Pre-Licensure Application

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BSU Email(Required)

Personal Email(Required)

Phone(Required)

BSU Tech ID(Required)

CNA/LPN Documentation(Required)

Max. file size: 8 MB.

Upload your CNA/LPN documentation. Need proof you took the course. Can be image of completion certificate or transcript from HS or college. Do not submit proof of your license as that is not accepted.

American Heart Association Basic Life Support CPR Documentation(Required)

Max. file size: 8 MB.

Upload CPR Certification

Do you have any experience, certifications, or licenses that relate to the healthcare field?(Required)

Yes

If you answered "yes", please list:

Do you have experience working with populations that different from your own?

Yes

Describe the importance of leadership in nursing, reflecting on your past experiences working within teams and collaborating with professionals from various disciplines. How do you envision utilizing your leadership skills to foster interdisciplinary collaboration in patient care, and what strategies would you employ to ensure effective teamwork in a healthcare setting?

How does your desire to excel academically relate to your ability to understand and respect diverse cultures in nursing? Share examples of how you plan to use your academic motivation to support cultural competence in your nursing practice.

Critical Thinking Recommendation (form should be returned to Department of Nursing by recommender)

https://www.bemidjistate.edu/academics/nursing/wp-content/uploads/sites/32/2024/08/Critical-Thinking-Recommendation-2.docx

Leadership Recommendation (form should be returned to Department of Nursing by recommender)

https://www.bemidjistate.edu/academics/nursing/wp-content/uploads/sites/32/2024/08/Leadership-Recommendation-Letter.docx

Are you an international student?(Required)

Yes

Race/Ethnic Background

Are you Hispanic, Latino or Spanish (a person of Cuban, Dominican, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture regardless of race)?

American Indian or Alaska Native - A person having origins in any of the original peoples of North, Central, and South America who maintains cultural identification through tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southest Asia or the Indian subcontinent (e.g., Chinese, Vietnamese, Filipino, Asian Indian, Korean, Japanese).

Black or African American - A person having origins in any of the black racial groups of Africa, Jamaica, or Haiti (e.g., Somali, African American, Nigerian, Jamaican, Ethiopian, Haitian).

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands (e.g., Chamorro, Tongan, Fijian, Marshallese, Palauan).

Middle Eastern or North African - A person having origins in areas of northern Africa or the Middle East (e.g., Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, Algerian, Iraqi, Kurdish).

White - A person having origins in any of the original peoples of Europe (e.g., German, Irish, English, Italian, Polish, French, Dutch, Norwegian, Swedish, Finnish).

Gender

Male

Female

Other

Are you from a rural residential area?

Yes

Application Agreement(Required)

I hereby apply for the pre-licensure nursing program at Bemidji State University. By checking this box, I state and certify that the information, statement, and answers as herein recorded on all application materials are full, true and correct to the best of my knowledge and belief and that no information required to be given therein, either expressly or by implication, has been knowingly withheld. I understand the statements and answers/omissions are part of this application and, if contrary to fact, could constitute grounds for my dismissal from the nursing program. I understand that my application will not be considered for placement if all required documents, including references, are not submitted by the deadline.

Pre-Licensure Application 2024 -2025