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RN to BSN Program Admission Application
Please note - You must be admitted to Murray State University before can submit this application. For more information, visit
murraystate.edu/admissions
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* Indicates required question
Last name
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Your answer
First name
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Your answer
Middle initial
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Your answer
M# (Murray State ID number) (Enter pending if not available.)
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Your answer
Street address
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Your answer
City
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Your answer
State
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Your answer
Zip
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Your answer
Murray State student email address. (Enter pending if not available.)
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Your answer
Personal email address
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Your answer
Phone number
Your answer
Which semester are you applying for admission?
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Fall
Spring
Summer
What year are you applying for admission?
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Your answer
What is your nearest Murray State regional campus?
Henderson
Hopkinsville
Madisonville
Paducah
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List the college(s) you've attended in the past.
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Your answer
At which college did you earn your associate's degree in nursing?
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Your answer
ADN Graduation date
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Your answer
RN License #
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Your answer
State
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Your answer
Has your nursing license ever been revoked or suspended?
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Yes
No
If yes, please explain why your license was revoked or suspended.
Your answer
Have you ever been convicted of a felony?
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Yes
No
If yes, please explain your felony conviction.
Your answer
How many years have you been a practicing RN?
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Your answer
List your RN employment history including employer, position and dates.
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Your answer
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