Arizona State University
College of Nursing & Health Innovation
Application
Instruction
Packet
Updated 5/31/11
College of Nursing & Health Innovation
500 North 3rd Street, Mail Code 3020
Phoenix, Arizona 85004-0698
Application Instructions:
ADMISSION PROCEDURE
Please be aware that because of the changes in the health care system, certain nursing roles are in great
demand and admission is highly competitive. Therefore, completed applications (including transcripts,
letters of recommendation, all required paperwork) must be received no later than the posted
deadline for priority review. Applications that are late will be reviewed only if there is space available after
the admission process (interviews and review) has been completed. Late applications that are not
reviewed will not be processed for the next application cycle; those applicants will need to reapply for the
following admission term.
1. Apply to the ASU Graduate College:



See web site: http://graduate.asu.edu/admissions/how_to_apply
An official transcript from each institution attended must be sent directly to
the Graduate College Admissions Office (see address below)
GRE (Graduate Record Examination) - Analytical Writing Score from the
General Test– request that scores be sent electronically to ASU. See web site:
http://www.ets.org/gre (Note: post-Masters students are not required to
provide a GRE score; recommended [not required] for Nursing Education
degree/certificate program if needed to enhance academic record.)
Send transcripts to:
Arizona State University
Graduate College, Interdisciplinary Bldg, B-Wing, Room 170
P.O. Box 871003
Tempe, Arizona 85287-1003
2. Apply to your desired degree program by completing the supplemental section
of the Graduate College’s application, and download the Required Application
Forms Packet from the link within this section of the application.


Upload a current, detailed resume or curriculum vitae
Upload your Statement of Purpose, per the below instructions:
Prepare a statement reflecting your goals and purposes for pursuing graduate
study. For admission purposes, goals will be judged for clarity and congruity
with graduate education, congruity with selected role in the degree/certificate
and congruity with past and current work experience. Please limit to no more
than 500 words. Include the following in your statement:
Updated 5/31/11




Relationship of your identified area of study, your career goals, and
specific outcomes you want to accomplish from graduate study
Relationship between your career goals and past and current clinical
experience including work experience or future plans to work in rural areas
and/or with medically underserved populations.
Ideas for your Applied Project in your planned area of clinical expertise.
Upload materials on creative/research activities in which you have participated.
3. Submit Self-Evaluation Form (in this packet) and other requested materials
Please complete and submit your self evaluation form and other materials to:
Arizona State University
College of Nursing & Health Innovation
Graduate Admissions Advisor
500 North 3rd Street, Mail Code 3020
Phoenix, Arizona 85004-0698
4. Advisement/Information
Applicants who wish to discuss the application process, or explore career choices
and graduate program options, can contact the Graduate Academic Advisor at (602)
496-0703.
5. Interview
Applicants are required to have an interview with a faculty representative from the
area in which the student plans to study. Only applicants with complete
application files will be scheduled for an interview with College of Nursing &
Health Innovation faculty.
TUITION AND FEES
The current University Tuition and Fees Schedules are published on the ASU Web site at:
http://www.asu.edu/admissions/tuitionandfees/ . Tuition and fees are subject to annual review and
possible change upon approval by the Arizona Board of Regents. Additional fees may be attached to
practice courses.
FINANCIAL ASSISTANCE
Financial Assistance for graduate study is available in the form of scholarships, traineeships,
assistantships and loans. Scholarships, some traineeships and assistantships are awarded to full-time
students with regular admission status and satisfactory academic standing. Students are advised to
consult the Graduate College Bulletin, Arizona State University Office of Student Financial Assistance, or
the College of Nursing & Health Innovation website for additional information.
Please visit our website at http://nursingandhealth.asu.edu for additional information
and links to University resources.
Updated 5/31/11
SELF EVALUATION FORM
Applicant’s Name (to be completed by applicant)
Applying to:
Address (to be completed by applicant)
Master of Science in Nursing Degree __ Nurse Educator __Community & Public Health
Certificate Programs:
Community and Public Health Certificate
Indicate your preference for program of study:
Full time
Nurse Educator Certificate
 Part time
DIRECTIONS TO THE APPLICANT: Please complete all three pages of this form, sign at the end, and mail
to the address indicated. Early receipt of the evaluation will be advantageous.
Place an “X” through the box that best reflects your assessment of yourself on each of the attributes listed
below.
A. CURRENT NURSING KNOWLEDGE
1 Outdated; scattered and irregular knowledge of nursing
2 Possesses limited current information
3 Familiar with most general information
4 Keeps abreast
5 Thorough systematic understanding of nursing
 CANNOT JUDGE
B.

