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Georgetown University's CNL Program Application Supplemental Form
We appreciate your interest in the Georgetown University School of Nursing & Health Studies Clinical Nurse Leader program for Fall 2017 entry! Please submit this completed supplemental form by January 15, 2017.

You will have the ability to edit your responses after submitting. Please copy your unique URL on the following page to edit your response at a later date. Be careful when sharing the URL of the page, because it will allow others to also edit your response.

Please contact Michelle Cole at Michelle.Cole@georgetown.edu if you have any questions.

Contact Information
Please consistently use the same contact information below as on your ApplyYourself application.
First Name
Last Name
E-mail
Your Personal Prerequisite Course Completion Plan
Please enter your personal prerequisite course completion plan below. You will have the opportunity to update this information.

The below seven prerequisite courses must be successfully completed prior to matriculation. You may still apply with some prerequisites in progress provided all seven will be complete prior to your intended matriculation entry date. Prerequisite courses may be completed at any U.S. Department of Education accredited university, college or community college. Please note that a laboratory is required for Human Anatomy and Physiology I, Human Anatomy and Physiology II, Chemistry, and Microbiology. Both the lecture and lab must be completed with a B or better. It is encouraged that all prerequisite courses be completed within 5 years from your intended matriculation date.

Prerequisite Course: Human Anatomy & Physiology I with lab, 4 credits
Georgetown will accept the alternative course structure sequence of 4 credits of Human Anatomy followed by 4 credits of Human Physiology.
Completion Status of Human Anatomy & Physiology I with lab, 4 credits
Name of the Institution Where the Course was Completed or is Expected to be Completed (ex: Georgetown University)
Course Name and Number (ex: Human Bio I - HSCI 101)
Prerequisite Course: Human Anatomy & Physiology II with lab, 4 credits
Georgetown will accept the alternative course structure sequence of 4 credits of Human Anatomy followed by 4 credits of Human Physiology.
Completion Status of Human Anatomy & Physiology II with lab, 4 credits
Name of the Institution Where the Course was Completed or is Expected to be Completed (ex: Georgetown University)
Course Name and Number (ex: Human Bio II - HSCI 102)
Prerequisite Course: Chemistry with lab, 4 credits
Acceptable Chemistry courses include Principles of Chemistry I or II, General Chemistry I or II, Organic Chemistry I or II, Bochemistry, or Inorganic Chemistry.
Completion Status of Chemistry with lab, 4 credits
Name of the Institution Where the Course was Completed or is Expected to be Completed (ex: Georgetown University)
Course Name and Number (ex: Organic Chemistry - CHEM-115)
Prerequisite Course: Microbiology with lab, 4 credits
A four credit, general introductory course in Microbiology with lab will fulfill this prerequisite.
Completion Status of Microbiology with lab, 4 credits
Name of the Institution Where the Course was Completed or is Expected to be Completed (ex: Georgetown University)
Course Name and Number (ex: Microbiology - HSCI 201)
Prerequisite Course: Statistics, 3 credits
A three credit, general introductory course in statistics listed in any department usually will fulfill this requirement. Biostatistics is also sufficient.
Completion Status of Statistics, 3 credits
Name of the Institution Where the Course was Completed or is Expected to be Completed (ex: Georgetown University)
Course Name and Number (ex: Statistics - MATH 040)
Prerequisite Course: Human Nutrition, 3 credits
Completion Status of Human Nutrition, 3 credits
Name of the Institution Where the Course was Completed or is Expected to be Completed (ex: Georgetown University)
Course Name and Number (ex: Nutrition & Disease Prevention - HEST 112)
Prerequisite Course: Human Growth and Development, 3 credits
Human Growth and Development is commonly housed in a Psychology department and covers lifespan development from birth through death. Lifespan Development or Developmental Psychology Across the Lifespan will fulfill this requirement.
Completion Status of Human Growth and Development, 3 credits
Name of the Institution Where the Course was Completed or is Expected to be Completed (ex: Georgetown University)
Course Name and Number (ex: Human Growth & Development - HEST 142)
Official Transcripts
Please mail all official transcripts from all institutions where post-secondary coursework has been completed to Michelle Cole.

The preferred method is by secure electronic transcript delivery to Michelle.Cole@georgetown.edu if offered by your institution.

Official hard copy transcripts may also be mailed to:
Georgetown University, NHS Admissions Office
ATTN: CNL Application Transcripts
123 St. Mary's Hall
Box 571107
3700 Reservoir Road NW
Washington, DC 20057-1107.

Please allow up to 2-3 weeks after the submission of your ApplyYourself application for your official transcripts or test scores to be paired with your application.

Have you sent your official transcripts directly to Michelle Cole? We recommend sending transcripts as soon as possible, by December 1, 2016 at the latest.
Required
Bachelor's Degree Earned or Expected to Earn (ex: BS in Human Science)
Bachelor's Degree Conferred?
University that has conferred or will confer your Bachelor's Degree? (ex: Georgetown University)
Bachelor's Degree GPA? (ex: 3.75)
Date of conferred Bachelor's Degree? (ex: May 2016 or expected May 2017)
Master's Degree Earned (if applicable)
University that has conferred your Master's Degree? (if applicable)
Master's Degree GPA? (ex: 3.75)
Date of conferred Master's Degree? (if applicable)
Georgetown's CNL Program application submission deadline is January 15, 2017 for Fall 2017 entry. Please note the below three-part application procedure:
1. ApplyYourself Application
2. Supplemental Form
3. Online Video Interview: https://app.kiratalent.com/applicant/9h0u3t/instructions
Please note which of the remaining two parts of the application you have completed.
Required
You will have the ability to edit your responses after submitting.
Please copy your unique URL on the following page to edit your response at a later date. Be careful when sharing the URL of the page, because it will allow others to also edit your response.

Please contact Michelle Cole at Michelle.Cole@georgetown.edu if you have any questions. Thank you!

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