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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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* 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. Previous education information (include year of completion)

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* 11. Prior certified patient care experience.
Examples include: Certified Nurse aide, patient Care Tech, Emergency Medical Service, Medical Assistant, Physical Therapy Assistant.

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* 12. If you have previously attended a nursing program (including LPN), reason for leaving:

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

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* 14. Are you a current LPN or LPN student?
If YES, please complete the Advanced Standing LPN to ADN application.

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

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

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

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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* 18. 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.

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