DICKINSON STATE UNIVERSITY
Bachelor of Science in Nursing Completion Program Application
(Application MUST be received in the Department of Nursing no later than February 1)
Name Date
Address
(street address) (city) (state) (zip)
Email Address
Phone / DSU Empl ID number (if applicable)
(Home) (Cell)
Have you applied/been accepted to Dickinson State University (as required)? Yes; No; Pending
It is the student’s responsibility to keep current contact information on file in the Department of Nursing.
Incorrect contact information may result in delay or exclusion of admission to the program.
Current nursing license number: RN or LPN ; State of licensure
OR
Nursing licensure pending passage of NCLEX: RN or LPN ; State of licensure
Your application will be considered INCOMPLETE and WILL NOT BE PROCESSED if the required
official evidence of the following is not submitted WITH THIS APPLICATION:
College cumulative GPA AND College cumulative nursing GPA
I plan to request ADMISSION to the nursing program for Fall (academic year); OR
I plan to request READMISSION to the nursing program for Fall or Spring of the (academic year)
Have you PREVIOUSLY applied to this nursing program? YES NO
(date of PREVIOUS application)
Please be advised all nursing students admitted or readmitted to our nursing programs are required to complete annual
criminal background checks (necessary for clearance for participation in clinical) & functional ability assessments.
All students who have previously attended any other college/university must submit copies of nursing course syllabi
to the Department of Nursing for consideration of course substitution.
List college/university attended and forward official transcript, (if not currently on file), to DSU Department of Nursing:
Name and address of college/university
Mail application with required evidence to: Department of Nursing, Dickinson State University, 291 Campus Drive, Dickinson, ND 58601;
OR Attach application to email and send to: dsu.nursing@dickinsonstate.edu; OR Fax to 701-483-2524
If you have any questions about the application, please contact the Department of Nursing at 701-483-2133 or 1-800-279-4295, x2133 7/16
PERMANENT RESIDENTS & INTERNATIONAL STUDENTS
(who have NOT completed their AASPN degree at DSU)
I have included an official copy of my TOEFL Test Scores (Test of English as a Foreign Language)
which indicate minimum required scores of:
Listening > 22 ; Reading > 22 ; Speaking > 26 ; and Writing > 24
