LPN to ASN Transition Nursing Program Applicant Information, Instructions, and Acknowledgement Form

LPN to ASN Transition Nursing Program Applicant Information, Instructions, and Acknowledgement Form LPN To ASN Transition Applicant Information: Last Name: First Name: Middle Initial: Maiden Name: Student
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LPN to ASN Transition Nursing Program Applicant Information, Instructions, and Acknowledgement Form LPN To ASN Transition Applicant Information: Last Name: First Name: Middle Initial: Maiden Name: Student C#: C0 Street Address: City, State, Zip Code: Phone: Ivy Tech Other Region/Campus where you are applying: Prerequisite Review: In order to be considered as a candidate for the nursing program, students must fulfill the following prerequisite course requirements. Please identify the course completed and highest grade for each prerequisite listed below. Please note: General education course transfers from other Colleges or Universities will only be included if they match the Ivy Tech Community College course for which transfer credit is being requested. All prerequisite courses must be completed with a C or higher to be considered for admission to the nursing program. MATH 123 or higher (Quantitative Reasoning) is a prerequisite to the nursing program however, no points are given toward admission for completion of this course. (APHY 101) Anatomy & Physiology I: (PSYC 101) Introduction to Psychology: (ENGL 111) English Composition: (MATH 123 or higher) Quantitative Reasoning: NURSING APPLICATION ACKNOWLEDGEMENT I acknowledge that I have completed required advising activities prior to submitting this application to the Associate of Science in Nursing Program and that the contents of the application packet are true and accurate. I further acknowledge the following: I have completed the on-line Nursing Programs Information Session or face-to-face information on my campus and I understand requirements of the nursing programs. I further understand that I am required to review this session within 3 months of the application deadline date, each time I apply to the Nursing Programs, so that I will have accurate information regarding any changes that have occurred. I have met with an advisor regarding program course requirements, including academic skills advancement courses and prerequisite courses, and further information or clarification I needed regarding nursing admission/selection policies and processes. I have read and understand the contents of the Nursing Programs Overview and Application Process Booklet that is available on the Ivy Tech Community College web site. I understand that the Test of Essential Academic Skills V (TEAS V) is a requirement for application to the Nursing Programs and that prior versions of the TEAS will not be considered for admission. TEAS examination fees are non-refundable. o o The TEAS may be taken 2 times in a two year period, provided there are 30 days between examinations, regardless of where I took the TEAS. I understand that TEAS results for any TEAS attempt that occurs more often than allowed will be considered invalid and no refund of fees will be made. I further understand that if the date of my last TEAS is more than 2 years old on the application deadline date, my TEAS examination will not be considered for my application. Note: the only exception to this rule is for graduates of the current PN Program curriculum who are applying to the LPN to ASN Program track within 2 years of graduating from the PN program AND who have taken the TEAS V version. If you are a current curriculum PN Program graduate and you graduated within 2 years of the ASN program application deadline date, you may choose to use the TEAS V scores you used for admission to the PN program or you may choose to repeat the TEAS V if you have test attempts left as described above. I understand that providing any false information or altered records in this application packet will result in my ineligibility to be admitted to the nursing program and that if discovered after my admission to the program, will result in immediate and permanent termination from the program. My signature below serves as acknowledgement of the requirements described above. I further acknowledge that all information and documents provided by me for this application are true and accurate. Signature Date Supporting Documentation List and Instructions: 1. All new students to Ivy Tech Community College are required to complete the college Admission Process. Online college admission applications may be found at or, you may apply through the region/campus Admissions Office. 2. Complete the online Nursing Information Session at within three (3) months preceding your nursing application date. NOTE: You may complete this session more than once. 3. Schedule and complete the TEAS V test. Go to for region/campus scheduling information. It is recommended that you meet with a nursing advisor PRIOR to taking TEAS V test. Prior attempts taking the TEAS V at other campuses or colleges will count in the maximum number of allowed attempts. NOTE: You must submit a copy of your test results in the application packet. 4. Submit this completed and signed application document including items listed below. All applications and required documents MUST be submitted to the School of Nursing office at the campus/region to which you are applying by the deadline date listed below. 5. A signed Nursing Application Acknowledgement form 6. A copy of your Official High School Transcript or a copy of GED scores 7. A copy of your TEAS V test results. Please submit only the copy of the test you wish to have considered for Admission 8. Copies of all College Transcripts: a. Ivy Tech LPN program graduates: A copy of your unofficial transcript may be submitted and is available through Campus Connect under, My Ivy Tech. b. LPN graduates from programs outside Ivy Tech and, for transfer credit of general education courses outside Ivy Tech: If courses have already been transferred to Ivy Tech and are showing on your Ivy Tech transcript, a copy, aka unofficial transcript from the outside college(s) must be submitted. If courses have not yet been transferred to Ivy Tech, you must submit an official transcript from the external college(s). Official verification of any pending grades on those transcripts must be submitted to the nursing office by the deadline date listed below. Note: It is the student s responsibility to ensure credits are transferred to the Ivy Tech transcript by the Registrar. The nursing department will not be responsible for forwarding transcripts to the Registrar s office or for obtaining copies from the Registrar s office for the purpose of awarding points 9. Credential Evaluation for International Students. See for documentation required. 10. Copy of your current unencumbered Indiana LPN license. Deadlines Start of nursing program Application Deadline ASN (RN) & PN Official Verification of Grades from other Colleges Due ASN Acceptance Letters Sent on or before PN Acceptance Letters Sent on or before Fall April 1 May 16 May 30 June 15 Spring September 1 September 1 September 30 October 15 Summer February 1 February 1 February 28 March 15 Applications must be received by 4:00 p.m. on the deadline date regardless if hand delivered or via the U.S. mail. If the application date falls on a Saturday or Sunday, the application will be due the next business day immediately following the application date listed. NOTE: It is your responsibility to ensure that the entire packet is submitted in its entirety by the deadline. Incomplete applications will not be considered in making admission selections. Fax, or random pieces of the application packet will NOT be accepted. Do not contact the nursing office to inquire about the status of your application after the deadline. You will be notified by mail of your status. Name: C# FOR OFFICE USE ONLY Date Received Prerequisite Requirements (must be completed prior to start of Program): Prereq ASA and Gen Ed math completed: MATH 123 or higher Minimum Application Requirements (must be completed by application deadline date): Nursing Application Acknowledgement form signed Current unencumbered Indiana LPN license TEAS V: Date Applicant Eligible HS Transcript/GED Academic Preparedness Category Applicant Not Eligible GEN ED COURSES WHEN TAKEN WHERE TAKEN GRADE POINTS APHY 101 PSYC 101 ENGL 111 TEAS V (record score to first decimal place SCORE WT POINTS Reading X 0.30 Math X 0.20 Science X 0.30 English X 0.20 TOTAL INITIAL POINTS TIE BREAKERS (IN ORDER APPLIED-ONLY ADDED IN EVENT OF A TIE Teas Adjusted Composite Percentage TEAS Science (1 decimal place) TEAS Reading (1 decimal place) TEAS English (1 decimal place) Number of prerequisites completed at Ivy Tech CUMULATIVE GPA POINTS Total Tie Breaker Points Applied TOTAL POINTS WITH APPLICABLE TIE BREAKERS ADDED
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