Application for Graduate Admission

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(a) American Indian or Alaska Native White (non-Hispanic) Multi-Ethnic Prefer not to Respond


RELIGIOUS AFFILIATION (OPTIONAL)


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
Degree program you are applying to:	Clinical Nurse Leader Medical-Surgical Clinical Nurse Specialist Nursing Administration Nurse Educator
How did you learn about West Suburban College of Nursing?



ENTRY OPTIONS	Traditional MSN Accelerated Combined Degree RN-MSN Post Masters Certificate
I plan to enroll in:	Fall 20 Spring 20


EDUCATION INFORMATION
List all colleges previously attended; most recent one first:
1. College or University:
City/State:
Dates Attended:
Major/Degree or Hours Completed:
2. College or University:
City/State:
Dates Attended:
Major/Degree or Hours Completed:
3. College or University:
City/State:
Dates Attended:
Major/Degree or Hours Completed:
4. College or University:
City/State:
Dates Attended:
Major/Degree or Hours Completed:
5. College or University:
City/State:
Dates Attended:
Major/Degree or Hours Completed:


LICENSE INFORMATION
Are you currently a registered nurse?	Yes. If yes, please submit a copy of your current RN license to WSCN No


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, three letters of recommendation and forms, essay and if applicable, your current RN license and 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.