Fillable Dnp Application (University of Hawaii at Hilo)

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Dnp Application (University of Hawaii at Hilo)

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University of Hawaii Hilo School of Nursing
DOCTOR OF NURSING PRACTICE
Supplementary Application form
BSN to DNP
MSN to DNP
Please check
ONE entry point:
Administrative
FNP
PLEASE PRINT OR TYPE
Last Name First Name MI
Gender (optional)
Male Female TG
Address: (street) City State Zip
Home:
Phone:
Cell:
e-mail:
ZipStateCityEmployer's Address: (street)
Employer's Name:
Work Phone:
Work e-mail (optional) UH ID Number (if known):
Yes No
Do you currently hold an active registered nurse (RN) license in the United States?
IF YES, in what state or states do you hold an active RN license?
License
Number:
Have you ever attended the
UH Hilo School of Nursing?
Yes No
Please list degree(s) received and graduation dates (if applicable):
Graduation Date
Month/Year
Yes No
Are you currently employed in
Nursing?
Yes No
IF YES, do you plan to continue
working while in graduate
school?
Part
Time
Full
Time
IF YES, do you plan on working
part-time or full-time?
Yes No
Are you a member of
Sigma Theta Tau?
Yes No
IF YES, list chapter(s) and
leadership positions held (if any)?
FOR INTERNATIONAL OR ENGLISH AS SECOND LANGUAGE STUDENTS ONLY
Yes No
Have you successfully completed the CGFNS qualifying examination?
Have you successfully completed the NCLEX qualifying examination?
TOEFL or IELTS score (within last 2 years):
If NO, when do you plan to take the
CGFNS qualifying examination?
If NO, when do you plan to take the
NCLEX qualifying examination?
If you are NOT applying for the MSN to DNP entry-point, please skip the next three questions:
Yes No
Are you currently certified as an Advanced Practice Nurse? IF YES, please specify: Agency & Expiration date:
If you have a Master's degree in nursing, what is your specialty?
FNP EducationANP AdministrationGero Other
If other, please list your area of study:
UNIVERSITY OF HAWAII AT HILO: 200 West Kawili St. Hilo, HI 96720 TEL: (808) 974-7414 TOLL FREE: (800) 897-4456 FAX: (808) 933-0861
Signature:
Date:
I have reviewed the UH-Hilo School of Nursing Faculty, Preceptor, and Student Graduate Handbook and understand the following:
I acknowledge that all information on this application is correct and that if admitted into the Doctor of Nursing Practice program, I will be
financially liable for obtaining all immunizations, a drug screen and background check, CPR certification, and other items required for the
clinical practicum and/or internship portion of this program. I understand that there may be required on-campus visits and that I will be
responsible for making arrangements to attend. An online Doctor of Nursing Practice program in nursing is time intensive; and I understand
that my coursework and/or clinical practicum requirements may conflict with other activities or my current employment and that I may need to
rearrange these commitments to allow myself the opportunity and time to do well as a UH-Hilo DNP nursing student.
Degree ReceivedName of Institution (School)
PLEASE PROVIDE THE FOLLOWING ADDITIONAL DOCUMENTS WITH YOUR APPLICATION
Resume or Curriculum Vitae: Please include a resume or curriculum vitae which documents your educational preparation, work
experience, leadership and professional organization activities, and scholarly endeavors such as publications, presentations, research,
honors, and awards.
Personal Goal Statement: Your personal goal statement should be typed, single-spaced, and attached to this application. In 600
words, submit a statement describing your professional goals and how participation in the DNP program will enhance these goals.
Additionally, the statement should identify and briefly discuss a practice-based problem of interest to you that might serve as the
topic for your final, scholarly, DNP project. The scope of the project when completed should be large enough that it would result in,
for example, a change at the organizational system, regional or national level; new or revised state health policy, or the establishment
of significant new health-related service to a population or geographic region. The purpose of this statement is to provide the
Admissions Committee insight into the professional goals and expectations of the applicant, congruency of topic area with faculty
expertise, and an opportunity to evaluate the applicant's written communication skills.
Recommendations: Please include three (3) professional recommendations, these can be from former faculty members or employers
prepared at the master's or doctoral level who can address your potential or ability to function in the advanced practice nursing role
(i.e. clinical skills, critical thinking, independent decision making, collaboration and communication with other health professionals,
and leadership abilities). Applicants currently enrolled in a nursing program must submit recommendation forms in a sealed
envelope with the reference's signature across the seal.
Final Checklist: SUBMIT ONLY A COMPLETED APPLICATION PACKET
Application for UH Hilo Graduate School and a non-refundable application fee.
Official Transcripts from all previous colleges/universities attended from an accredited nursing program.
Current resume or curriculum vitae
Personal Goal Statement (Est. 600 words, single spaced)
3 Recommendations from academic and/or professional references (recommendation form: http://hilo.hawaii.edu/
admissions/forms/documents/dnp_recommendation.pdf)
Copy of Current RN Licensure for Hawaii
Copy of current Licensure in state where clinical practice or practice inquiry project will be conducted.
Copy of Verification of APRN certification or license appropriate to the state where the clinical practice and practice inquiry
will be conducted.
Health Clearance: Tuberculosis clearance documentation, documentation for tetanus/diphtheria vaccination received within
the last ten years; documentation for hepatitis-B vaccination series or serological evidence of immunity; serological evidence
of immunity to mumps, rubella, rubeola and varicella. Others as requested by agency.
TOEFL/IELTS results to be sent to UH-Hilo
Successful completion of CGFNS exam
FOR INTERNATIONAL STUDENTS:
Please send your Supplementary Application form to:
UH Hilo Admissions Graduate Applications
200 W. Kawili Street
Hilo, HI 96720
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Dnp Application (University of Hawaii at Hilo)

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Completed 20 July 2020

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