First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Telephone Home:

Telephone Work:

KSU ID#:

E-mail Address:

Your KSU ID number is REQUIRED to process your application; you MUST apply to KSU to receive your KSU number.

REQUIREMENTS:

1. Must be accepted to KSU.

2. Must have a grade of C or better in all science, math, and English courses.

3. Must have a minimum of 2.7 GPA.
   

EDUCATIONAL INFORMATION

EMPLOYMENT HISTORY

Institution Name
& Address

From/To

Full Time or
Part Time

Title

Supervisor & Phone Number

Submission of this application confirms that the above information is accurate to the best of my knowledge. I understand and agree to the information in this application.

All applicants should be aware that the state examining board has the right to refuse to grant a registered nurse license to any individual regardless of his/her educational credentials under circumstances of:

1. Falsification of application for licensure

2. Conviction of a felony or crime of moral turpitude

3. Other moral and legal violations specified in Georgia Law

Applicants who think they might have an applicable situation should talk with the department chair early in the program of study.

Date:

Signature:

The Department of Baccalaureate Degree Nursing is fully accredited by the Commission on Collegiate Nursing Education.

Contact information:

Admissions & Advisement Center
(770) 499-3211
Fran Herzig - email: fherzig@kennesaw.edu
Sandi Pitts - email: spitts7@kennesaw.edu