Nursing Application for EMU Students

This application is required by all students who seek admission to Eastern Mennonite University's clinical level nursing Program. Please review the admission policy that is located on the clinical level of the department website, www.emu.edu/nursing prior to completing your application. General admission to the university does not imply admission to the nursing program.

Applications for the clinical level for fall semester are due by February 15th and applications for the spring clincial level are due by June 15th.

Name
Date Date / MM / DD YYYY
EMU Student ID
Date of Birth Date of Birth / MM / DD YYYY
Permanent Home Address Permanent Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Email Address
Ethinic Classification

Ethinic Classification American Indian Asian Black Hispanic Caucasian Other
Religion

Religion Mennonite Christian Other
Applying as a:

Applying as a: Freshman Sophomore LPN
When will you be ready to enter the clinical level nursing courses?
Are you an LPN?

Are you an LPN? Yes (Note: submission of a vocational school transcript is required) No
Prerequisites Course Completion

Please indicate the letter grade you received in each of the following nursing prerequisites or mark "In Progress" for those courses you are currently enrolled.
Anatomy and Physiology I
Anatomy and Physiology I
Anatomy and Physiology II
Anatomy and Physiology II
Chemistry
Chemistry
Bio-Chemistry
Biochemistry
Developmental Psychology
Developmental Psychology
Microbiology
Microbiology
Nutrition
Nutrition
Sociology
Sociology
Speech
Speech
Statistics
Were any of the above courses taken more than once, repeated?
If you answered yes, which course(s) were repeated?
Current GPA
International Students: TOEFL Score
Date Completed or date test will be taken Date Completed or date test will be taken / MM / DD YYYY
Have you ever been placed on probation or dismissed from an academic prorgram?
If yes, please explain:
By signing this application, I confirm that all information submitted for admissions to EMU is accurate. I understand that if I have falsified information, I may be asked to withdraw my application or leave the university if enrolled. (Enter initials)

Nursing Application for EMU Students

Nursing Application for EMU Students

Prerequisites Course Completion Please indicate the letter grade you received in each of the following nursing prerequisites or mark "In Progress" for those courses you are currently enrolled.

Prerequisites Course Completion

Please indicate the letter grade you received in each of the following nursing prerequisites or mark "In Progress" for those courses you are currently enrolled.