January 2020 Practical Nursing Application


PLEASE READ EVERY QUESTION AND DESCRIPTION VERY CAREFULLY!  Do NOT use ALL CAPS.  If you have any errors while filling out the application, DO NOT FILL OUT MULTIPLE APPLICATIONS!!  Multiple applications will be deleted.  If you have any changes to a current application, call us to make the changes.  Read everything and answer accordingly.  Read the descriptions of the questions to be sure you are filling everything out correctly.  Check your spelling!  Make sure you put the correct information, in the correct field, in the correct format.  


THIS IS YOUR FIRST IMPRESSION-----MAKE IT A GREAT ONE!


ENTRANCE REQUIREMENTS:

1. Application

2. Official High School transcript or G.E.D.

3. Official College transcripts.

All transcripts must be official and not copies.  They must be sent to us from the school, in a Sealed Envelope.

Required:   1. Graduation transcript from an accredited high school or GED certificate. The GED must show test scores.          
                  2. College transcripts (if applicable) for all schools attended, even if no course credit or diploma was
                             received.

4. Entrance Testing:
ACT Score of 18 or higher, OR
SAT Score of 860 or higher, OR
Review of official college transcripts by BSPN Nursing Director to determine if previous courses taken meet admission requirements.

The transcripts must be submitted to BSPN PRIOR to scheduling Work Keys testing at the ROE.  No refunds will be given for those who cancel testing which has been scheduled prior to transcript review.

IF ACT or SAT or transcripts are not available:
Work Keys Entrance Exam which identifies skills levels in Math, Workplace Documents, and Graphic Literacy.  Applicants must have a Score of 5 in both Workplace Documents and Math, and a 4 in Graphic Literacy.

Students results that are too low, are recommended to consider developmental courses prior to reapplication.

5. Two letters of professional reference.

Note: All items listed above must be completed and turned into school before a student will be considered for admission.
 
*******IT IS THE STUDENT'S RESPONSIBILITY TO ENSURE ALL REQUIRED DOCUMENTS HAVE BEEN COMPLETED.*******  

ACCEPTANCE INTO THE PROGRAM:

Record Review: All application materials will be reviewed by the Department of Nursing upon receipt.

NOTE: Not all candidates receive interviews with the Admissions Committee or the Director of Nursing. Some application documents may receive record review only and no further action may be taken by BSPN. Phone interviews may be substituted when necessary.

Interview: A personal interview may be scheduled after all entrance requirements are met for applicants who meet the required criteria.        

Upon completion of record review and/or interview, the applicant will receive written notification as to whether or not he/she has been accepted for admission.

