Nursing - Standard

We are no longer accepting printed applications. Please fill out the online form.

Prerequisite Declarations

* I have applied and been accepted to the University of Southern Indiana as an undergraduate.
* I meet the admission criteria for the undergrad nursing program as published in the Undergraduate Nursing Handbook.
* I have a minimum prerequisite course GPA of 2.8 or higher.

Falsification or misuse of records and/or misrepresentation of facts on University forms and documents, including but not limited to, application forms, data sheets, ID cards, fee receipts, may result in disciplinary action and/or cancellation of registration. See Section 2.16 of Student Rights and Responsibilities: A Code of Student Behavior.

Exceptions Form

Do you have an exceptions request form?
(Applicants who have all pre-requisites completed without exceptions will be given priority consideration.)
Note: This is not a requirement; you generally will not need the form.
- Yes, I have an exceptions request form to attach.

Enrollment

Select a program start time: Fall (Must have all required admissions prerequisite courses completed and documents submitted by the document deadline May 15th)
Spring (Must have all required admissions prerequisite courses completed and documents submitted by the document deadline August 15th)

Contact Information

USI Student ID Number, if known....(Not Your Social Security number)

Social Security Number (Mandatory disclosure of Social Security Number is required due to the Zachary Law and Registered Nurse Licensure application requirements.)

First Name *
Middle
Last *
Maiden

Current Address *
Address Line 2
City *
State/Province/Region *
Postal/Zip Code *

Primary/Current Phone Number *
Email Address *

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

Send correspondence to: * Current Address
Permanent Address

Post Secondary Education (Since high school)

First Institution
1. Date From
2. Date To
3. Name of Institution
4. City and State
5. Major
6. Credential Earned
7. GPA
Second Institution
1. Date From
2. Date To
3. Name of Institution
4. City and State
5. Major
6. Credential Earned
7. GPA
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, by April 15th for the Fall admission cycle, or August 15th for the Spring admission cycle.

Career Questionnaire

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 and all official transcripts have been sent
- Nursing Credits

Have you ever taken any nursing classes? No
Yes

If yes, name of school(s) (Maximum of 200 characters.)
Outcomes (Maximum of 1250 characters.)

USI Environment

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

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
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.

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

Prerequisite Worksheet

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 or Currently Enrolled: Indicate the semester (F for fall, S for spring, and SU for summer) and the year (20, 21, 22, 23, or 24 for example) the course was completed. S23 would indicate a course completed in the spring semester of 2023. If you are enrolled in the course, enter the current term.
Grade: Enter the letter grade you received. If in the course, enter "IP" for In Progress.

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

Prerequisite #10

Subject
USI Equivalent
Semester Hours
University Attended
Course Name & Number
Date Completed
Grade

Prerequisite #11

Subject
USI Equivalent
Semester Hours
University Attended
Course Name & Number
Date Completed
Grade

To be completed before 1st Semester of Nursing

Prerequisite #12

Subject
USI Equivalent
Semester Hours
University Attended
Course Name & Number
Date Completed
Grade

Prerequisite #13

Subject
USI Equivalent
Semester Hours
University Attended
Course Name & Number
Date Completed
Grade

To be completed before 2nd Semester of Nursing

Prerequisite #14

Subject
USI Equivalent
Semester Hours
University Attended
Course Name & Number
Date Completed
Grade

Prerequisite #15

Subject
USI Equivalent
Semester Hours
University Attended
Course Name & Number
Date Completed
Grade

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

Emergency Contact

Person to be notified in case of an emergency *

Relationship *
Telephone *

Signature

* By checking this box, I am providing my electronic signature verifying that all the above information is true and accurate to the best of my knowledge. I also authorize the Admission Committee to review and verify my application and academic records.
Email Address Verification *

By signing below I am verifying that all the above information is true and accurate to the best of my knowledge. I also authorize the Program Admission Committee to review and verify my application and academic records.

Printed Name
Date
Signature

It is the policy of the University of Southern Indiana to be in full compliance with all federal and state non-discrimination and equal opportunity laws, orders and regulations relating to race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity, or veteran status. Questions or concerns should be directed to the Affirmative Action Officer, USI Human Resources Department, University of Southern Indiana, 8600 University Boulevard, Evansville, Indiana 47712.

We are no longer accepting printed applications. Please fill out the online form.

Contact CNHP Support

Send Email to