INDIANA UNIVERSITY KOKOMO - SCHOOL OF NURSING
Application Guidelines for Bachelor of Science in Nursing Program
Application Deadlines & Submission Information:
Deadline for Fall class – May 10th
Deadline for Spring class – September 10th
Submit in Person to:
Indiana University Kokomo
Nursing/Allied Health Advising Center
East Building, Room 120
765.455.9384
Submit by Mail to:
Indiana University Kokomo
Nursing/Allied Health Advising Center (KE 120)
2300 S. Washington Street
P.O. Box 9003
Kokomo, IN 46904
In order to apply to IU Kokomo’s Nursing program you must meet the application requirements. Failure to meet
these requirements will make you ineligible to apply. Nursing admission is competitive and meeting the minimum
requirements does not guarantee admission into the program.
Application Materials: All application materials must be submitted together at one time unless otherwise noted.
Application materials are only good for one semester. Students not selected for the nursing program must re-apply
and re-submit new application materials each semester if they wish to be reconsidered.
1. A completed nursing application (included below) – this is a different application than was submitted for admission
to the IU Kokomo campus
2. Official TEAS test results – results should be printed directly from the ATI website.
3. Unofficial transcripts from all non-Indiana University colleges/universities attended*
All applicants must provide, with their application, an official or unofficial college transcript from every non-IU
college or university attended. If you have recently completed a semester at another college/university or you
have not previously submitted an official transcript to IU Kokomo - then you must submit an official transcript,
with this application, so that those courses can be posted to your IU transcript. Applications will not be
considered until they are complete.
* If you have attended IPFW you may need to submit unofficial/official transcripts from Purdue. Some classes taken
on the IPFW campus will not be reflected on your IU transcripts if they were classes offered through the Purdue side of
campus. Please review your transcript if you are unsure about your classes.
4. Backgrounds checks are required to be completed before the application deadline; however students are not
required to submit paperwork for the check. The Nursing Department will be able to see that a background check
has been completed. Background check information is included below.
Additional Information:

Applications are only accepted in person at the Nursing/Allied Health Sciences Advising Office by 5 pm., or post
marked and mailed to the above address by the deadline. No faxed or e-mailed applications will be accepted. (If
deadline falls on a Saturday or Sunday students will have until the following Monday by 5 pm to submit their
application).

Students applying for the Fall class will be notified via IUK email of their status no later than June 1st and no later
than October 1st for those applying for the Spring class.
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IU KOKOMO BSN APPLICATION
Application for: (choose one)
Fall 20______
Indiana University Student ID Number: ____
____
Spring 20______
____
____
____ ____
____
____
____ ____
Name: _________________________________________________________________________________________________
Last
First
MI
In order to identify transcripts and/or other supporting documents, please list any other name(s) you
have used.
_________________________________________________________________________________________________________
Current Address:
_________________________________________________________________________________________________________
Street
Apt#
_________________________________________________________________________________________________________
City
State
Zip
Phone: _________________________________________________
IUK Email: __________________________________________________
If applicable, list the IU campus you are currently attending: ______________________________________
Number of credit hours taken at IU Kokomo: ______________________________________
List all other colleges and universities that you have previously attended:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
TEAS Test:
Date Taken: __________________
Where Taken: __________________________
For Office Use Only
Overall GPA: ___________________
Pre-Nursing GPA: ___________________
IUK Credit Hours: ___________________
Cumulative TEAS Score: ___________________
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Completion Plan: List the courses which you have completed or will complete.
Course Name
Where Taken
Course Number
Grade
Semester Enrolled
Semester
Completed
English Composition 1 (ENG-W131)
English Composition 2 (ENG-W132)
Public Speaking (SPCH-S121)
General Psychology ( PSY-P103)
Introduction to Sociology (SOC-S 100)
Basic Human Anatomy (ANAT-A 215)
Basic Human Physiology (PHSL-P 215)
Microbiology & Immunology lecture
(MICR-J200)
Microbiology & Immunology lab
(MICR-J 201)
College Algebra (Math-M105) or PreCalculus (MATH-M125) or Finite Math
(MATH-M118) or Topics in Probability
& Statistics (MATH-M133) AND Topics
in Mathematics (MATH-M134)
Please read the statements below and check the box to indicate that you have read and understand
the outlined information:
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I have read the Application Guidelines and I agree that I have met all of the requirements outlined for
application.
I understand that if I am admitted to the nursing major but decline to accept, I must reapply for reconsideration and admission is not guaranteed. I also understand that if I fail to accept admission to the major for a
second time, I will no longer be eligible for future consideration to the nursing program.
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I also understand that failure to meet all of the application requirements will make me ineligible for the IU
Kokomo Nursing program and if accepted, it will be provisionally.
I have included unofficial transcripts of all non-IU colleges/universities, which I have attended, with my
application. (If you have recently completed a semester at another college/university or you have not
previously submitted an official transcript to IU Kokomo - then you must submit an official transcript, with this
application, so that those courses can be posted to your IU transcript. Applications will not be considered
until they are complete.)
I have included a copy of my TEAS test results.
I have completed my Criminal Background.
I have read the Legal Limitations for Licensure. Click on the link.
I have filled out the Completion Plan for all pre-nursing courses.
