UNIVERSITY OF MICHIGAN-FLINT~ HURLEY MEDICAL CENTER
Bachelor of Science in Nursing Program
Application Packet Checklist for Traditional BSN Program
For winter 2017,complete applications will be acceptedbetween the dates of
Monday, August 1, 2016 and 5:00 pm Friday, September 16, 2016.
Applications will not be accepted at any other time.
It is your responsibility to submit your packet complete with the following items to the Department of Nursing
prior to the deadline. Any applications submitted without all of the information listed below will be considered incomplete and not eligible for admission to the program.
Please use this checklist to make sure you are turning in a complete packet.
Please verify that you have completed the following requirements prior to submitting your application:
You must have applied to the University of Michigan-Flint and have a complete application on file in the Undergraduate
Admissions office which includes official transcripts.
Official transcripts from each institution you have attended (with the exception of UM-Flint) must be submitted in an envelope sealed by that institution along with your nursing application. Transcripts that are submitted with the application will become the property of the Department of Nursing and will not be returned to you. If you are a transfer student, we understand that official transcripts were submitted to Admissions when you transferred; however, transcripts must also be submitted with your nursing application. If additional coursework has been completed at any institution since initial admission to the University, it will be your responsibility to submit an updated copy of your official transcript to the University of Michigan-FlintOffice of Admissions to obtain an updated transfer evaluation.Do not forward transcripts ahead of your application. Transcripts must bein a sealed envelope from the institution attended and included with your application packet. Some institutions will send only unofficial transcripts to students; these are acceptable, as long as they are in a sealed envelope from the Registrar’s Office. Please note: This may take some time. Please plan accordingly.
Required prerequisites:
Please note:
- Four prerequisites (at least two must be science courses) must be completed before applying to the Nursing program. CHM 150/151 counts as one course.
- All prerequisites must be completed before beginning the Nursing core curriculum.
- A minimum grade of C+ is required for prerequisite courses.The exception is chemistry; a grade of C is acceptable in chemistry.
- Biology credits must be no more than seven years old (BIO 135, 167, 168). Competency exams may be taken through the Department of Nursing if completed more than seven years ago. Cost is $80.00/exam (A&P and Microbiology).
- SWR 301, SWK 320, or PSY 237 are also accepted in place of PSY 313.
- Students with previous CHM courses: A combination of courses may be used to fulfill the CHM 150, CHM 151, and CHM 252 requirements. Consult the Department of Nursing to determine this.
Two professional references are required, but no more than three may be submitted. Please see page 2 for specific requirements. Your letters must be in sealed envelopes with your reference’s signature across the back(forms attached). At least one reference must be from a faculty member/instructor.
A copy of your current class schedule
Completed Clinical Student Disclosure Statement (page 7)
Completion of essay requirement
An English language proficiency exam is required for ALLnon U.S.citizens and non-native English-speaking applicants even if you are a permanent resident and regardless of enrollment in the English educational system. Students are allowed to complete TOEFL, IELTS or MELAB. Please note: There is a fee for taking the test that can range from US$150 to US$225.
Signed application (bottom of page9)
ESSENTIAL INFORMATION
We highly recommend that you attend nursing information meetings for answers to all your program and admission questions. Please see the Department of Nursing website for a schedule of information meetings –
- Applicants must have applied to the University of Michigan-Flint through the Office of Admissions and have a complete application on file. You may apply online at
- GRADEPOINT: A minimum college grade point average of 3.0 is required in both your prerequisite classes and your last 30 credits to be considered for selection. Having the minimum GPA does not guarantee admission. Admission is competitive within the current pool of applicants. Due to the number of qualified applicants within an applicant pool, it is likely that the prerequisite GPA and overall GPAof accepted students may be well above minimum requirements. The Department of Nursing may find it necessary to deny admission to a qualified applicant due to enrollment limits.
- REFERENCES: A minimum of two references is required, but no more than three may be submitted. Forms are included in this application packet. One mustbe from one of your college or university instructors; the other shouldbe from someone who is in a supervisory role at your place of employment. If this is not possible, a second university professor may be used. Personal references are not accepted.
- PATHOPHYSIOLOGY (NSC 207): If you are enrolled in Pathophysiology (NSC 207) in the fall 2016 semester, your midterm grade will be considered for this application process. Grades for students enrolled at UM-Flint will automatically be reviewed. If you are completing a NSC 207 equivalent course in fall 2016at another institution, please submit official documentation of your midterm grade by Monday, October 24th via email to Vickie Jaskiewicz, Nursing Advisor, at . Official documentation is either an email from your professor sent directly to Vickie or a screenshot of your current grade in Blackboard or other online teaching tool. The screenshot or email must contain your name and current grade.
- TRANSFER COURSES: All prerequisite courses must transfer to UM-Flint as equivalent courses. Please be sure of this and check the equivalency database or review your transcript analysis report in your Student Information System (SIS) account. UM-Flint Transfer Database–
- REAPPLICATION: The Department of Nursing does not keep a waitlist. If you reapply for admission, a new application packet will need to be signed and submitted to the Department of Nursing. Updated transcripts are required only if you have completed additional courses at an institution other than the University of Michigan-Flint since your previous application. You may use references from a previous application. The Department of Nursing will hold previous applications for one year. If you do not reapply within that timeframe, your information will be destroyed. If you plan to use transcripts or reference forms from a previous application, please note this on page 3 of your application.
