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Master’s Nursing Program (Leadership & Nurse Practitioner) Application Packet

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Master’s Nursing Program

(Leadership & Nurse Practitioner)

Application Packet

CO L L E G E O F AP P L I E D S C I E N C E S A N D T E C H N O L O G Y

SC H O O L O F N U R S I N G

Dear Applicant, Thank you for your interest in Ball State University’s Master’s Nursing Program. We are excited you are interested in earing your Master’s Degree from Ball State University. The programs we offer include Leadership (Administrator & Educator) and Nurse Practitioner (Family). The application cycle for the Fall 2015 semester runs November 9, 2014—January 9, 2015 and is for both the Leadership and Nurse Practitioner tracks. In this packet you will find a variety of helpful information including program expectations, clinical information, frequently asked questions, and all of the supplemental materials required to be submitted as part of your School of Nursing application. Below are the different sections found in this packet. Please read everything in the packet carefully before attempting to complete the application process. If after reviewing all of the information you still have questions about the program please do not hesitate to contact the Graduate Advisor, Shantelle Estes, at [email protected] or by phone at 765-285-9130. We look forward to working with you in the near future! Sincerely, The Master’s Nursing Program Staff

Program Information

Application Process

Supplemental Forms to be Submitted

Ball State University - Master’s Nursing Program—Fall 2015

Program Information

1) Program tracks defined

2) About the Program

3) Master’s admission requirements

4) What to expect from an online master’s program

5) Frequently asked questions

6) Clinical information

Ball State University - Master’s Nursing Program—Fall 2015

Program Tracks Defined

Nurse Educator The program prepares students to meet nurse educator competencies. Role courses provide a foundation in curriculum and program development; teaching and learning in nursing; and evaluation methods. During the last semester the student will take a 225 hour practicum (2 days/week) in an associate or baccalaureate on campus nursing program. Students will have the opportunity to work with an experienced nurse educator both in the classroom and clinical setting

Nurse Administrator The program prepares students to develop management and leadership skills in preparation for higher-level management and leadership positions within healthcare. In addition to the didactic portion of the course students will complete 225 practicum hours in an approved healthcare environment focusing on completion of a large-scale research based project. Students will select their own master’s or doctoral prepared registered nurse preceptor and clinical supervisor in their community to help supervise the details of the project.

Family Nurse Practitioner

The program prepares students to provide health care across the life span in a family practice setting. In addition to the classroom requirements students will complete 735 supervised clinical hours in primary care settings caring for adults, children, women, and families. Students will find their own preceptors and clinical supervisors in their community. Students are eligible to apply for the FNP certification exam (ANCC and/or AANP) on completion of the program.

Ball State University - Master’s Nursing Program—Fall 2015

Our Master’s Nursing program is online and we do not offer an on campus program. The program is designed to be completed through part-time study and you have up to six years to complete your degree. For classes that have clinical components to them you will arrange your clinical experiences in your own community and use an outside specialist (preceptor) in your area of study who will provide supervised experience. Each student has an individualized plan of study that they create with the Graduate Advisor. Because the program is designed to be completed on a part-time basis students can expect to take two classes a semester. The Master’s Nursing program is not a correspondence program, where usually you complete a course and then immediately start the next course in the sequence. Instead our program operates on a semester basis (Fall, Spring, and Summer) however not all courses are offered every semester due to pre-requisites, clinical hours, etc. You can expect weekly assignments and class interaction. Providing you take two classes almost every semester (Fall, Spring and Summer) you can expect it will take a minimum of nine semesters (three years) to complete the Family NP track, and seven semesters for the Leadership (Educator & Administrator) tracks. A list of the courses required for each track can be found on the School of Nursing website.

About the Program

Ball State University - Master’s Nursing Program—Fall 2015

The Master's Admission Requirements are both for MS and RN-MS applicants. Applicants must meet the admission requirements of the Graduate School. Applicants are not required to take the GRE. Applicants must also:

Have graduated from a National League for Nursing Accrediting Commission (NLNAC) now referred to as the Accreditation Commission for Education in Nursing (ACEN) or Commission on Collegiate Nursing Education (CCNE) accredited bachelor's program in nursing.