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I have set up my IUK email (ADS Account) and understand if accepted into the nursing program all future
correspondence will be sent via my IUK email.
I certify all of the information provided on this application is true and accurate. I understand that I
must meet all School of Nursing admission requirements and deadlines in order to be considered for
admission.
Signature of Student: _______________________________________________
Date: ________________
CertifiedBackground.com
Instructions-Students
Indiana University Kokomo, School of Nursing
The above organization has chosen CertifiedBackground.com as an approved source for background checks.
CertifiedBackground.com is a background check service that allows individuals to order and purchase their own background checks
online. CertifiedBackground.com is a secure, tamper-proof website that does not sell or divulge any of your personal in- formation to
a third party. The results of these background checks are posted to the CertifiedBackground.com website where the
student, as well as school, can view the background check results.
Instructions
1. Go to www.CertifiedBackground.com and click on "Students".
2. In the Package Code box, enter the appropriate package code. *If you have any questions, please contact Customer Service at
888-666-7788 ext. 1.
IUK package code: IA03
3. Select a method of payment: Visa, MasterCard or Money Order
Additional Information
*If your order requires one or more release forms, you will be prompted to electronically sign your documents at the end of the
ordering process.
*If you are required to submit immunization, medical or certification r ecords with your order, you will be prompted to do so at
the end of the ordering process. You will be redirected to a page where you will view additional instructions for uploading your records.
After your order has been submitted, you will receive a confirmation email containing the password needed to view the results of your
background check. To view your results visit www.CertifiedBackqround.com, enter your password in the area provided on the lower
right side of the homepage, then enter the last four digits of your Social Security Number. Results are usually available within 3-5
days, though some searches take longer so please allow adequate time when ordering. For A Summary of Your Rights under the Fair
Credit Reporting Act visit www.ftc.gov.
www.CertifiedBackg round.com
Phone: (888) 666-7788
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info@certifiedbackground.com
Indiana University Kokomo School of Nursing
Criminal Background Results Guidelines
To protect patients in the clinical facilities used by IU Kokomo School of Nursing, and to assure the highest quality of care is given to the
patients, background checks will be required for all students prior to beginning the nursing program at IU Kokomo and rechecked on a yearly
basis.
The following limitations on acceptance into IU Kokomo School of Nursing are based on expectations set by our clinical facilities for
placement of our students in their facilities:
No student will be admitted to the program with a record of conviction for any of the listed crimes below:
1. Rape or any sex crime
2. Child Molesting
3. Sexual misconduct with a minor or vicarious sexual gratification
4. Criminal deviate conduct
5. Exploitation of an endangered adult, child, or adolescent or possession of child pornography
6. Failure to report battery, neglect, or exploitation of an endangered adult, child, or adolescent
7. Murder
8. Voluntary manslaughter
9. Conviction of a Federal Funded Program-related crime (i.e. Medicare or Medicaid)
10. Conviction relating to patient abuse
11. Felony conviction relating to health care fraud
12. Felony conviction related to dealing an illegal substance
A record of conviction within the previous five (5) years of admission for the following crimes will prohibit admission to the IU Kokomo School
of Nursing:
1. Theft
2. Involuntary manslaughter
3. Felony battery within the previous five (5) years
4. A felony offense relating to controlled substances within the previous five (5) years
If the conviction for the above is older than five (5) years, the Dean or his/her designee will make the determination for admission based on
the severity of the event, how long ago it happened, and what life changes have taken place since that time.
A pattern of criminally related activities, within the previous five (5) years of admission, may prohibit admission to the IU Kokomo School of
Nursing.
* These guidelines are aligned with guidelines used in the hospitals for new employees. Guidelines are subject to change based on changes
in policies at healthcare facilities where students participate in clinical experiences.
TITLE: Limited Criminal Background Check and Nationwide Healthcare Fraud and Abuse Scan
POLICY NO: SON-CL-3
RESPONSIBLE COMMMITTEE: Administrative
TARGET GROUP: Students
PLACEMENT: Handbook for Nursing Students
REVISION/REVIEWED: November 2010
Limited Criminal Background Check and Nationwide Healthcare Fraud and Abuse Scan
All of the clinical sites utilized by the Indiana University Kokomo School of Nursing for student clinical experience (e.g. hospitals, clinics, and
other agencies) require verification of a criminal background check before students may be placed in their organization.
Based on the requirements of these facilities, as well as state and federal regulations, all students applying to the undergraduate nursing
program must complete a limited criminal background check and a Nationwide Healthcare Fraud and Abuse Scan. The first background
check must be completed with the application to the school of nursing.
The school of nursing currently utilizes CertifiedBackground.com, as their approved source for background checks. The instructions on how
to complete this are on the following page or on the website. The current cost is $65.00.
A yearly recheck (within 365 days of the previous one), must be completed by August 1 st of each year. The cost of the recheck is currently
$25.00.
A student’s past criminal history may impact his/her admission to undergraduate nursing programs, limit the number of suitable
practice/clinical sites, and/or affect ability to obtain licensure as a registered nurse (RN) in the state of Indiana and other states.
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All positive check results will be reviewed by the Dean of the School of Nursing or her designee to determine the safety and appropriateness
for practice in the clinical setting.
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