- TUITION: Once admitted to the Nursing program, students follow a fee schedule that is specific to nursing students. This differential is applied to all classes, not just nursing classes. The curriculum is based on a fulltime load of fall and winter courses.
- EXPENSES/REQUIREMENTS: Once admitted to the Nursing program, you will need to purchase uniforms, equipment, ID badges, and professional textbooks. Expenses will also be incurred for assessment testing and health requirements,background checks/fingerprinting for clinical agencies, as well as ACE clinical placement feesthroughout the program. Physical examination, immunizations, toxicology testing, HEALTH INSURANCE, and CPR training are required at your expense, and students will NOT BE ALLOWED TO REGISTER FOR THE CLINICAL PROGRAM UNTIL THESE ARE VERIFIED.
- CRIMINAL BACKGROUND CHECK: A Clinical Student Disclosure Statement must be submitted with the application. Failure to disclose a criminal conviction that has not been expunged or dismissed may be grounds for denial from the nursing program. If you choose not to disclose a conviction, even if it has been expunged or discharged from your record and your background check is returned with a conviction listed, your admission may be delayed or denied.
Admission is contingent on successful completion of a Criminal Background Check. This is done after admission to the program. There will be a fee for this service.
Note: Felony conviction or charges and/or a history of substance abuse may exclude you from clinical placements and/or being eligible to sit for the National Council Licensure Examination (NCLEX). This means you might not be able to complete all of the required clinical placements and/or would not be eligible for a license to practice as a registered nurse. If you have questions regarding this matter, you may wish to consult independent legal counsel and/or the Michigan Board of Nursing, Discipline Unit.
UNIVERSITY OF MICHIGAN-FLINT ~ HURLEY MEDICAL CENTER
Bachelor of Science in Nursing Program – TraditionalBSN Program
Application must be typed. Please type information into this form and print.
To avoid delay in processing your application, please complete it in full.
Last Name: dsfd / First Name: / MI: / Maiden Name:UMID: / Last four digits of SSN: / Date of Birth:
Current Mailing Address:
City/State/Zip: / Female Male
UM-Flint email address: / Personal email address:
Cell Phone Number: / Alternate Phone Number:
Ethnicity/Racial Group:
African-American-BlackAmerican Indian/Alaskan Native Asian American/Pacific Islander
CaucasianHispanic/LatinoMulti-racial/Multi-ethnic
Ethnicity/racial group not included above (please specify) Prefer not to answer
______
Are you a veteran? Yes No
Are you a United States citizen? Yes No Were you born in the United States? Yes No
Is English your native language? Yes No
If no to any, please provide copies of your English Language Proficiency exam. You may take TOEFL must be internet-based, proctored exam; offered at UM-Flint, MELABoffered at UM-Flint, or IELTS.
Click on the following link for more information - and click on testing. Please contact Vickie Jaskiewicz, Nursing Advisor, at for minimum score requirements.
Are you the first generation (since your grandparents) in your immediate family to attend college? Yes No
Please list the colleges/universities (including UM-Flint) where you have earned college credit:
Name of Institution / City / State / Number of Credits Earned / Degree EarnedHave you previously applied for admission to the UM-Flint Nursing program?
Yes NoIf yes, when?
Do you plan to use transcripts and/or reference forms submitted with a previous application? Yes No
Please list which transcripts and/or references previously submitted that you would like to use:
______
Have you ever been admitted to this or any other Nursing program?
Yes NoIf yes, program(s) and year(s) attended
The University of Michigan-Flint Department of Nursing reserves the right to contact your previous nursing school to determine your previous academic standing/progression. You are required to sign the waiver below to allow the release of information if you checked a box above. Applications will not be accepted from students who are not eligible to re-enter a previous nursing program or who have failed two nursing courses while in another nursing program.
Student Waiver for Release of Information: ______
COURSES
Courses currently enrolled in for Fall 2016 (if applicable):
Institution / Course Number & Title / CreditsPrerequisite Course Information:
Prerequisite / Semester/Year Completed / Institution / Grade / CreditsBIO 167
BIO 168
BIO 135
CHM 150
CHM 151
ENG 111
ENG 112
NUR 110
NSC 207
Nursing Support Courses. Please fill out the form below (if applicable).
Course / Semester/Year Completed / Institution / Grade / CreditsCHM 252
NSC 178*
PSY 313
NSC 209
NSC 233
NUR 308
NUR 369
Nursing Elective (1)
Nursing Elective (2)
*As of fall 2013, NSC 178 is the required ethics course for the Department of Nursing. If you completed NSC 168, PHL 168, PHL 162 or HCR 304 and you were admitted or readmitted to the University prior to fall 2013, you are set; you will not be required to take NSC 178. If you were admitted to the University fall 2013 or after, you are required to complete NSC 178 even if you received transfer credit for one of the above listed courses.
