RN to BSN Completion ApplicationThis application form is not for use by re-entry nursing students or students who have taken nursing courses in another baccalaureate nursing program. Contact Janet Johnson-Deeds for re-entry or transfer advising.RN to BSN Completion Program Application Name* First Last Social Security Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Working Home Phone*Working Cell Phone*Working Email Address* Date First Entered SAU* Date Format: MM slash DD slash YYYY Last Date of Enrollment at SAU* Date Format: MM slash DD slash YYYY Have you ever been enrolled in a nursing clinical course?*YesNoWhich university or universities?*ListCOLLEGE/SCHOOLDATESDEGREE EARNED The following application requirements are completed:Application Requirements* 1. Admitted to SAU with regular admission status. 2. Graduate of an NLNAC or ACEN accredited nursing program leading to RN licensure. (Graduates of non-accredited schools will be considered on an individual basis). 3. Of the total hours earned toward graduation, no more than 25 percent may be “D” grades. 4. Copy of current unencumbered RN license from the student's state of residency and/or nursing practice. 5. Submit current copies of Hepatitis B vaccination, TB screening, American Heart Association Healthcare Providers certification, and CPR certification. 6. Submit copies of ALL unofficial transcripts with application.I understand that the following are requirements of BSN program: 1. Travel may be required to Arkansas, Louisiana, or Texas for clinical sites. 2. Attendance for evening or weekend clinical may be required. 3. Realize if an injury occurs in the clinical setting, the student is responsible for all applicable cost related to the injury. Students are strongly encouraged to obtain health insurance. Information concerning health insurance available for SAU students may be accessed at the following website: www.saumag.edu 4. Understand criminal background checks, driving history record checks, and urine drug screens are required during semester of nursing program enrollment and yearly thereafter.Complete the following information for the courses you have completed at the time of application.Transfer equivalency information is available on the SAU website under “Prospective Students/Transfer Students/Articulation Agreement.”*Southern Arkansas UniversitySAU TechOtherFreshman Seminar GSTD 1002Composition I ENGL 1113Composition II ENGL 1123Philosophy PHIL 2403World Literature I ENGL 2213 OR World Literature II ENGL 2223World Literature I ENGL 2213 ORWorld Literature II ENGL 2223 ORArt Appreciation ART 2013 ORFilm Appreciation HUM 2003 ORMusic Appreciation MUS 2013 ORTheatre Appreciation THEA 2003 ORForeign Language 3 hoursGeneral Psych PSYC 2003US History HIST 2013 ORUS History HIST 2023 ORAmer Gov PSCI 2003World Hist I HIST 1003 ORWorld Hist II HIST 1013Col Chem/Lab CHEM 1011/1013 ORUniv Chem/Lab CHEM 1023/1021A&P I BIOL 2061/2063College Algebra MATH 1023 ORPre-Calc MATH 1045 ORCalculus I MATH 1525Speech SPCH 1113Develop. Psych PSYC 3223Statistics SOC 3183A&P II BIOL 2071/2073Microbiology Biol 3032/3022Nutrition & Diet BIOL 2003Unrestricted Elective 2 hoursPlease attach copies of the following: Hepatitis B, Flu Vaccination, TB screening, and current American Heart Association CPR certification.* Drop files here or Accepted file types: jpg, gif, png, pdf.By clicking submit on this form, I certify that all information is true and correct. I understand that withholding or submitting inaccurate information may make me ineligible for admission and enrollment and subject to administrative withdrawal.