CREATIVITY
1 Fails to incorporate new information
2 Maintains status quo; requires assistance with new information
3 Supports the development of new ideas; deals adequately with information
4 Contributes to development of new ideas; grasps new information
5 Generates new ideas; grasps new information easily
 CANNOT JUDGE
C.
INITIATIVE
1 Requires detailed instruction; dependent on others
2 Frequent supervision required; relies on others
3 Routine worker; requires supervision on new tasks
4 Resourceful; independent; paces self
5 A self-starter; seeks additional tasks
 CANNOT JUDGE
Updated 5/31/11
D.
ACCURACY
1 Makes frequent avoidable errors
2 Work is inaccurate
3 Adequate level of accuracy; occasional errors
4 Seldom makes an error; careful
5 Always accurate; work shows great attention to detail
 CANNOT JUDGE
E.
COMMUNICATION
1 Difficulty communicating ideas and intentions to others
2 Acceptable communication within nursing under normal circumstances
3 Communicates clearly within nursing under unusual circumstances
4 Communicates clearly to multiple audiences under unusual circumstances
5 Clearly expresses ideas even under stress; can translate communication of others (negotiator)
 CANNOT JUDGE
F.
PERSEVERANCE
1 Changes objectives; unable to complete tasks without direction
2 Not well focused; rarely completes tasks without direction
3 Usually focused; completes most tasks; requires some direction
4 Focused; completes tasks with only appropriate direction
5 Focused on objectives; completes tasks; overcomes obstacles
 CANNOT JUDGE
G.
ORGANIZATION
1 Unable to prioritize tasks; disorganized work habits
2 Variable efficiency in managing tasks
3 Reorganizes efficient ways of accomplishing tasks with some direction
4 Organizes work and accomplishes tasks with minimal direction
5 Prioritizes and accomplishes tasks independently
 CANNOT JUDGE
H.
PRODUCTIVITY
1 Insufficient; needs prodding
2 Does only required minimum
3 Good, average output
4 Usually does more than required
5 Energetic; highly productive
 CANNOT JUDGE
I.
LEADERSHIP
1 Does not understand how to get cooperation; poor discipline, too lax or severe
2 Frequent difficulty in obtaining cooperation; difficulty getting job done
3 Receives routine cooperation; gets satisfactory job done
4 Influences and inspires others; get job done well
5 Forceful leader; promotes top performance from others
 CANNOT JUDGE
J.
JUDGMENT
1 Poor judgment; likely to make illogical decisions
2 Fair judgment under normal circumstances; sometimes acts before thinking
3 Judgment good on routine matters
4 Thinks clearly and positively under unusual circumstances
5 Logical; sound judgment
 CANNOT JUDGE
Updated 5/31/11
K.
ADAPTABILITY
1 Has considerable difficulty in adjusting to any assignments
2 Has some difficulty when shifted to new/different assignments
3 Average amount of guidance needed to learn variety of duties
4 Usually learns new assignments with normal supervision
5 Highly flexible; can handle many varied assignments
 CANNOT JUDGE
L.
STRESS TOLERANCE
1 Easily irritated; finds pressures intolerable
2 Occasionally goes to pieces under pressure; is “jumpy” and nervous
3 Has average tolerance for crises; usually remains calm
4 Tolerates pressures; tolerates crises better than most
5 Thrives under pressure; enjoys challenges and problems
 CANNOT JUDGE
M. DEPENDABILITY
1 Unreliable; needs detailed supervision and follow-up
2 Somewhat unreliable; requires occasional check on routine tasks
3 Usually can be depended on, but must be checked on important matters
4 Usually meets responsibilities carefully and correctly
5 Merits utmost confidence
 CANNOT JUDGE
N.
OVERALL POTENTIAL FOR GRADUATE STUDY
1 Unlikely to be successful in graduate studies
2 Likely to have some difficulties in graduate studies
3 Has potential for success in graduate studies
4 Likely to be successful in graduate studies
5 Highly likely to be successful in graduate studies
 CANNOT JUDGE
Updated 5/31/11
Additional comments:
If possible, please list the names, addresses, and phone numbers for five potential Clinical Sites / Preceptors in your
area (this is especially important if you are outside the Phoenix area, or are an out-of-state applicant):
1.
2.
3.
4.
5.
Printed Name:
Your Signature:
Date:
Reference forms received by the College of Nursing and Health Innovation are the property of Arizona State
University. They are confidential and not shared with the applicant or persons other than the faculty on the
ASU College of Nursing and Health Innovation Standards Committee or in an advisement position.
Please send completed reference form to:
Graduate Admissions Advisor
College of Nursing & Health Innovation
Arizona State University
500 North 3rd Street, Mail Code 3020
Phoenix, AZ 85004-0698
Updated 5/31/11
ARIZONA STATE UNIVERSITY
COLLEGE OF NURSING AND HEALTH INNOVATION
GRADUATE PROGRAMS
Immunizations, Health and Fingerprint Information Required
Submit to: Graduate Academic Advisor-DNP, College of Nursing and Health Innovation, 500 N. 3rd
Street, Phoenix, AZ 85004-0698 prior to the application deadline :

