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Semester/Year requesting admission:/Name:

Date:

The University of TexasHealthScienceCenter at San Antonio

School of Nursing

Nurse Practitioner Statement

CHECK ONE:
Acute Nurse Practitioner / Family Psychiatric Mental Health Nurse Practitioner
Family Nurse Practitioner / Pediatric Nurse Practitioner

Thank you for your request for consideration fora Nurse Practitioner (NP) clinical major in the graduate nursing program. We appreciate your interest in a dynamic area of study. We are requesting that all individuals seeking admission to an NP program of study provide us with some additional information. Please respond to the following items in relation to your requested major, sign and return with your application.

  1. The School of Nursing is committed to improving access to primary health care for medically underserved rural and inner-city urban populations. Please describe how you as an NP would work to improve the health of these groups.
  1. Describe your willingness to work with medically underserved communities/populations while attending the program.
  1. State your willingness to continue an employment position or to take a new employment position, to work with medically underserved/health disparity (according to federal guidelines) populations, immediately upon completion of this program of study.
  1. Briefly describe your work experience since completion of your BSN (MSN if Post-MSN applicant) program.

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  1. Briefly describe your experience in working with cultures other than your own.
  1. Please describe your ability to communicate with ethnically diverse groups; e.g., speak Spanish, conduct a health history in Spanish, describe a diagnosis or treatment regimen in Spanish, understand Spanish as spoken, read and write in Spanish.
  1. Describe any current/previous endeavors with individuals who experience health disparities.
  1. Describe how being a Nurse Practitioner would further your career goals.
  1. Describe any special attributes, characteristics, or experiences that you believe may contribute to your success as a
    Nurse Practitioner.

I affirm that the above information is accurate and true.

Signature of ApplicantDate

Thank you for responding to the above items. Please return your signed response when you submit your application for admission and all other supplemental items to the University Registrar’s Office. If you have any questions regarding this form, please contact the Graduate Nursing Program, 7703 Floyd Curl Drive, San Antonio, TX 78229-7943 at (210) 567-5815.

Application deadlines: Fall semester, January 10-- Spring semester, July 1

Application packets must be complete to be considered.