized U.S. Citizen
c. Resident Alien Status
6. Employment Status:
d. Non-resident Alien Status
a.
Full Time
b.
c.
7.
Part Time ______hrs/week
Unemployed
Occupation:______________________
12. Have you previously applied to this School of
Nursing for admission?
a. Yes____
Date(s):__________
b. No ____