3. Select a program start time:
   • Fall (must have all first-year coursework successfully completed by the end of the Spring 2024 semester)
   • Spring (must have all first-year coursework successfully completed prior to the beginning of the Fall 2023 semester)

USI Student ID Number, if known....(Not Your Social Security number)
4. Social Security Number (Mandatory disclosure of Social Security Number is required due to the Zachary Law and Registered Nurse Licensure application requirements.)

6. First Name *
7. Middle
8. Last *
9. Maiden

10. Current Address *
11. Address Line 2
12. City *
13. State/Province/Region *
14. Postal/Zip Code *

15. Primary/Current Phone Number *
16. Email Address *

17. Permanent Address *
    Same as above.
    1. Street Address
    2. Address Line 2
    3. City
    4. State/Province/Region
    5. Postal/Zip Code

18. Send correspondence to: *
    • Current Address
    • Permanent Address

19. First Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA
20. Second Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA
21. Third Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA

Official transcripts of high school or GED scores and all post high school education must be submitted to the Office of Admission, 8600 University Boulevard, Evansville, IN 47712.

22. Please indicate if you hold any professional health care license or certification *
    • No
    • Yes
    1. If yes, indicate license or certification and the year received.
       1. First license or certification:
       2. Second license or certification:
       3. Third license or certification:
23. Have you ever enrolled in a nursing program?
    • No
    • Yes
    1. If yes, name of school(s) (Maximum of 200 characters.)
    2. Reason for leaving (Maximum of 1250 characters.)
24. Have you ever applied to a nursing program and been denied admission?
    • No
    • Yes
    1. If yes, name of school(s) (Maximum of 200 characters.)
    2. Reason for denial (Maximum of 1250 characters.)
25. Have you previously applied to a USI College of Nursing and Health Professions program? *
    • No
    • Yes
    1. If yes, when?
    2. Reason for non-acceptance (Maximum of 1250 characters.)
Have you ever taken any nursing classes?
• No
• Yes
1. If yes, name of school(s) (Maximum of 200 characters.)
2. Outcomes (Maximum of 1250 characters.)
26. Check the information appropriate to your application. (Check all that apply.)
    • Currently enrolled at USI
    • Previously enrolled at USI
    • Have college credit from another college
    • Nursing Credits

USI works to maintain a safe environment for all members of the University community. The following questions will help us better maintain this environment.

28. Have you ever been convicted of a misdemeanor, felony or other crime (excluding routine traffic offenses and convictions expunged or sealed by the sentencing court or juvenile court or otherwise protected from disclosure by the specific authority of law)? *
    • Yes
    • No
29. Are any criminal charges currently pending against you? *
    • Yes
    • No

If your answer is "Yes" to any of these questions, you will be asked to provide additional information. Being convicted of a crime, pending criminal charges, probation, suspension, dismissal or expulsion do not serve as an absolute bar to admission, but will require additional evaluation.

30. Have you been convicted of a sex offense against children? *
    • Yes
    • No
    (Requirements of Indiana Public Law 11-1994.)

• Directions:
• Semester Hours: Enter the credit hours for courses you have completed and for which you have received a grade. Enter numbers only. If, for example, you have completed a 4-hour anatomy and physiology course, place a 4 in the column for the corresponding anatomy and physiology course.
• University Attended and Course Name & Number: Briefly list the name of the course you actually completed and the university at which the course was completed. For instance COMM 111 and UofL would represent the course equivalent to CMST 101 taken at the University of Louisville.
• Date Completed: Indicate the semester (F for fall, S for spring, and SU for summer) and the year (10, 11, 12, 13, or 14 for example) the course was completed. S13 would indicate a course completed in the spring semester of 2013.
• Grade: Enter numbers only for the grade you received. Use the following key to convert letter grades to the USI numerical grading system:
  • A/A- = 4
  • B+ = 3.5
  • B/B- = 3
  • C+ = 2.5
  • C/C- = 2
  • D+ = 1.5
  • D/D- = 1
  • F = 0

1. Prerequisite #1
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
2. Prerequisite #2
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
3. Prerequisite #3
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
4. Prerequisite #4
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
5. Prerequisite #5
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
6. Prerequisite #6
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
7. Prerequisite #7
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
8. Prerequisite #8
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
9. Prerequisite #9
   1. Subject
   2. USI Equivalent
   3. Semester Hours
   4. University Attended
   5. Course Name & Number
   6. Date Completed
   7. Grade
Prerequisite #10
1. Subject
2. USI Equivalent
3. Semester Hours
4. University Attended
5. Course Name & Number
6. Date Completed
7. Grade
Prerequisite #11
1. Subject
2. USI Equivalent
3. Semester Hours
4. University Attended
5. Course Name & Number
6. Date Completed
7. Grade

*USI First Year Experience, UNIV101, is Not required for transfer applicants.

As of August 1 2024, I will have the following USI BSN prerequisite course(s) yet to complete:
Include appropriate 2024 spring and summer semester coursework, as well as courses you are retaking to increase your GPA.

1. Unfulfilled Prerequisite #1
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
2. Unfulfilled Prerequisite #2
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
3. Unfulfilled Prerequisite #3
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
4. Unfulfilled Prerequisite #4
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
5. Unfulfilled Prerequisite #5
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
6. Unfulfilled Prerequisite #6
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
7. Unfulfilled Prerequisite #7
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
8. Unfulfilled Prerequisite #8
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
9. Unfulfilled Prerequisite #9
   1. Prerequisite Course
   2. University Attended
   3. Semester of Completion
10. Unfulfilled Prerequisite #10
    1. Prerequisite Course
    2. University Attended
    3. Semester of Completion