SKC RN-BSN NURSING APPLICATION

SKC NURSING RN-BSN APPLICATION

Enter your admission information below
Name*

First NameMiddle InitialLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemaleOther
Of which country are you a citizen?*
Phone*
Personal E-mail Address*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Relationship*
Email
example@example.com
Phone Number*
Please enter a valid phone number.

Tribal, Military & Veteran Status
Enrollment Status*
Name of Tribe
Federally Recognized Tribes only
State
Military*
Branch

Education
High School or Equivalent Name
Graduation Date

MonthDayYear
Date
College/ University
Degree/ Certificate

Demographic

for statistical data purpose only
Ethnicity*
Age*

Criminal History
Have you ever been convicted of any criminal charges?*

YesNo
Are you in the process of court proceedings for any criminal charges?*

YesNo
Have you ever been required to register as a sexual or violent offender or been convicted of a sexual offense or violent crime?*

YesNo
If you answered yes to any of the above questions please explain in detail and include date of conviction.

RN-BSN Student Responsibility Statement
As part of the RN-BSN acceptance process, I understand that:
- Official transcripts must verify coursework completed (All high schools, colleges/universities attended) and be submitted to admissions at SKC in order to be considered for admission to the nursing program.
- A complete application does not guarantee admission to the Nursing Program.
- Expenses for the enrollment in the Nursing Program are higher than those for the general college student. While SKC assists students in obtaining financial aid, I am fully responsible for timely payment of tuition, related education obligations, and living expenses.
- Attendance is mandatory for all face-to-face class meetings; including virtual sessions.
- I must have a computer with a camera and microphone, access to the Internet, and have an SKC email set up
- I must be competent in computer skills; including programs in Microsoft Office, prior to BSN course enrollment
- Scholarly writing skills must be demonstrated in nursing coursework.
- I must maintain professional liability insurance
- I must provide proof of health insurance coverage: I.H.S., Medicaid, or private health insurance.
- Salish Kootenai College is committed to providing educational opportunities for individuals with disabilities. Reasonable accommodations are provided for eligible students with identified disabilities through the Disability Services Office. Disability Services is located in the John Peter Paul Building, or can be reached at 406-275-4968. The College complies with the American With Disabilities Act and Section 504 of the Rehabilitation Act of 1973.
- Nursing Students are expected to maintain the professional code for nurses at all times.
- I must demonstrate a clear background check annually through the SKC vendor. A fee will be charged.
- Fraud or misrepresentation of information requested on the application or health form may lead to denial of admission, or dismissal, from the nursing program.
A copy of your RN License must be attached; license must be active and in good standing with no restrictions or unresolved disciplinary action.*

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SKC NURSING RN-BSN APPLICATION

Tribal, Military & Veteran Status

Education

Demographic

Criminal History

RN-BSN Student Responsibility Statement