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Application for Admission

Allen College considers admitting applicants living out of state or country.

However, select states require approval prior to offering online courses and clinical study. Additionally, a state certification or governing licensing board may also require prior approval. Therefore, Allen College cannot guarantee students maintaining residency in a state other than Iowa will be allowed to enroll in online courses.

Applicants planning to maintain residency in any state other then Iowa, and planning to enroll in an online course or engage in clinical study in any state other than Iowa, should consult an admission counselor prior to applying.

Allen College
Student Services Office
1825 Logan Avenue Waterloo, IA 50703
Admissions@allencollege.edu
(319) 226-2000
Fax: (319) 226-2010
http://www.allencollege.edu
Instructions
To be considered for admission to Allen College, the applicant must submit the following:

    Undergraduate Application Process

  • Completed application form
  • Non-refundable $50 application fee (Submit application online with fee OR print a copy and return by mail with a check made payable to Allen College)
  • Official high school transcripts sent directly from the institution to Student Services office
  • Official transcripts from all colleges attended sent directly from the institution to Student Services Office
  • Reference (ONE for BSN, ASR, and BHS; TWO for 15-Month Accelerated and Evening / Weekend BSN)
  • Job Shadow Experience Documentation (NMT and DMS only)
  • Essential Functions form
  • Results from TOEFL, IELTS or Pearson (if foreign born without US college credit)

    Graduate Application Process

  • Completed application form
  • Non-refundable $50 application fee (Submit application online with fee OR print a copy and return by mail with a check made payable to Allen College)
  • Official transcripts from all colleges attended sent directly from the institution to Student Services Office
  • Three recommendations from professional or academic representatives
  • Biosketch (MSN)
  • Resume or Curriculum Vitae (DNP)
  • Goal Statement
  • Proof of RN Licensure
  • Essential Functions form
  • Results from TOEFL, IELTS or Pearson (if foreign born without US college credit)
  • Evidence of national certification (DNP only)
PLEASE NOTE: Most data is required, * signifies optional fields or sections where information not required
Personal Information
Application Date: Friday Apr 18, 2014 at 12:36:22 AM
Last Name
First Name
Middle *
Other Names? (i.e. Maiden)
If yes, give name(s)
Current Street Address

Current City
Current State
Current County (if Iowa):
Current Zip


Number of Months at Current Address

Is your Permanent Address the same as your Current Address?
Permanent Street Address

Permanent City
State

Permanent County
(if Iowa)
Permanent Zip
Primary Phone
555-555-5555
Work Phone *
555-555-5555
Cell Phone *
555-555-5555
E-mail Address
Date of Birth mm/dd/yyyy

Place of Birth Gender
Male Female
Social Security Number
(000-00-0000)


Your social security number is being collected in compliance with the Dept of Education, the federal financial aid regulations, Federal Trade Commission and the truth and lending laws. Your personal identification number will be kept confidential in compliance with the FTC and the Gramm-Leach-Gliley Act (GLB).
Country of Citizenship: USA Other, please specify:
If you are not a U.S. citizen, in which country were you born?
If you are not a U.S. citizen, what is your visa type? Student Exchange Visitor Permanent Resident Other, please specify:
If you are not a U.S. citizen, are you a permanent resident of the U.S.? Yes No If NO, enter your Alien Registration Number
A-
If you are not a U.S. citizen, are you a lawfully admitted alien? Yes No
Is English your native language? Yes No, please explain:
Ethnic Origin? (Optional)*
Hispanic/Latino(a)  OR   Non-Hispanic/Latino(a)
Alaskan Native or American Indian, Tribal/Nation Affiliation:
Caucasian/White, not of Hispanic/Latino(a) origin
African American/Black
Asian
Native Hawaiian or Pacific Islander
Two or More Races
Race/Ethnicity Unknown
Please be informed that licensure or certification may be sanctioned for conviction of a crime including a felony, a gross misdemeanor, or misdemeanor with the exception of speeding and parking violations. Additionally, acceptance and successful completion does not guarantee licensure, certification, or employment, which may be contingent on factors unrelated to the education process. I acknowledge that if my answer is not true, I may not be eligible for admission
1. Do you have a record of convicted child or dependent adult abuse? Yes No
2. Have you ever been convicted of a crime in this state or any other? Yes No
3. Are you currently incarcerated? Yes No
4. Have you ever been excluded from or served with notice of exclusion from any governmental programs, i.e., medicare, medicaid, financial aid, loan default? Yes No
If yes to any questions, explain and give dates:
Education (List chronologically)
Official transcripts from high school, colleges, and/or technical schools (if attended) are required for admission to Allen College and should be sent directly from the respective school to the admissions office.
Are you a current or future Wartburg College Student?Yes   No I will be part of the 3 + 1 Program   2 + 2 Program
Are you a current or future Loras College Student?Yes   No I will be part of the 3 + 1 Program   2 + 2 Program
Are you a current or future Central College Student?Yes   No I will be part of the 3 + 1 Program   2 + 2 Program
Are you a current or future Simpson College Student?Yes   No I will be part of the 3 + 1 Program   2 + 2 Program
Name of School Location Date of Entrance
MM/YYYY
Date of Leaving
MM/YYYY
List Diploma or Degree Received
High School or GED
College
College
College
Are you currently? Registered Licensed Certified N/A
RN Licensure License Number
Renewal Date
State
Current Professional Certification Title
Credentialing Organization
Renewal Date
Are you a current UnityPoint Health employee? Yes No
Current Employer Name
Location
Position
Admission Information
Desired Enrollment Status: Part Time Full Time
Program to which you are applying:
School of Health Sciences School of Nursing
Associate of Science in Radiography (ASR)