A STUDENT'S 2019/2020 FAFSA AND 2020/2021 FAFSA MUST BE COMPLETED PRIOR TO ATTENDING THE MANDATORY FINANCIAL AID ORIENTATION BEFORE SCHOOL STARTS!
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Email *
First *
Please enter your first name.
Middle *
Please enter your middle name.  If you do not have a middle name, please enter "N/A".
Last *
Please enter your last name.
Maiden *
Please enter a maiden name, or any other legal name you have ever had.  If you DO NOT have a maiden name, please enter "N/A".
Social *
Please enter your Social Security Number.  ONLY USE NUMBERS, NO (-) DASH MARKS!
Birth *
Please enter your date of birth.
MM
/
DD
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YYYY
Age *
How old are you?
Gender *
Address *
Please enter your street address here, please be sure to say St. Dr. or Ln.  There are many streets in one town only distinguished by street, lane, or drive.   DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE!
City *
What city do you live in?
State *
Please pick the state you live in.  If your state is not listed, please select "Other".
Zip *
Please enter your zip code.
County *
Please enter the county that you live in.  If your county is not listed, please select "Other".
Phone *
Please enter your Primary Phone Number here.  If your cell phone is your primary number, please enter that here. ONLY USE NUMBERS, NO (-) DASH MARKS!
Cell *
Please enter your cell phone number here.  If your cell is your primary number, please also enter it here.  ONLY USE NUMBERS, NO (-) DASH MARKS!
Cell Carrier *
Who do you contract with for your cell service?
Marital Status *
What is your marital status?
Income *
What is your annual household income?
Race *
(Requested not Required) If you would prefer not to give us this information, please select "N/A".
Citizenship *
Visa *
If you are NOT a U.S. Citizen please indicate your type of Visa.  If you ARE A CITIZEN, please enter N/A
Living Arrangements *
Attended Beck *
Have you attended Beck School of Practical Nursing in the past?
Schooling *
Do you have an Associates, Bachelor's, or Master's degree in ANY other field, regardless of type of profession?
College *
Please list ALL college or vocational colleges attended as well as the years attended, beginning with the most recent first.  Official transcripts required for each school listed.  Failure to provide all transcripts will remove your eligibility for the program.  If you have NOT ATTENDED a college, please enter N/A.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
High School *
What is the name of your high school, which city, and state, did you graduate from?  If you DID NOT GRADUATE, PLEASE ENTER N/A. DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
H.S.Year *
What year did you graduate high school?  Please ONLY give us the YEAR YOU GRADUATED HIGH SCHOOL. Numbers ONLY.  If you DID NOT GRADUATE, PLEASE ENTER FOUR NUMBER ZEROS (0000).
GED *
If you did NOT graduate High School, do you have a GED?  An official transcript in the original, sealed envelope must also be provided to the school from the place you received your GED.
Employment History
Employer 1 *
Indicate in the box below: Current or most recent EMPLOYER name, location, type of work, dates, reason for leaving.  If you have no other employer, please ENTER N/A.  If you have no other employer, please ENTER N/A.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Employer 2 *
Indicate in the box below: SECOND EMPLOYER name, location, type of work, dates, reason for leaving.  If you have no other employer, please ENTER N/A.  If you have no other employer, please ENTER N/A.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Employer 3 *
Indicate in the box below: THIRD EMPLOYER name, location, type of work, dates, reason for leaving. If you have no other employer, please ENTER N/A.  If you have no other employer, please ENTER N/A. DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Employer 4 *
Indicate in the box below: FOURTH EMPLOYER name, location, type of work, dates, reason for leaving. If you have no other employer, please ENTER N/A.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Reference #1 *
Indicate a PROFESSIONAL, NON-Family member in the box below: name, relationship, mailing address, & phone number.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Reference #2 *
Indicate a PROFESSIONAL, NON-Family member in the box below: name, relationship, mailing address, & phone number.   DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Reference #3 *
Indicate a PROFESSIONAL, NON-Family member in the box below: name, relationship, mailing address, & phone number.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Certification #1 *
Do you have any Licensure or Certification?  In the box below indicate:  State of licensure, TYPE of licensure or certification, Lic/Cert. number, issue date, status (active, lapsed, etc.).  If you have NO CERTIFICATION, PLEASE ENTER N/A.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Certification #2 *
Do you have any Licensure or Certification?  In the box below indicate:  State of licensure, TYPE of licensure or certification, Lic/Cert. number, issue date, status (active, lapsed, etc.).  If you have NO CERTIFICATION, PLEASE ENTER N/A.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Certification #3 *
Do you have any Licensure or Certification?  In the box below indicate:  State of licensure, TYPE of licensure or certification, Lic/Cert. number, issue date, status (active, lapsed, etc.).  If you have NO CERTIFICATION, PLEASE ENTER N/A.  DO NOT USE "ENTER" KEY, USE SPACE BAR AND COMMAS TO DISTINGUISH DIFFERENT LINES. MUST ALL BE ON ONE CONTINUOUS LINE.
