Welcome to Arkansas State University!

P.O. BOX 910


Deadline For Application:  Applicants may begin with the fall or spring or summer semester. Deadline for application for the Summer semester is April 1.  Deadline for Fall is July 1. Deadline for Spring semester if October 15. Applications are not reviewed on a first come, first served basis but are judged according to the published criteria.

(*) denotes required information.

Please indicate when you plan on entering the NRS courses: Fall Spring Summer
* Last Name: * First Name: Middle Name:
Other names by which academic records or license may be found
* ASU ID Number:
License Information: Licensed as (check all that apply): RN LPN Other Other:
Home Phone Number Cell Phone Number Work Phone Number
Which number do you prefer we use? Home Cell Work
* Local Address:
* Local City: * Local State: * Local Zip:
Permanent Address:
Permanent City: Permanent State: Permanent Zip:
Notification of Admission decision should be sent to:
1. Has your license in nursing or any other health profession ever been disciplined (revoked, suspended, placed on probation, or reprimanded) or voluntarily surrendered in any state or jurisdiction? Yes No
2. Is your license currently suspended, revoked, or on probation or reprimanded for any reason? Yes No
3. Have you withdrawn, been dismissed, or attended but did not complete another nursing program? (**If yes, you MUST submit a letter of good standing from the director/chair of each nursing program you have attended, withdrawn from, been dismissed from or otherwise not completed.) Yes No
4. Are you an international student? Yes No If yes, what country?
5. Do you speak Spanish proficiently? Yes No
6. Have you ever participated in a MASH (Medical Applications of Science in Health) program or a CHAMPS (Community Health Applied for Medical Public Service) program? Yes No
If yes, where?
7. Have you completed all the general education requirements as described in the ASU undergraduate bulletin? Yes No
Education: List all colleges, universities, or other institutions (including ASU) attended since high school, credit hours earned, and degree(s) if applicable. Official transcript (s) showing ALL college (including ASU) and other post-high school work completed (i.e. courses taken at technical schools) including grades on the courses taken in the last semester of enrollment must be submitted with this application form. You must request and official transcript from EACH institution (including ASU).
Current Enrollment:
Initial preparation as a registered nurse was obtained from in (Month/Year) License Number
Malpractice Insurance: (Company) Malpractice Insurance: (coverage amounts) Malpractice Insurance:(Dates of Coverage)
Cardiopulmonary Resuscitation (expiration date)
PPD or CXR (expiration date)

Please mail a copy of your insurance, immunizations, CPR, validation of work experience form, and signature page for handbook to:
RN-BSN Admissions Committee,
PO Box 910
State University, AR 72467.