RN-BSN Application

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• Gender selection is required.

Title*	Mr. Mrs. Ms.
First Name*
Last Name*
Student ID# (if available)
DOB*
Gender*	MaleFemale
Age*	Select One 25 years and younger 26-30 years 31-40 years 41-50 years 51-60 years 61 years and older
Ethnicity*	Select One African American American Indian Filipino Non-Filipino/Asian or Pacific Islander Caucasian Hispanic Other Decline to state
Street Address*
City*
State*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip*
Home Telephone*
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Email address*
Confirm email address*
Have you applied to the CSUSB Nursing Department before?*	Select One Yes, I have No, I have not
If yes, when?
How many other schools/programs are you applying to:
Campus Applying to*	Select One CSUSB PDC Both
Number of units completed*
Other colleges attended* (3500 character limit)
Experience in any of the following criteria:	Healthcare experience Community service Other
First generation of college attendance	Yes

Bilingual Proficiency (includes sign language)

Language 1.		Proficiency 1	OralWritten
Language 2.		Proficiency 2	OralWritten
Language 3.		Proficiency 3	OralWritten

REQUIRED PREREQUISITE COURSES

COURSE	UNIT	GRADE	SEM/QTR COMPLETED	UNIVERSITY course was TAKEN	COURSE NAME
BIOL220 (Microbiology)
BIOL223 (Anat & Phys I)
BIOL224 (Anat & Phys II)
ENG 101 (A1 GE)
COMM120 (A2 GE)
CRITICAL THINKING (A4 GE)
One math course that satisfies Category A3/B1 General Ed Requirement
CHEM205 (General Chemistry)
CHEM208 (Human Biochemistry)
PSYCH201
NURS316
NURS340
NURS380
MATH305

PLEASE USE THE FOLLWING WEBSITES TO ASSIST IN COURSE EQUIVALENCY
www.assist.org
catalog.csusb.edu

By submitting this application, you agree that the above information is complete and accurate.  You have read all the information on this application and understand that proof of ALL prerequisite courses and ANY "additional course" completed and/or in progress will be provided by you before the deadline.
Signature*