Traditional Nursing Application 2024-2025

Traditional Nursing Application

2024-2025
Fall 2025 Application Open Between
Sept 1, 2024 to Feb 1, 2025
From
To
Name:*

First NameMiddle NameLast Name
Previous Last Names:
Seperate with a comma if there are more than one previous last name.
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.
Preferred Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a SWOSU student enrolled at SWOSU this current semester applying for admission to the School of Nursing?*

YesNo
Student ID*
Student ID number
Are you a former SWOSU student NOT currently enrolled this semester at SWOSU who is applying for admission to the School of Nursing, OR are you a transfer student from another college or university applying for admission to the School of Nursing?*

YesNo
I have completed the SWOSU Admissions Application Yes No*
I understand all prerequisites must be completed prior to starting the Nursing school in the Fall semester and I may only lack 12 hours in the Summer 2025 semester. I also understand it is my responsibility to enroll in all remaining prerequisite courses. *please reach out to your advisor for guidance**

YesNo
Are you a United States citizen?*

YesNo
Date of Birth*
What is your sex?*

FemaleMale
What is your gender identity?
What is your race and/or ethnicity?*
Emergency Contact Name

First NameLast Name
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Information

Please complete all fields.
What high school did you graduate from?
Have you previously made an application to the SWOSU Department of Nursing?*

YesNo
Do you currently hold an active, unencumbered LPN (licensed practical nurse) license?*

YesNo
Are you a CNA (certified nursing assistant)?*

YesNo
Are you a Basic or Intermediate EMT (emergency medical technician)?*

YesNo
Are you a paramedic?*

YesNo
Have you ever attended a nursing program?*
Please list any additional health profession experience.
Postsecondary Education

Please list all formal education after high school.
Name of Institution, City and State, Dates Attended, Degree(s) earned*
Additional School: Name of Institution, City and State, Dates Attended, Degree(s) earned
The following information is required by the Oklahoma Board of Nursing Registration and Nursing Education.

In addition to the background check, applicants for licensure who have ever been summoned, arrested, taken into custody, indicted, convicted or tried for, or charged with, or pleaded guilty to, the violation of any law or ordinance or the commission of any misdemeanor or felony, or requested to appear before any prosecuting attorney or investigative agency in any matter; or have ever had disciplinary action taken against a nursing license, certification or registration, any professional or occupational license, registration, or certification and/or any application for a nursing or professional or occupational license, registration, or certification or if there is currently any investigation of your nursing license, registration, or certification; and/or any professional or occupational license, registration, or certification; and/or any application for a nursing and/or professional or occupational license, registration, or certification in any state, territory or country, or have ever been judicially declared incompetent are required to notify the Oklahoma Board of Nursing in writing.
Do any of these categories apply to you?*

YesNo
If you answered "yes" to the previous question, have you notified the Oklahoma Board of Nursing of this by completing and submitting the Petition to Request Determination of Eligibility for Licensure form?*

YesNoI did not answer "yes" to the previous question
SWOSU Department of Nursing Marijuana Policy

The use of cannabis, marijuana and/or any form of tetrahydrocannabinol (THC) is illegal under federal law, and is prohibited under SWOSU policy. Nursing students attend clinical sites that receive federal funding. In addition, nurses and nursing students have a safety-sensitive job duty to their client. A positive cannabis/marijuana/THC drug screen will result in immediate dismissal from the nursing program, regardless of medical marijuana card status. To comply with guidelines set forth by our clinical sites, all SWOSU Department of Nursing students will be required to complete random drug screening. The SWOSU Department of Nursing has contracted with an independent agency to complete the screening. All testing will be completed before the beginning of the clinical experience.
Marijuana Policy Agreement: I have read, understand, and agree to obey the SWOSU Department of Nursing Marijuana Policy.*

Yes
Employment Information
How many hours per week do you plan to work while in nursing school?*
Do you have prior employment?*

YesNo
Please list only your last two employers, beginning with the most recent. Or write NA for not applicable.*
Agreements

I herein submit my application for admission into the Nursing, Bachelor of Science program at Southwestern Oklahoma State University (SWOSU). I declare my intention to enroll in the SWOSU Nursing, Bachelor of Science program and declare Nursing, Bachelor of Science as my academic major. I understand the Southwestern Oklahoma State University (SWOSU) Department of Nursing admits a limited number of students due to available resources and/or faculty, and although I may meet or exceed the minimum requirements for admission, circumstances may prevent the SWOSU Department of Nursing from admitting all students who have met the admission criteria. I also agree that if I am admitted, I will read and abide by the most current SWOSU Department of Nursing student handbook, which can be found on the SWOSU website. I understand that the SWOSU Department of Nursing will often communicate with me via email or the online learning management system, and that I will check my SWOSU email and the online learning management system announcements several times weekly if admitted.
Statement Agreement*

I AGREE with the above statement.I DISAGREE with the above statement.
Affirmative Action Compliance Statement

This institution is in compliance with Title VI of the Civil Rights Act of 1964, Executive Order 11246 as amended, Title IX of the Education Amendments of 1972, and other federal laws and regulations. This institution does not discriminate on the basis of race, color, national origin, sex, age, religion, disability, or status as a veteran in any of its policies, practices, or procedures. This includes but is not limited to admission, employment, financial aid, and educational services.
Should be Empty:

Traditional Nursing Application

Educational Information

Postsecondary Education

The following information is required by the Oklahoma Board of Nursing Registration and Nursing Education.

SWOSU Department of Nursing Marijuana Policy

Employment Information

Agreements

Affirmative Action Compliance Statement