Graceland University Application

GRADUATE NURSING PROGRAMS APPLICATION

Call 1-800-833-0524 or email distancelearning@graceland.edu with any questions.

This is the Graduate MSN and Post Grad MSN Application. It is also the correct application if you are seeking acceptance into our combined BSN/MSN program. If you are seeking only a BSN degree, use the Undergrad BSN to RN application.

PERSONAL INFORMATION
Please enter your full legal name:
Full First Name*
Middle
Last*

Preferred Greeting Name (Liz for Elizabeth, Bill for William, etc.)
Previous Last Name (Maiden name for example)
Other names
(Please list any name that could be on one of your past transcripts)
Email*

Confirm Email*

Home Address*

City*
State/Province*
Zip/Postal Code*

Country*
County*

Home Phone* Example: 111-222-3333
Cell Phone Example: 111-222-3333
FAX Number
Business Phone
Citizenship*
Resident Alien* Yes No (If yes, a copy of your permanent resident card is required.)
Birth Country*

Birth Date: Month* Day* Year* Enter all 4 digits of the year
Gender* Male Female Other

State of High School Graduation
Year of High School Graduation

Social Security Number (U.S.) or Canadian SIN Example: 111-22-3333

Have you previously applied for admission to Graceland? Yes No What Year

How did you hear about this program?*

Have you ever served in the US Armed Forces? Yes No If yes, discharge date

Are you a registered nurse? Yes No
If yes, state where licensed RN License Number Renewal Date
Was baccalaureate nursing program NLNAC or CCNE accredited? Yes No
Institution

ENROLLMENT INFORMATION
*

EMPLOYMENT HISTORY
Please list all full-time or part-time positions as a registered nurse in reverse chronological order.

Name of Employer
Address
Telephone
Type of Work
Dates of Employment

Name of Employer
Address
Telephone
Type of Work
Dates of Employment

Name of Employer
Address
Telephone
Type of Work
Dates of Employment

Name of Employer
Address
Telephone
Type of Work
Dates of Employment

PREVIOUS EDUCATION
List Colleges, Technical, Nursing or Allied Health Schools attended. Students are responsible to collect all previous transcripts. Transcripts must be submitted in the sealed envelope in which they are received.

Please send all transcripts to:

Graceland University
1401 W. Truman Road
Independence, MO 64050
Attn: Admissions

If you have any questions, please call 816-833-0524

Name of Institution*
Location*
Dates of Attendance*
Type of Degree*
Major*
Date Degree Awarded or Expected*

Name of Institution
Location
Dates of Attendance
Type of Degree
Major
Date Degree Awarded or Expected

Name of Institution
Location
Dates of Attendance
Type of Degree
Major
Date Degree Awarded or Expected

Name of Institution
Location
Dates of Attendance
Type of Degree
Major
Date Degree Awarded or Expected

Name of Institution
Location
Dates of Attendance
Type of Degree
Major
Date Degree Awarded or Expected

Name of Institution
Location
Dates of Attendance
Type of Degree
Major
Date Degree Awarded or Expected

If you have attended additional schools, please list information here.

Professional Goals Statement of 150 words or less.

PROFESSIONAL REFERENCES
We require three separate references submitted by current or former employers or individuals professionally acquainted with you and familiar with your academic competencies and goals (not relatives, friends, family physician or clergy). References from Masters or Doctorally prepared nurses are preferred. Reference Form.

SPECIAL CONSIDERATIONS
If there are any special circumstances or factors you wish taken into consideration in connection with your application, please enter a statement here.

CRIMINAL BACKGROUND CHECK
The Joint Commission on Accreditation of Health Care Organizations (JCAHO) institutes regulations in order for hospitals, home health agencies, clinics, etc., to gain or maintain accreditation status. One of these regulations requires that "all persons who are involved in patient care activities, i.e., employees, volunteers and students must have criminal background checks as well as other health care related checks." Criminal background checks must be initiated by the student and completed after the student has been accepted into our program. CastleBranch,Inc., the required processing agency, will charge for this service. Fees must be paid by the student for the process to begin. A more detailed explanation can be found on our Web site.

CONTRACT
I understand that withholding information requested on this application or giving false information will make me ineligible for admission to Graceland University or subject to dismissal. I also understand that the submission of fraudulent academic records by a student for undergraduate admission, transfer of credit, or any other purpose shall be cause for dismissal from the University. I certify that the information given in this application is complete and accurate, and if admitted, I agree to comply with the regulations of the University.

PLEASE NOTE: Other admission requirements, as listed in the university catalog, must be met before your application is considered complete. Additional application information, including transfer credit, can be found in the Application Requirements.

APPLICANT'S NAME*

(Please click only once.) * Required field

POLICY ON NONDISCRIMINATION

Graceland University does not discriminate against any student or prospective student on the basis of race, color, religion, age, sex, national origin, disability, or sexual orientation. We are a caring community dedicated to the physical, intellectual and spiritual well-being of each individual. Gracelanders join together to create an atmosphere of openness, mutual respect and diversity.