Essay:
Please submit a one-page, double-spaced essay (Times New Roman font, size 12 required) on the following question. Include your University ID, not your name, on the response.
1)A nurse should be caring, committed, and have empathy to be effective. Let’s assume you already have those values. What threeadditional attributes do you have that will make a positive impact on the profession of nursing if accepted into the University of Michigan-Flint Nursing Program.
2)Students may experience course failures and/or withdrawals during their academic studies. Please use this opportunity (if applicable) to explain the circumstances and your plan for success in a separate paragraph (200 word limit) on another page.
1
Clinical Student Disclosure Statement
To be Retained by the Educational Institution
DURING THE ENTIRE COURSE OF ENROLLMENT IN THE UNDERGRADUATE NURSING PROGRAM, STUDENTS ARE REQUIRED TO REPORT ANY FELONY OR MISDEMEANOR CONVICTIONS TO THE DIRECTOR OF THE DEPARTMENT OF NURSING.
Name: Date of Birth:
Educational Institution Name: University of Michigan-Flint
Training Program: Nursing
- I certify that I have not been convicted of a crime or offense that prohibits me from being granted clinical privileges in a long-term care setting as required by P.A. 27, 28, and 29 of 2006 within the applicable time period prescribed by each crime.
______
Signature of StudentDate
- I certify that I have not been the subject of an order or disposition under the Code of Criminal Procedure dealing with findings of “not guilty by reason of insanity” for any crime.
______
Signature of Student Date
- I certify that I have not been the subject of a state or federal agency substantiated finding of patient or resident neglect, abuse, or misappropriation of property or any activity that caused my nurse aide certification to be “flagged.”
______
Signature of Student Date
- I have listed below all offenses for which I have been convicted, including all terms and conditions of sentencing, parole, and probation and any substantiated finding of patient or resident neglect, abuse, or misappropriation of property.
______
Signature of Student Date
Conviction/Offense / Date of Conviction/Finding / City / State / Sentence / Date of Discharge- I certify that I have reviewed the list of prohibited offenses as defined in P.A. 27, 28, and 29 and that the above list of my convictions and/or substantiated findings of patient or resident neglect, abuse or misappropriation of property (if any) is true, correct, and complete to the best of my knowledge. I also understand that if the information is not accurate or complete, my clinical privileges will be withdrawn immediately. I understand that the faculty or educational program denying my privileges based on information retained through background check is provided immunity from any action brought by a Student due to the decision to remove clinical privileges.
______
Signature of Student Date
Criminal Background Check – Mandatory Exclusions for Specified Time Period
In order to be granted clinical privileges at any covered facilities, 15 years must have lapsed since the individual completed all the terms and conditions of sentencing, parole, and probation for conviction of the following offenses:
Felony that includes the intent to cause death or serious impairment of a bodily function that results in death or serious impairment of the bodily function that involves the use of force or violence, or that involves the threat or the use of force or violence. This includes:
-Homicide
-Assault and infliction of serious injury
-Assault with intent to commit murder
-Assault with intent to do great bodily harm less than murder
-Assault with intent to maim
-Attempt to murder
Felony involving cruelty or torture.
Felony of crime committed against “vulnerable adults” who because of age, developmental disability, mental illness, or physical disability, require supervision or personal care or lack the personal and social skills required to live independently.
Felony involving criminal sexual conduct.
Felony involving abuse or neglect generally related to vulnerable adults or children which typically results in serious physical or mental harm to the vulnerable adult.
Felony involving the use of a firearm or dangerous weapon.
Felony involving the diversion or adulteration of a prescription drug or other medications.
In order to be granted clinical privileges at any of the covered facilities, 10 years must have lapsed since the individual completed all the terms and conditions of sentencing, parole, and probation for conviction of the following offenses:
Misdemeanor involving the use of a firearm or dangerous weapon with the intent to injure, the use of a firearm or dangerous weapon that results in a personal injury, or a misdemeanor involving the use of force or violence or the threat of the use of force or violence.
Misdemeanor crime committed against “vulnerable adults.”
Misdemeanor involving criminal sexual conduct which involves instances of sexual contact with another person that does not involve sexual penetration and is typically known as “fourth degree criminal sexual conduct.”
Misdemeanor involving cruelty or torture (usually first conviction regarding animals).
Misdemeanor involving abuse or neglect in the third or fourth degree if the caregiver intentionally or recklessly causes “physical harm” to a vulnerable adult.
Third Driving Under the Influence (DUI) conviction.
In order to be granted clinical privileges at any of the covered facilities, 5 years must have lapsed since the individual completed all the terms and conditions of sentencing, parole, and probation for conviction of the following offenses:
Misdemeanor involving cruelty if committed by an individual who is less than 16 years of age including cruel treatment of animals.
Misdemeanor involving home invasion that typically is described as “breaking and entering” into another person’s home.
Misdemeanor involving embezzlement which is a person who has taken money from another person who had entrusted the money with the wrongdoer, e.g., a store cashier.