RN-to-BSN ProgramApplication

RN-to-BSN Program

Application

Nursing Department

ASU West Campus, Building L

2400 Gillionville Road

Albany, GA 31707

(229) 500-2329

Application Periods

• Fall Semester – January 1 through June 1

• Spring Semester – June 2 through November 1

• Summer Semester – November 2 through April 1

University Admission Acknowledgement:*

Please select the option that applies to your admission into Albany State University:

I graduated/am graduating from Albany State University’s/Darton State College’s ASN program and have received confirmation from the Office of Admissions that I have been readmitted into Albany State University in good standing.

I graduated/am graduating from another institution’s ASN/ADN program and have received confirmation from the Office of Admissions that I have been admitted into Albany State University in good standing.

Semester for which you are applying:*

Include semester AND year.

Ram ID:*

Applications are not accepted without a verifiable student ID.

Last Name:*

First Name:*

Middle Initial:

Maiden Name

Pronouns (select all that apply):*

He/Him

She/Her

They/Them

Other

If “Other” was selected above, please specify:

Permanent Mailing Address (Street, City, State, Zip):*

Student Email Address:*

Personal Email Address:

Cell Phone Number:*

Home Phone Number:

Work Phone Number:

Institution from which you earned your ASN/ADN degree (name and address):*

ASN/ADN Graduation Month/Year:*

RN License Information (number and state):*

RN License Acknowledgement:*

I have attached a copy of my current RN licensure to this application or (if you have not yet taken and passed the NCLEX-RN licensure exam) understand that I will need to provide a copy of my RN license to the program director prior to taking 9 credit hours of RN-to-BSN courses.

Yes

Are you currently working as an RN?*

Yes

Has any state board of nursing even imposed disciplinary action against you?*

Yes

Program Pathway Preference:*

Full-Time

Part-Time

Application Submission Acknowledgement:*

I certify that the information on this form is true, correct, and complete, and I understand that intentionally providing false, incorrect, or incomplete information may disqualify me from program consideration. Additionally, I understand that completion of this application packet does not in itself grant admission to the nursing program and that I must submit another application to the nursing program if I am not selected for the indicated semester.

Yes

Today's Date:*

Electronic Signature:*

Required Documents

File Attachments:*

Attach a copy of your RN License (if applicable).

Drag and drop files here or

Personal Identifiable Information (PII) Notice:

All personal data and special categories of sensitive personal data collected or processed by Albany State University (ASU) must comply with the ASU Cybersecurity Program Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity:

https://www.usg.edu/policies

Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to:

LegalAffairs@asurams.edu

Otherwise, questions concerning GDPR can be forwarded to LegalAffairs@asurams.edu. Typing your name in the box below and submission of this application provides consent to and acknowledgment of the ASU Data Security and Privacy Policy.

Please check the box below to indicate that you have read and understood the PII policy above.

Personal Identifiable Information (PII) Consent:*

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