Have a minimum 3.0 undergraduate GPA on a 4.0 scale. Have earned a grade of C or better in at least 2 quarter or semester hours in an undergraduate

research course. Have an unencumbered license as a registered nurse in state of practice.

Admitted students will need to meet all required health clearance, criminal background checks, and other requirements for clinical practice. Required forms must be submitted to Certifiedprofile.com before starting classes in the Master's Program. Non-submission of all required documentation will result in admission offer being rescinded. Students admitted who have been admitted before completion of the bachelor's degree must submit the final transcript and RN license before the first day of class the semester admitted. Students who do not have a valid RN license or transcript will have the admission offer rescinded.

Master’s Admission Requirements

Online programs are designed and structured very differently from traditional on campus programs. While online and on campus programs both have unique sets of qualities that appeal to individuals for a variety of reasons not all individuals are successful in online programs. Students who have been out of school for several years or who have never taken online courses may find an online program to be a big change from what they are accustomed to in a traditional on campus setting. Therefore, it may take those students more time to adapt to the different leaning environment an online program presents. Student in the Master’s Nursing program are expected to be and/or possess the following:

Computer literate (Microsoft Office, email, access to and knowledge of how to use a webcam and microphone, Internet navigation, ability to scan and uploading documents to website, etc.)

Self-motivated & have strong time management skills Responsible for one’s own learning Able to adapt to new learning styles Critical thinking & problem solving skills Able to read and follow detailed instructions Excellent writing skills (APA format, professional email correspondence, discussions boards, etc.)

In an online environment your written communication acts as your voice and represents who you are not only as an individual, but also as a professional nurse to your class mates, course instructors, program officials, etc. Being able to think critically and then express your thoughts in a professional and kind manner is of high importance. The Master’s Nursing program does not have recorded or live lectures as you would expect from an on campus program. Reading assignments, videos, group work, and discussion board are some of the methods used by the course faculty to facilitate your learning. Students are not required to log into a virtual class at a set time every day/week, instead, assignments will be given with due dates. Tests, however, may be proctored by a third party via webcam and microphone and students will be required to sign up for a testing time during the timeframe given by the instructor. Because online programs do not meet physically it is easier for students to put off coursework because the weekly reminder of going to class is not present. We have found that setting a weekly routine, with built-in study/homework time, and then disciplining yourself to stick with the routine will help students stay on top of the course requirements. Students in the Master’s Nursing program can expect to spend a minimum of 10-12 hours each week, per each 3 credit hour class, for homework, readings, discussion board posts, etc. When in clinical courses the 10-12 hours is in addition to the amount of time you will spend in your weekly clinical rotations.

What to Expect from an Online Master’s Program

Ball State University - Master’s Nursing Program—Fall 2015

Question Answer

How many students do you accept each application cycle?

Typically the committee selects up to 20 Leadership and 45 NP students each application cycle.

How competitive is your Master’s Nursing program?

It is not unusual for us to receive 150-200 applications and for 130+ to be moved forward to the admissions committee for review . Please be aware that admission into the School of Nursing is competitive, and meeting or exceeding the minimum requirements does not guarantee admission into the program.

Is the GRE required? No

Are there any required trips to campus?

No. All of your coursework will be done online and your clinicals will be done in your local community.

If I already hold a Master’s Degree in Nursing am I eligible to apply for a second Master’s Degree?

No, however you may be eligible to apply to Post-Master’s Certificate (PMC) program.

Do I need to have a certain number of years experience as a registered nurse in order to apply?

No. Previous nursing experience is not required.

If the Graduate School calculates my undergraduate GPA and it is below the minimum required 3.0 GPA am I eligible to be admitted on a probationary basis?

No. The School of Nursing does not admit students on a probationary status. Applicants with undergraduate GPAs below the required 3.0 will not be considered in the admission process.

How long does it take before admission decisions are made.

Applications will not be reviewed until after the deadline. Please allow a minimum of 6-8 weeks after the deadline for admission decisions to be made. Once decisions have been made all applicants will receive notification via the email address listed on their School of Nursing application.

