University of Connecticut
School of Nursing

Application
Masters Entry into Nursing

Please provide the following information.
If you have questions, contact the
Admission & Enrollment Services Office.
A "?" symbol indicates additional information related to the item
Note that required fields are marked with a pointing hand.
When you have entered all of the information, click on the "submit" button at the bottom of this page.

Today's date (mm/dd/yyyy)

What is your preferred campus?

Storrs

Waterbury

Stamford

Expected Year of Enrollment

2011

2012

2013

Biographical Information

First Name

Last Name

Social Security #

Birth or other surname(s)
in your academic record

Birthdate (mm/dd/yyyy)

Gender

Male

Female

Citizenship Status:

Visa status:

Birth Country?

Birth Location (City, County or Province)?

Ethnicity

Note to international students: Please contact the International Services and Programs Office at UCONN for assistance with any appropriate documentation needed (860) 486-3855.

Address 1

Email Address

City

State

Zip

Home Phone

Work Phone

Education

Baccalaureate degree

	Year	Institution	Location	Major	Degree earned	Accredited?
Baccalaureate

List all other educational institutions that you have attended, dates, and courses completed.

Transcripts

List institutions that are sending transcripts.

	Institution	Degree/Diploma	Date

Verification of Pre-Requisites

Indicate your grade and name of institution for each pre-requisite. If you have not completed a course, please enter the semester you plan to complete it.

	Grade Earned	Name of Institution	Course Number/Name
Statistics
Research
Biology
Chemistry
Human Genetics
Microbiology
Human A&P 1
Human A&P 2

Please note: A TOEFL (IBT) exam is required if English is not your native language, regardless of where you were educated. A phone interview may be required to validate english proficiency. Passing scores are as follows: A total score of 92 with the following breakdown: a minimun of 26 in both the listening and speaking sections and a minimum of 20 in both the reading and writing sections. Please have an official copy of your scores sent to the School of Nursing at the address below. Please insert N/A in textbox if this does not apply to you.

TOEFL Total Score (IBT)

Listening

Speaking

Reading

Writing

Professional Experience

Are you currently employed?

Full time

Part time

Not employed

Employer name and address

Describe your past work experience

Professional Interests and Goals

I am interested in pursuing the following clinical track at the masters level:

What are your career interests and goals?

Why are you interested in this program?

Additional Application Materials

The following items are sent directly to the School of Nursing. Please indicate the date that you sent (or plan to send) these items. Please note if you are sending by way of e-mail attachment, or by some form of paper transmission such as US Post, Federal Express, UPS, etc. (Note that the application fee is not refundable).

	Date	Mode used to send
Current Curriculum Vitae
Papers/Publications optional
Application fee: $50.00
Baccalaureate transcript

List all other transcripts requested, the date requested, and mode of sending.

	Institution	Date requested	Mode of sending

Provide the names of three individuals who you have contacted to provide letters of reference. Give a brief description of your professional relationship or prior association with each individual. Letters of reference should address your background, perseverance, potential for academic success, potential as a nurse, and ability to successfully work independently and in groups.
Please note that one reference letter needs to be academic.

	Name	Professional Relationship
1.
2.
3.

Additional material to be sent to:
University of Connecticut
School of Nursing
MbEIN Admission Committee
231 Glenbrook Road, Unit 2026
Storrs, CT 06269-2026

Send e-mail attachments to MbEIN Admissions.

Indicates Response Required

Application Masters Entry into Nursing