* Last Name:
	* First Name:
	Middle Name:
	Preferred First Name:
	* Home Address:
	* Home City:
	* Home State:	Kansas Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
	* Home Zip:
	Home County:

	Current Mailing Address (if different from above):
	Current City:
	Current State:	Kansas Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
	Current Zip:
	Current County:
	* Male: Female:
	Telephone:	- -
	Email Address:
	Date of Birth:	- -
	Social Security Number:	- -
	Are you a U.S. citizen or an eligible non-citizen?	Yes: No:
	Are you:	Single Married Separated Divorced Widow/Widower

	Tell us...about your family
	Father's name:
	Father's Address (if different):
	Father's City:
	Father's State:	Kansas Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
	Father's Zip:
	Father's County:
	Father's Phone:
	Father's Employer:
	Mother's name:
	Mother's Address (if different):
	Mother's City:
	Mother's State:	Kansas Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
	Mother's Zip:
	Mother's County:
	Mother's Phone:
	Mother's Employer:
	Parent's Marital Status:	Married Single Separated Divorced Widow/Widower

	Who/What influenced your decision to apply to Baker University School of Nursing?
	Are you related to or do you know anyone who has gone to Baker? Please list their name and relationships to you below.

	Academic Information
	List below the high school or preparatory school which you are now attending/attended:
	Name of School:
	City:
	State:
	Period of Attendance:
	Graduation Date:

	List below the colleges or universities you have attended, including correspondence or extension work. It is the student's responsibility to have all official transcripts sent directly to the Office of Student Affairs at Baker University School of Nursing from the previous institution(s). Failure to report enrollment at another institution may result in suspension from Baker University.
	College	State	Dates Attended	Hours Completed	Hours in Progress
		Kansas Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
		Kansas Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
		Kansas Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

	List below degrees earned and the institution from which they were earned.
	Degree Earned (BA or AS)	Name of Institution

	Please respond to the following questions:
	Are you now or have you ever been on academic or disciplinary probation at any college?	Yes No
	Have you ever been suspended or dismissed from any high school or college?	Yes No
	If you answered yes to either of the last two questions, please enter a brief explanation below:
	If you have attended another college, are you eligible to continue your studies at the last college or university you attended?	Yes No
	If not, please enter a brief explanation below:
	Do you currently have an application on file with any other college or university?	Yes No
	If so, please give the name(s) of the other school(s) below:

	Enrollment Information
	I expect to enroll at Baker in:	Spring 2008Fall 2008Spring 2009Fall 2009 as a -- Select --Part Time (1-11 hours)Full Time (12 or more)

	Classification:	Special (non-degree seeking)	Junior (64-97 hours)	Senior (98 or more hours)
		Transfer (Previously enrolled at another school or college of nursing.)
		Basic Degree Completion Student	Registered Nurse Degree Completion Student
		RN License #	State	Expiration

	Will you be an applicant for financial aid?	Yes No
	I am currently enrolled at

	Please list the courses in which you are currently enrolled, and those you plan to take next semester(if any):
	Department	Course No.	Course Title	Credit Hours
	Next Semester

	Employment History: (Employers will not be contacted)
	Employer	Location City, State	Dates of Employment	Position	Status Full or Part Time

	What stimulated your interest in nursing and what attributes do you possess that you feel would enhance your career as a nurse?

	By checking the box below, I verify that the information I have provided on this form is true and complete to the best of my knowledge.
	I agree
	Please make certain all information above is correct. Once you click Submit Application below, you will NOT be able to go back and modify it.