Nursing Program Application Form Advanced Standing LPN to ADN

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* 1. Full legal name

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* 2. Mailing Address

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* 3. Telephone number

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* 4. Personal email address

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* 5. Current employer

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* 6. Cloud Student ID
(If available)

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* 7. Emergency Contact Name

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* 8. Emergency Contact Phone Number

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* 9. Emergency Contact Address

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* 10. High School Attended

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* 11. High School Graduation or anticipated Graduation year.

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* 12. PN School Attended/Attending

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* 13. PN School Graduation or anticipated Graduation year.

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* 14. Previous education information (include year of completion)

College, University, Vo Tech

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* 15. If you have previously attended an RN nursing program, reason for leaving:

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* 16. Are you requesting admission as a transfer student from another nursing program?

Yes

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* 17. Are you a current LPN?

Yes

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* 18. Are you enrolled in an LPN program?

Yes

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* 19. Are you interested in the BSN Partnership opportunity?

Yes

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* 20. Completed, in progress, or plan for completion of the following classes:

English Composition I

Human Growth & Development

General Education Math Course

Anatomy & Physiology I & II

Anatomy & Physiology 5 cr

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* 21. Have you been convicted of a misdemeanor or felony?

Yes

Convictions or Disciplinary Action - Felony Crimes Against Persons are an automatic bar to Kansas nursing licensure as set by the Kansas legislature. It would require a law (statute) change by the Kansas legislature to allow licensure. Those actions are “as specified in article 34 of chapter 21 of the Kansas Statutes Annotated, prior to their repeal, or article 54 of chapter 21 of the Kansas Statues annotated or K.S.A. 2015 Supp. 21-6104, 21-6325, 21-6326 or 21-6418, and amendments thereto.” --Kansas Nurse Practice Act. The Kansas State Board of Nursing Staff can answer questions relating to Kansas licensure (785-296-4325).
Prospective students must understand the:
♦Qualifications for writing the state board licensure examinations, Kansas Nurse Practice Act 65-1115. https://ksbn.kansas.gov/wp-content/uploads/NPA/npa.pdf
♦Grounds for disciplinary action/denial of license, Kansas Nurse Practice Act 65-1120. https://ksbn.kansas.gov/wp-content/uploads/NPA/npa.pdf
♦Crimes against persons. https://www.kslegislature.gov/li/b2025_26/statute/021_000_0000_chapter/021_054_0000_article/

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* 22. I certify that I have carefully considered each question and that my information is true and complete to the best of my knowledge. I have read the admission requirements, nursing admission procedure and legal qualifications for RN licensure.

Nursing Program Application Form Advanced Standing LPN to ADN

Question Title

* 1. Full legal name

Question Title

* 2. Mailing Address

Question Title

* 3. Telephone number

Question Title

* 4. Personal email address

Question Title

* 5. Current employer

Question Title

* 6. Cloud Student ID(If available)

Question Title

* 7. Emergency Contact Name

Question Title

* 8. Emergency Contact Phone Number

Question Title

* 9. Emergency Contact Address

Question Title

* 10. High School Attended

Question Title

* 11. High School Graduation or anticipated Graduation year.

Question Title

* 12. PN School Attended/Attending

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* 13. PN School Graduation or anticipated Graduation year.

Question Title

* 14. Previous education information (include year of completion)

Question Title

* 15. If you have previously attended an RN nursing program, reason for leaving:

Question Title

* 16. Are you requesting admission as a transfer student from another nursing program?

Question Title

* 17. Are you a current LPN?

Question Title

* 18. Are you enrolled in an LPN program?

Question Title

* 19. Are you interested in the BSN Partnership opportunity?

Question Title

* 20. Completed, in progress, or plan for completion of the following classes:

Question Title

* 21. Have you been convicted of a misdemeanor or felony?

Question Title

* 22. I certify that I have carefully considered each question and that my information is true and complete to the best of my knowledge. I have read the admission requirements, nursing admission procedure and legal qualifications for RN licensure.

* 6. Cloud Student ID
(If available)