Nursing Program Application - Alcorn State University

Nursing Program Options

Biographical and Contact Information

First Name

Middle Name

Last Name

Sex

Mailing Address Country

Street

City

State

Postal Code

Email Address

Phone Number

Birthdate

Education History

Below, please list all colleges you attended, dates you attended and your degree.
Separate by comma. PLEASE NOTE ***Current Alcorn State students, please list Alcorn as one of your schools attended.***

Credentials Needed

College 1

College 2

College 3

College 4

Receipt of required documents by February 20, 2022: (1) Copy of Immunization Record-Proof of MMR and Hepatitis B (2) Resume and (3) Personal Statement

Generic Option applicants need to submit (1) 3 Letters of Recommendation; 2 academic/scholastic and 1 community service letter
LPN to RN and RN to BSN applicants need to submit (1) 2 Letters of Recommendation and (2) Copy of LPN License or Copy of RN License
***RN to BSN Application Deadline is June 30, 2022 ***

Upload required documents here *documents must be in one scanned file*

Choose File

Have you ever attended another nursing school?

Yes

No

If yes, where did you attend, when did you attend, and why did you leave?

Have you ever been convicted of a misdemeanor or felony? If yes, please explain.

Yes

No

Individuals who have been convicted, pleaded guilty or pleaded no contest to certain felony crimes may be unable to attend clinical training or obtain employment in a licensed health care facility. Applicants convicted of a misdemeanor or felony offense may be denied licensure by the Mississippi Board of Nursing and/or other Boards of Nursing.

I certify that the statements in this application are true and complete to the best of my knowledge, and that I have attended no institution other than those listed therein. I am aware that falsification of information is a basis for denying admission or for immediate termination of enrollment.

Signature

Please type full name

Select Today's Date