Do you offer a full-time plan of study?

No. Our program is designed to be completed on a part-time basis. Students usually take two classes a semester. With permission from the Graduate Program Director, students may be able to take 3 classes during a couple of specified semesters in order to graduate a little bit earlier.

Frequently Asked Questions About the Master’s Nursing Program

Ball State University - Master’s Nursing Program—Fall 2015

Question Answer

What is the RN-MS option and how do I apply for it?

For the RN-MS track you must hold an Associate’s Degree in Nursing and a Bachelor’s Degree in a non-nursing field. For students accepted into the RN-MS track they are required to take an additional 16 credit hours of 300 and 400 level undergraduate coursework in addition to your Masters courses. Theses additional hours are also completed online as part of their Master’s program. There is not a separate application process for those interested in the RN-MS track.

Can I apply if I have not yet graduated with my nursing degree?

Yes. You would apply as usual and if you were admitted into the School of Nursing and had not yet graduated your admission would be a provisional admission providing final completion of your Bachelors’ degree with the appropriate grades and that you hold an unencumbered license as a registered nurse in your state of practice prior to the first day of classes.

Does the School of Nursing place me in my clinical rotations?

No. Please refer to the “Clinical Information” section to read more about the clinical process.

Do I need to buy a mobile device? Yes, with School of Nursing specifications. You will be sent information for the mobile device after you are registered for Nursing 605.

Once I finish one class can I start on the next class immediately?

No, courses are taught on a semester basis and follow a curriculum sequence. This program is not a correspondence program.

Do I work at my own pace in the program?

The program is structured on a semester basis with assignments due at certain times. You may work at your own pace during the assignment period, usually every week.

Can I transfer in Masters level courses I have already completed?

Students are able to transfer in up to 15 credit hours for the FNP track and up to 9 hours for the Leadership track. All credits (including transfer credits) cannot be older than six years at the time of graduation. Evaluation of transcripts for possible transfer credit are only by the School of Nursing are done at the students request once they have been admitted into the program. In order for a course to be considered for transfer credit you would need a grade of B or higher in order in the course ; grades of B- or below are ineligible for transfer consideration. Please note that the Research and Practicum courses must be taken at Ball State University and cannot be transferred in. Courses used to earn a previous Master’s degree are not eligible to be transferred in.

Frequently Asked Questions Continued

Ball State University - Master’s Nursing Program—Fall 2015

Students are responsible for arranging clinical placements within their local community. To assure students select and receive the appropriate clinical experiences, faculty have established requirements for each Nurse Practitioner and Leadership clinical courses. The requirements will be made available to students once they start the program. Clinicals are done in your home community with preceptors you select based on the requirements of the course. A clinical supervisor will be a second person you select to evaluate you onsite for advanced role courses. The Nurse Practitioner tracks are not acute care programs, so your clinicals will be done in primary care and clinic settings. Often students find there is competition for clinical preceptors and supervisors, so planning early may help in securing a spot. It is recommended that students start planning clinical experience one year in advance of when they are scheduled to take the course. Waiting until a month or two before the semester the clinical course begins will likely result in not securing an appropriate clinical site, clinical supervisor, and preceptor. Clinicals can not be done in your unit or clinic and the School of Nursing does not assist students with clinical placement, so it is recommended that you start your search for clinical placement early.

What should I do now to be better prepared for securing clinical placement? Cold calling/emailing offices or facilities is usually not an effective practice in securing clinical placement. Networking is the key to finding good clinical sites. If you do not already have a network of professionals built-up, start identifying individuals in your place of employment, local community, etc. who are currently working in your area of intended study (Nurse Practitioner, Nurse Administrator, Nurse Educator) and begin talking with them about their field. Let them know you are considering pursuing that field and let that be a start to build a foundation for communication.

Once admitted to the NP program it is strongly recommended... Indiana resident admitted into a NP track - It is strongly recommended that you join the Coalition of Advance Practice Nurses of Indiana (CAPNI). The website is: http://capni.org/index.cfm. Some regions are more active than others but the meetings are a place you can meet NPs in your area and network. Non-Indiana residents admitted into a NP track - It is recommend that you join a similar group in your state. We also recommend membership in AANP http://www.aanp.org/index.php as they also may have resources to locate NPs in your area as well as discounts on the certification exam, updates on policy, educational opportunities, etc.