Proof of required two doses of MMR, Measles (Rubeola), Mumps, and Rubella vaccine (second
MMR must be given after 12/31/79). If the student chooses not to have the second MMR, the
student must have a titer that demonstrates immunity for Measles (Rubeola) and Rubella.
*Required of all students applying to ASU. Therefore, you must also submit MMR
information separately to the ASU Health Services office; please download the form from
the following website: http://students.asu.edu/forms/measles-immunization-form
If this is not in place, you will be unable to register for classes. Students who have had
organ transplants should notify the Graduate Program Office to request a permanent
waiver.

Proof of completion of Hepatitis B vaccine (a series of three inoculations or titer)

Proof of Tetanus/Diphtheria (Td) immunization within the past 10 years.

Proof of Chicken Pox (Varicella) immunity by titer. If titer is negative, a series of two
vaccinations (at least 8 weeks apart) is required.

Proof of a negative TB Skin Test that will be current at the beginning of the time of admission.
Follow-up treatment is required if the TB Skin Test is positive. Documentation of BCG does not
mean you do not have to meet this requirement. BCG does not give a true positive TB test and
therefore does prevent you from being required to demonstrate a negative TB skin test or proof of
treatment for latent TB infection. . Treatment must be initiated prior to enrollment in any clinical
course. A TB Skin Test (or evidence of follow-up treatment) is required every 12 months while
students are participating in clinical courses.

Copy of active RN license (and copy of advanced practice license if applicable); copy of
current CPR “Level C” Certification (Health Care Provider) that will not expire in the next 12
months.

Fingerprint Clearance Card (AZ residents.) (Xerox copy must be submitted; student responsible
for retaining the original card and showing it to agencies upon request). “Restricted” fingerprint
card requires a Petition submitted to the College of Nursing & Healthcare Innovation Standards
Committee. See website: http://www.azdps.gov/reports/fingerprint/faq/default.asp . Out-of-state
applicants: please submit similar verification of clearance of a fingerprint/background
check.
The following items will need to be submitted to the College of Nursing and Health Innovation
Graduate Program Office, upon admission to your program:


Proof of negative drug screen. Applicants will be notified by the Graduate Education and
Advanced Practice Program Office about the procedure for the drug screen. Due to changes in
contracts with clinical agencies this requirement may need to repeated annually.
Additional laboratory tests, and/or immunizations, or documentation may be required for
practicum courses by certain health care agencies.
Updated 5/31/11
NOTE: Students are responsible for maintaining the current status of their health records in their student
file located in the Graduate Program Office. Only photocopies of all documentation of health related
materials will be accepted, and may be faxed to 602-496-0545. Students are responsible for maintaining
their own records of current CPR certification, proof of negative TB skin tests and current fingerprint card
until graduation. Copies of proof of these updates must be submitted to the Graduate Program Office
when due.
APPLICATION CHECKLIST
A complete application MUST be submitted prior to the application deadline for priority
review. Please ensure you have submitted all of the following items:
Complete the Application for Graduate Admissions through the Graduate College
at http://graduate.asu.edu/admissions/index.html and pay the appropriate fees.
Be sure to upload your Statement of Purpose, your Resume, and any creative
and/or research activity materials as part of this application.
Have your transcripts from every college and university from which a Bachelors
degree or higher was earned, sent to:
Arizona State University
Graduate College
Interdisciplinary Building, B-Wing, Room 170
PO Box 871003
Tempe, AZ 85287-1003
Click on the link within the application to download the Required Application Forms
Packet and submit all required forms.
Complete and submit all supplemental materials to the DNP Academic Advisor:
Self-Evaluation Form
GRE Score (Analytical Writing score only is required)
**NOT required of post-Masters applicants
Copy of active RN License
Copy of active Advanced Practice license (required for post- Masters with
advanced practice ONLY)
Health and Immunization Documentation (complete all requirements
specified on the information page)
Copy of AZ DPS Fingerprint Clearance Card (or similar documentation for
out-of-state residents proving clearance of fingerprint/background check)
International students: all additional Graduate College requirements
Updated 5/31/11