LPN To ASN Transition Nursing Program Applicant .

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LPN to ASN Transition Nursing ProgramApplicant Information, Instructions, and Acknowledgement FormLPN To ASN Transition Applicant Information:Last Name:First Name:Maiden Name:Student C#: C0Middle Initial:Street Address:City, State, Zip Code:Phone:Ivy Tech Email:Other Email: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 courserequirements. 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 ifthey 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 admissionto the nursing program. MATH 123 or higher (Quantitative Reasoning) is a prerequisite to the nursing programhowever, no points are given toward admission for completion of this course.(APHY 101) Anatomy & Physiology I:Course completed:Year/semester completed:College:Grade:(PSYC 101) Introduction to Psychology:Course completed:Year/semester completed:College:Grade:(ENGL 111) English Composition:Course completed:Year/semester completed:College:Grade:(MATH 123 or higher) Quantitative Reasoning:Course completed:Year/semester completed:College:Grade:LPN TO ASN TRANSITION Application Form Rev. 9/2015

NURSING APPLICATION ACKNOWLEDGEMENTIacknowledge that I have completed requiredadvising activities prior to submitting this application to the Associate of Science in Nursing Program andthat 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 mycampus and I understand requirements of the nursing programs. I further understand that I am required toreview this session within 3 months of the application deadline date, each time I apply to the NursingPrograms, 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 skillsadvancement courses and prerequisite courses, and further information or clarification I needed regardingnursing admission/selection policies and processes. I have read and understand the contents of the Nursing Programs Overview and Application ProcessBooklet 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 tothe Nursing Programs and that prior versions of the TEAS will not be considered for admission. TEASexamination fees are non-refundable.oThe TEAS may be taken 2 times in a two year period, provided there are 30 days betweenexaminations, regardless of where I took the TEAS. I understand that TEAS results for any TEASattempt that occurs more often than allowed will be considered invalid and no refund of fees willbe made.oI further understand that if the date of my last TEAS is more than 2 years old on the applicationdeadline 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 curriculumwho are applying to the LPN to ASN Program track within 2 years of graduating from the PNprogram AND who have taken the TEAS V version. If you are a current curriculum PNProgram graduate and you graduated within 2 years of the ASN program application deadlinedate, you may choose to use the TEAS V scores you used for admission to the PN program oryou 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 resultin my ineligibility to be admitted to the nursing program and that if discovered after my admission to theprogram, will result in immediate and permanent termination from the program.My signature below serves as acknowledgement of the requirements described above. I furtheracknowledge that all information and documents provided by me for this application are true andaccurate.Signature DateLPN TO ASN TRANSITION Application Form Rev. 9/2015

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 www.ivytech.edu or, you may apply through theregion/campus Admissions Office.2. Complete the online Nursing Information Session at www.ivytech.edu/nursing within three (3) monthspreceding your nursing application date. NOTE: You may complete this session more than once.3. Schedule and complete the TEAS V test. Go to www.ivytech.edu/teas/ for region/campus schedulinginformation. It is recommended that you meet with a nursing advisor PRIOR to taking TEAS V test. Priorattempts taking the TEAS V at other campuses or colleges will count in the maximum number of allowedattempts. 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 andrequired documents MUST be submitted to the School of Nursing office at the campus/region to whichyou are applying by the deadline date listed below.5. A signed “Nursing Application Acknowledgement” form6. A copy of your Official High School Transcript or a copy of GED scores7. A copy of your TEAS V test results. Please submit only the copy of the test you wish to have considered forAdmission8. Copies of all College Transcripts:a. Ivy Tech LPN program graduates: A copy of your unofficial transcript may be submitted and is available through CampusConnect under, “My Ivy Tech”.b. LPN graduates from programs outside Ivy Tech and, for transfer credit of general educationcourses outside Ivy Tech: If courses have already been transferred to Ivy Tech and are showing on your Ivy Techtranscript, a copy, aka “unofficial transcript” from the outside college(s) must besubmitted. If courses have not yet been transferred to Ivy Tech, you must submit an officialtranscript from the external college(s). Official verification of any pending grades onthose transcripts must be submitted to the nursing office by the deadline date listedbelow.Note: It is the student’s responsibility to ensure credits are transferred to the Ivy Tech transcript by theRegistrar. The nursing department will not be responsible for forwarding transcripts to the Registrar’s office orfor obtaining copies from the Registrar’s office for the purpose of awarding points9. Credential Evaluation for International Students. See tudents.pdf for documentation required.10. Copy of your current unencumbered Indiana LPN license.LPN TO ASN TRANSITION Application Form Rev. 9/2015

DeadlinesStart of nursingprogramApplication DeadlineASN (RN) & PNOfficial Verification ofGrades from otherColleges DueASN AcceptanceLetters Sent on orbeforePN AcceptanceLetters Sent on orbeforeFallApril 1May 16May 30June 15SpringSeptember 1September 1September 30October 15SummerFebruary 1February 1February 28March 15Applications 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 dayimmediately following the application date listed.NOTE: It is your responsibility to ensure that the entire packet is submitted in its entirety by the deadline. Incompleteapplications will not be considered in making admission selections. Fax, email or random pieces of the applicationpacket will NOT be accepted.Do not contact the nursing office to inquire about the status of your application after the deadline. You will benotified by mail of your status.Name: C#FOR OFFICE USE ONLYDate ReceivedPrerequisite Requirements (must be completed prior to start of Program):Prereq ASA and Gen Ed math completed: MATH 123 or higherMinimum Application Requirements (must be completed by application deadline date):Nursing Application Acknowledgement form signedHS Transcript/GEDCurrent unencumbered Indiana LPN licenseTEAS V: DateAcademic Preparedness CategoryApplicant EligibleApplicant Not EligibleGEN ED COURSESWHEN TAKENWHERE TAKENAPHY 101PSYC 101ENGL 111TEAS V (record score to first decimal placeReadingMathScienceEnglishTOTAL INITIAL POINTSTIE BREAKERS (IN ORDER APPLIED-ONLY ADDED IN EVENT OF A TIETeas Adjusted Composite PercentageTEAS Science (1 decimal place)TEAS Reading (1 decimal place)TEAS English (1 decimal place)Number of prerequisites completed at Ivy TechCUMULATIVE GPASCOREGRADEPOINTSWTX 0.30X 0.20X 0.30X 0.20POINTSPOINTSLPN TO ASN TRANSITION Application Form Rev. 9/2015

Total Tie Breaker Points AppliedTOTAL POINTS WITH APPLICABLE TIE BREAKERS ADDEDLPN TO ASN TRANSITION Application Form Rev. 9/2015

LPN TO ASN TRANSITION Application Form Rev. 9/2015 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 www.ivytech.edu or, you may apply through the

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