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LWC Pre Licensure BSN Program Application
Admission to the pre-licensure BSN program occurs in the fall semester. Admission to the College does not guarantee admission to the pre-licensure BSN program. Students may apply to the pre-licensure BSN program beginning January 1 of the calendar year for which admission is sought. For consideration of admission in the fall semester, the deadline for submission of the application to the Division of Nursing & Health is March 1. In the event March 1 deadline falls on a weekend, the deadline for application will be extended to the following Monday at 5:00 p.m. Correspondence to applicants regarding admission status will be sent to the email address on record.

You will need the following information to complete this application:
Biographic Information: Email address, mailing address, phone number, date of birth, country of birth
Citizenship status and VISA information if you are not a United States Citizen.
United States Armed Service information if you have been a member or are currently serving in the United States Armed Forces.
Criminal Background Information, if applicable.
Academic Infraction information, if applicable.
Professions License Infraction information, if applicable.
Academic History - Previous college attended, if applicable.

Email address
BIOGRAPHIC INFORMATION
Last Name
Your answer
First Name
Your answer
Middle Initial
Your answer
Alternate Name - Do you have any materials under another name (for example a maiden name, middle name or nickname?
Required
If yes is selected above, please enter alternate name information below.
Your answer
What is your gender?
Date of Birth
MM
/
DD
/
YYYY
Country of Birth
Your answer
Current Street Address
Your answer
Current City
Your answer
Current State
Your answer
Current Zip Code
Your answer
Approximate Date through which your current address is valid (select from date field
MM
/
DD
/
YYYY
Is this your permanent address?
Required
If you answered no above, please enter permanent address below (include street address, city, state, zip code.
Your answer
Preferred Phone Number (include area code)
Your answer
Alternate Phone Number (include area code)
Your answer
CITIZENSHIP INFORMATION
United States Citizenship Status
Country of Citizenship (if not a United States Citizen)
Your answer
Do you have dual citizenship?
If Yes is selected above, enter second Country of Citizenship below.
Your answer
Do you have a United States Visa?
If Yes is selected, please provide Visa Number below.
Your answer
What type of Visa?
RESIDENCY DETAILS
Legal State of Residence
Your answer
Legal County of Residence
Your answer
How long have you been a resident of your state?
RACE AND ETHNICITY
Do you consider yourself to be of Hispanic/Latino Origin?
Required
If yes is selected above, check all that apply:
Please select one or more of the following groups in which you consider yourself to be a member
Required
OTHER INFOMATION
What is your native language?
If English is not your primary language, please enter TOEFL iBT score below. Please note applicants to the Pre Licensure BSN program who document English as a second language must demonstrate an overall passing standard score of 83 on the Test of English as a Foreign Language (TOEFL iBT).
Your answer
Indicate your anticipated US Military status at the time you enroll
Please specify branch of the United States Armed Forces
Service began
MM
/
DD
/
YYYY
Service ended
MM
/
DD
/
YYYY
Are you still serving?
Legal Infractions
Kentucky State law, KRS 314.109, required licensed/credentialed individuals report criminal convictions to the Kentucky Board of Nursing within ninety (90) days of the conviction.

Kentucky Board of Nursing Administrative Regulations 201 KAR 20:370, states that any individual applying for license/credential must report criminal convictions. LWC Program of Nursing informs applicants of this regulation upon application to the program. Questions regarding KRS 314:109 should be directed to nursing@lindsey.edu and the Kentucky Board of Nursing.

KENTUCKY BOARD OF NURSING
312 Whittington PKY, SUITE 300
LOUISVILLE, KY 40222-5172
1-800-305-2042 or (502) 429-3300
http://kbn,ky.gov

Have you ever been convicted of a Misdemeanor?
Required
Have you ever been convicted of a Felony?
Required
Academic Infractions
Have you every been disciplined by any college, university, or professional school for: (1) unacceptable academic performance (academic probation, suspension, dismissal, etc.) or (2) conduct violation?
Required
If you answered yes, you must provide an explanation. Include 1)a brief description of the incident and/or arrest, 2)specific charge made, 3) related dates, 4) consequence, and 5) a reflection on the incident and how the incident has impacted your life.
Your answer
License Infractions
Have you ever had any certification, registration, license or clinical privileges revoked, suspended or in any way restricted by an institution, state or locality?
Required
If you answered yes, you must provide an explanation. Include 1)a brief description of the incident and/or arrest, 2)specific charge made, 3) related dates, 4) consequence, and 5) a reflection on the incident and how the incident has impacted your life.
Your answer
Check if any of the following apply to you:
Do you plan on applying for financial aid?
Required
Have you ever been admitted to but not completed a nursing program (excluding pre-nursing)?
Required
Are you the first generation of your family to enroll in an institution of higher education?
Marital status
How did you hear about the Pre-Licensure BSN Program at Lindsey Wilson College?
Your answer
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