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Nursing Application

*For ADN Program only, current application deadline is June 1, 2010.

Program of Interest
First Name
Middle Name
Last Name
Other names by which you have ever been known
Date of Birth (MM/DD/YYYY)
Gender
Permanent Street Address
Permanent City
Permanent State
Permanent Zip Code
Current Address
Current City
Current State
Current Zip Code
Email
Home Phone
Work Phone
Mobile phone
Where did you receive your High School Diploma/GED?
HS Graduation Date (MM/DD/YYYY)
GED: State and Date received
Have you ever been licensed by any country, state, or province to practice as a health care provider (including but not limited to certified nursing assistance, licensed practical nurse, registered nurse, pharmacist, physician, dentist, physical therapist, occupational therapist, dental hygienist, psychologist)?
Licensure History
If you have been licensed as a health care provider (as stated above), please indicate the year(s) you were licensed, what profession you were licensed as, and the jurisdiction (state, etc.).
Request for accommodations: In order to serve your best interests as a student, we would like to plan ahead for any accommodations necessary as a consequence of a disability you may have. Please respond to the question below.
Special Accommodations
If you require special needs, please provide information here. We are happy to make those reasonable accommodations that are required under the law to make certain you have the fullest opportunity to succeed.
Criminal History, Criminal Background Check, Random Screening for Substance Abuse
If accepted, you will be afforded clinical opportunities to care for patients. We must inquire about your criminal history, since we are providing you access to patients through our affiliating clinical agencies. We will be asking you for a criminal background check and may ask for random biometric screening for substance abuse (example - urine sample, blood sample). Refusal to submit to a criminal background check or random drug screening, if asked, is grounds for program dismissal.
Criminal History
If you have a criminal history, please list below any history you have of legal convictions (felony or misdemeanor) against you. Provide the convictions, date, and resolution (fines/imprisonment).
Before submitting this online form, please review the additional information regarding application submission provided below the submit button.
  
Once this application is submitted, it becomes the property of the University of Charleston.  Please keep a record of your information that you submitted along with the supplemental information that is required (see below).

We will respond to your application with a letter of decision within no more than 15 working days from the date that we have your complete application on file. 

After submitting this application, you will be redirected to a page confirming your application submission.  It might be helpful to print the confirmation page for your records.  If you do not receive the confirmation page, please contact Admissions at 1.800.995.4682. 

If you are a current UC student, your application is NOT complete until we have:

  • A copy of your current degree audit.
  • A copy of your scores on the Nursing Entrance Test (TEAS) which can be taken on campus through the Learning Support Services office.  (You can call 304.357.4931 to schedule an appointment.  Tests are only given on Mondays and Fridays at 9 AM, but students must have an appointment in order to take the exam.)

If you are not a current student at UC (transfer student), we require:
  • Confirmation of your admission as a student to the University of Charleston through the Admissions Office.
  • A copy of your scores on the Nursing Entrance Test (TEAS) which can be taken on campus through the Learning Support Services office.  (You can call 304.357.4931 to schedule an appointment.  Tests are only given on Mondays and Fridays at 9 AM, but students must have an appointment in order to take the exam.)
Thank you for your interest in the University of Charleston.