BSN Application for Admission 2006-2007

Please download and print the instructions before filling out the application:

PERSONAL INFORMATION	Mr. Miss Mrs. Ms.
Last Name: *
First Name: *
Middle Name:
Maiden Name (if applicable):
Address: *
City: *
State: *
Zip: *
Home Phone: *
Day Phone:
E-Mail Address: *
Gender:	Male Female
Birth date: (mm/dd/yyyy)


VETERAN STATUS	Are you a veteran or on active duty in the U.S. Armed Forces Yes No


MARITAL STATUS (OPTIONAL)	Single Married Divorced Separated Widowed


ETHNIC/RACIAL GROUP STATUS (OPTIONAL)	African-American/Black (non Hispanic) Asian or Pacific Islander Hispanic/Latino/Latina American Indian or Alaska Native White (non-Hispanic) Multi-Ethnic Prefer not to Respond


CITIZENSHIP	United States Permanent Resident Alien (Registration Number: ) * Please mail front and back copies of your Alien Registration card to West Suburban College of Nursing
Other:	F-1 Student Visa J-1 Exchange/Visitor Visa Other type of Visa
Country of Citizenship:
Nationality:


ENROLLMENT INFORMATION	Transfer Student RN-BSN Completion Option Fast Track Option Pre-nursing Non-degree seeking Readmission
I plan to enroll in:	Fall (Year: ) Spring (Year: )
	Full-time Part-time
How did you learn about West Suburban College of Nursing?



EDUCATION INFORMATION
High School:
City, State:
Date of Graduation:
List all colleges previously attended; most recent one first:
1. College or University:
City/State:
Dates Attended:
Degrees Earned:
2. College or University:
City/State:
Dates Attended:
Degrees Earned:
3. College or University:
City/State:
Dates Attended:
Degrees Earned:
4. College or University:
City/State:
Dates Attended:
Degrees Earned:
5. College or University:
City/State:
Dates Attended:
Degrees Earned:
To what other schools are you applying?
1. College or University:
City/State:
Major:
2. College or University:
City/State:
Major:


I certify that that the information on this application is to the best of my knowledge, accurate, complete, and my own. I understand that if I have falsified or withheld information, I would be ineligible for admission to West Suburban College of Nursing, or subject to cancellation of registration if admission has occurred or dismissal if already enrolled. I give my permission to officials at all institutions I have attended to release information needed to verify statements I have made on this application.
Name: _______________________________________________ Date: __________
West Suburban College of Nursing admits without regard to age, race, color, sex, national or ethnic origin, creed, religion, or disability.




Please print two copies of this page now before submitting. Keep one copy for your records. Print This Page Submit the second printed application (signed and dated) through postal mail with your check or money order for $30.00 made payable to: West Suburban College of Nursing. Official transcripts, letter of recommendation and form, essay and if applicable, the front and back copies of your Alien Registration card should also be submitted to: West Suburban College of Nursing, Office of Enrollment Management, 3 Erie Court, Oak Park, IL 60302. You will also need to call the Office of Enrollment Management at 708.763.6530 to schedule your TEAS Exam appointment.