Desired enrollment
Summer

Bachelor of Health Science (BHS)
Diagnostic Medical Sonography (DMS)  
Cert Bach
Medical Laboratory Science (MLS)
Nuclear Medicine Technology (NMT)  
Cert Bach
Public Health (Fall Only)

Desired enrollment
Fall

 Bachelor of Science in Nursing (BSN)
Traditional Upper Division (fall or spring start)
15-Month Accelerated (summer start only)
Evening/ Weekend PT (fall start only)
LPN-BSN (fall start only)
RN-BSN (fall or spring start)
RN-MSN (fall or spring start)


Desired enrollment
Fall
Spring
Summer
 Master of Science in Nursing (MSN)**
 Post-Master's Certificate**

MSN Track Options
**Must declare a track

Nurse Educator
Nurse Leader/Administration
Community/ Public Health Nursing
Family Nurse Practitioner
Family Psychiatric Mental Health Nurse Practitioner
Adult/ Geronotological Primary Care Nurse Practitioner
Adult/ Gerontological Acute Care Nurse Practitioner
Community/ Public Health & Family Nurse Practitioner Combination
Community/ Public Health & Adult/ Geronotological Primary Care Nurse Practitioner Combination


Desired Enrollment
Fall
Spring
Doctor of Nursing Practice (DNP)

Desired Enrollment
Fall


Doctor of Education (EdD)
 Health Professions Education

 Desired Enrollment
Fall
Are you planning to apply for financial aid? Yes No
MSN Applicants: Will you have completed 800 hours of clinical nursing experience prior to attending Allen? Yes No
Will you have earned a bachelor's degree prior to attending Allen? Yes No
How did you hear about Allen College? (check only one)
Advertisement
Health Care Professional Family Member
Alumni High School Visit Internet
Information Session UnityPoint Health or Affiliate Staff Other, please specify:
Counselor Friends
Have you taken or are you scheduled to take the American College Test (ACT) or the Scholastic Aptitude Test (SAT)?
SAT (If yes, indicate month and year) Yes No
Month   Year
ACT (If yes, indicate month and year) Yes No
Month
Year
Are you a first generation student?   (Neither of your parents completed a college degree) Yes    No
Are you fluent in more than one language? Yes    No    If Yes, which languages:
Have you had experience in providing care to an ill family member/friend? Yes    No    If Yes, please explain:
Have you had any role models/mentors that were in the health care profession? Yes    No    If Yes, please explain:
Describe your involvement in leadership activities.
Describe your community involvement or activities in service to others.
Tell us about your ability to overcome significant challenges.
Tell us about your experience with diverse cultures.
What are your plans after you graduate?
ESSAY:
Please tell us what influenced you to pursue your health profession goals and any other
information you would like us to consider when reviewing your application?

Application Payment
I wish to pay the $50 application fee by:
Please charge my
Card Number
Expiration Date
Credit Card Verification Code
Credit Card Billing Address


City State
Zip
Signature

Allen College does not discrimate on the basis of race, color, religion, national origin, gender, sexual orientation, age or qualifying disability in admission, employment, programs or activities. Persons have inquiries regarding compliance with Title VI, Title I, or Section 504 may contact the Student Services Office, Allen College, 1825 Logan Avenue, Waterloo, IA 50703, or the Assistant Secretary for Civil Rights, U.S. Department of Education.

It is hereby cerfitied that information given in this application is true and correct. It is understood that misrepresentation, omission of information, or failure to answer any single question may cause delay or cancellation of admission or registration. For the purpose of determining admission, I hereby authorize any educational institution, which I have previously attended, and officials of such institutions to release academic, disciplinary and medical records and to discuss these records with appropriate officials at Allen College.

Applicants planning to maintain residency in any state other then Iowa, and planning to enroll in an online course or engage in clinical study in any state other then Iowa, should consult an admission counselor prior to applying.


Applicant/Electronic Signature
Type in your name


Date
Type in the Date (mm/dd/yyyy)