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Ignite Your Journey: Apply Now and Blaze Your Trail with Vincennes University!
RN-BSN & HCSA BS Application
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*Please indicate which Program you are interested in
*Please indicate which Program you are interested in
RN-BSN
Health Care Services Administration (HCSA)
*This program is intended for applicants that already possess licensure as a registered nurse. Seniors in an accredited ASN Program may also apply*
* if current
Senior,
type
Senior
below *
RN License #
*Indicate your preferred Start Term
*Indicate your preferred Start Term
Fall (August/October Start Dates)
Spring (January Start Date)
*Admission into this baccalaureate degree program requires the prospective student to possess an AS or ASCT degree from an accredited institution. Acceptance into this program will be granted through the approval of the HCSA Degree Department Chair and the Dean of Health Sciences.*
List AS Degree Major
List College/University
*Indicate your preferred Start Term
*Indicate your preferred Start Term
Fall (August)
Spring (January)
→
Personal Information
*Legal First Name
Legal Middle Name
*Legal Last Name
Former Last Name (if applicable)
*Birthdate
*Birthdate
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*Phone #
*Email Address
*Please Pick 1 Unique Identification # to Enter
*Please Pick 1 Unique Identification # to Enter
Student ID # (A#)
Social Security Number (SSN)
*Student ID # (A#)
*Social Security # (SSN)
→
Other Information
If you completed a GED, please type the code
A04202
in the High School Name field
If you attended an International HS, please type the code
A00026
in the High School Name field
If you attended a Homeschool, please type the code
970000
in the High School Name field
HS CEEB Code
*High School Name
*Year of HS Graduation
*Year of HS Graduation
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*Have you attended colleges other than VU? Please note this includes colleges/universities you may have received dual credits from while in High School
*Have you attended colleges other than VU? Please note this includes colleges/universities you may have received dual credits from while in High School
Yes
No
*If yes, please list all colleges/universities below:
*Official Transcripts must be on file at Vincennes University.*
Have you ever been convicted of a felony or misdemeanor?
Have you ever been convicted of a felony or misdemeanor?
Yes
No
If yes, please indicate the charge, and explain the event/circumstances leading to the charge.
*Please refer to our website
www.vinu.edu/healthcareers
for information on our criminal history policy/procedure *
Do you currently have any criminal charges pending or are you involved in a pre-trial diversion?
Do you currently have any criminal charges pending or are you involved in a pre-trial diversion?
Yes
No
If yes, please explain
Do you currently hold or have you ever held licensure for any health care related field?
Do you currently hold or have you ever held licensure for any health care related field?
Yes
No
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Vermont
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Wyoming
License #
Has there been any disciplinary action taken against this license or have you ever been denied licensure/permit for any health care profession ?
Has there been any disciplinary action taken against this license or have you ever been denied licensure/permit for any health care profession ?
Yes
No
If yes, please explain below:
Do you have any additional comments/information you would like to include?:
→
Final Student Checklist
(Do Not Submit Until All Items Checked)
HS Transcript or GED sent to Vincennes Univeristy
Send in College/University Transcripts
Completed Accuplacer Test? (or have other alternate test scores on file?)
Vincennes University does not discriminate based on race, religion, color, national origin or ancestry, age, sex, sexual orientation, or handicap or against disabled veterans and veterans of the Vietnam Era, or other non-merit factors in its
employment or educational programs or activities.
The receipt of this application does not imply that the applicant will be admitted to the program. By signing below you certify that you have received copies of VU’s Pharmacy Technology general information, policies and procedures, including health form requirements, criminal history and drug screening requirements located in the general information packet at
www.vinu.edu/healthcareers
. If selected for admission, the applicant understands that all requirements listed in the general information and/or admission acceptance packet are required and agrees to fulfill all requirements at the applicant’s expense.
*Signature
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Date
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By signing above, you affirm that the information on this application is correct. Falsification of your application may result
in your denial of admission to the College of Health Science and Human Performance and/or Vincennes University.
Submit