Personal History
Beck *
How did you hear about Beck School of Practical Nursing?
Criminal? *
Have you been convicted of any criminal offense in any state or in federal court (other than minor traffic violations)?  If yes, forward to BSPN a certified copy of the court records regarding your conviction, the nature of the offense, and the date of discharge, if applicable, as well as a statement from the probation or parole office.
Felony? *
Have you been convicted of a felony?
Ability? *
Have you had or do you now have any disease or condition that interferes with your ability to perform the essential functions of this profession, including any disease or condition generally regarded as chronic by the medical community, i.e., (1) mental or emotional disease or condition; (2) alcohol or other substance abuse; (3) physical disease or condition, that interferes with your ability to practice this profession?
Denied? *
Have you ever been denied a professional license or permit, or privilege of taking an examination, or  had a professional license or permit disciplined in any way by any licensing authority in Illinois or elsewhere?
Discharged? *
Have you ever been discharged, other than honorably, from the armed services or from a city, county, state or federal position?
Child Support? *
In accordance with 5 Illinois Compiled Statutes 100/10-65(c), applications for renewal of a license or a new license shall include the applicant’s Social Security number, and the licensee shall certify, under penalty of perjury, that he or she is not more than 30 days delinquent in complying with a child support order.  Failure to certify shall result in disciplinary action, and making a false statement may subject the licensee to contempt of court.  Are you more than 30 days delinquent in complying with a child support order?
Default? *
In accordance with 20 Illinois Compiled Statutes 2105/2015-(5), “The Department shall deny any license or renewal authorized by the Civil Administrative Code of Illinois to any person who has defaulted on an educational loan or scholarship provided by or guaranteed by the Illinois Student Assistance Commission or any governmental agency of this State; however, the Department may issue a license or renewal if the aforementioned persons have established a satisfactory repayment record as determined by the Illinois Student Assistance commission or other appropriate governmental agency of this State.”  (Proof of a satisfactory repayment record must be submitted.)  Are you in default on an educational loan or scholarship provided/guaranteed by the Illinois Student Assistance Commission or other governmental agency?
Financial *
I understand that my Financial Aid history and eligibility will be reviewed as part of my application process.
Read *
Please read the following in its entirety and select the box next to each statement, as this will acknowledge your acceptance of each.  You will be required to sign the submitted application at the time of your interview.
Permission *
I give my permission for the Practical Nursing Director or his/her designee to contact any persons listed as references or employers for the purpose of clarifying information in my student file or to obtain additional information at the Practical Nursing Director’s discretion.
Fraud *
I understand that any falsification or omission of information in application to the Practical Nursing program is seen as fraud and is cause for me not being accepted to or for my immediate dismissal from the program.
Denial *
Applicants are reminded that licensing boards may deny, suspend or revoke a license or may deny the individual opportunity to sit for an examination if an applicant has a criminal history or is convicted or pleads guilty or nolo contendere to a felony or other serious crime.  Successful completion of a health professions program of study at the Career Center of Southern Illinois and Beck School of Practical Nursing does not guarantee licensure, the opportunity to sit for a licensure examination, certification or employment in the relevant health care occupation.
No discrimination *
Career Center of Southern Illinois and Beck School of Practical Nursing does not discriminate because of race, age, color, sex, religion, national origin, handicap, or status as veterans:
Truth Statement *
I have read the information provided in this application and am familiar with its contents.  By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting information submitted with my application packet are true and correct to the best of my knowledge.
MUST READ THE FOLLOWING!! Thank you for your interest in our program! WE DO NOT CONTACT YOU!  Feel free to call us so we can create your file (618-473-2222 ext. 122), then you must submit to us Official High School Transcripts, Official College Transcripts, two professional letters of reference, as well as arrange your entrance testing requirement. (If you failed to list a school on your application that you actually went to, you will be required to submit a transcript for that school as well.) All of this information MUST BE SENT TO BECK SCHOOL OF PRACTICAL NURSING, 6137 Beck Road, Red Bud, IL 62278 .  Once all forms have been submitted, if you meet the criteria for the program, you will be contacted for an interview.
Please mail letters of reference and official transcripts to:
Beck School of Practical Nursing
6137 Beck Road
Red Bud, IL 62278
A copy of your responses will be emailed to the address you provided.
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