Clinical Information

Ball State University - Master’s Nursing Program—Fall 2015

Application Process

1) How to apply

2) Supplemental materials for the School of Nursing

3) How to submit your supplemental materials

4) Application checklist

5) What to expect after the deadline

Ball State University - Master’s Nursing Program—Fall 2015

There are two (2) applications that must be completed. Both applications have supplemental materials that must be submitted before the application will be reviewed. Submitting an application does not guarantee admittance into any program.

1) Graduate School Application This form is submitted electronically. An official transcript from each college/university attended must be submitted directly from the institutions attended to the Graduate School. It is not necessary to request Ball State transcripts as these will be on file. Transcripts are to be submitted directly to the Graduate School. Do not send transcripts to the School of Nursing. Submitting transcripts to any other office than the Graduate School will delay your application process.

If you have taken or are currently enrolled in graduate level courses you will need to submit official transcripts from those institutions as well.

Submitting the Graduate School application and supplemental materials early is strongly recommended, as the Graduate School has a review and clearing process for each application that must be completed by the School of Nursing application deadline. Meeting the requirements of the Graduate School does not guarantee admission into the School of Nursing. Applicants must complete the application process and be cleared for graduate studies at Ball State University by the School of Nursing application cycle deadline the applicant is applying for.

Applicants who are cleared by the Graduate School after the Nursing application cycle has ended will not be considered for that application cycle.

The review process may take several weeks to complete depending on the volume of applications the Graduate School receives at that time. Please plan on having all of your materials submitted at least one month prior to the School of Nursing application deadline. Questions regarding the Graduate School application should be directed to the Graduate School.

2) School of Nursing Application - Master's Program Application will be available on the School of Nursing's website during the application cycle. This form will be submitted electronically.

The application will be posted online, after the start of the business day, on the first day of the application cycle. Should the application cycle begin on a weekend the application will be posted on the following Monday. The application will be available until, the close of the business day, on the last day of the application cycle. If the deadline falls on a weekend then the application will be made available until the close of the business day on the following Monday.

Once your School of Nursing application has been received you will receive an email confirmation from the Graduate Advisor within two business days. If you do not receive a confirmation email please contact the Graduate Advisor as your application may not have been received and may need to be resubmitted. If your application has been successfully submitted you should receive a copy of the complete application at the email address you provided on the application. The list of required supplemental materials for the School of Nursing is listed on the next page.

The Fall 2015 application cycle below is for both the Leadership and Nurse Practitioner tracks. November 9, 2014 - January 9, 2015

How to Apply

Ball State University - Master’s Nursing Program—Fall 2015

Supplemental Materials for the School of Nursing

1) Print out of applicants registered nursing license e-verification which includes the applicant’s name, license number, expiration date, current status, and disciplinary action. Visit your state’s e-verification website and print out your information. Copies of your card will not be accepted. The e-verification website for Indiana is: https://mylicense.in.gov/eVerification/ If you have not yet graduated and do not have a nursing license at the time you apply please include an 8x10 sheet of paper with a note letting the committee know when you will graduate and when you intend to take the NCLEX.

2) Entry Disclosure of Criminal Background Form (located at the end of this packet)

3) Essay - Using American Psychological Association (APA) format Applicants will need to address all of the following in one essay:

Your philosophy of Nursing Why you are seeking a Master’s degree from Ball State University What your professional goals are and how Ball State University’s Master’s Nursing Program will

help you meet your professional goals.

The essay should be a maximum of three (3) pages, not including the cover or reference pages. The purpose of the essay is to provide the Admissions and Progressions Committee insight into your philosophy, professional goals, desire of earning a Master's Degree at Ball State University, and to evaluate your written communications skills.

4) Three (3) recommendation forms (located at the end of this packet) All recommendations forms are to be in sealed and signed envelopes from the recommender. Each recommendation form must be submitted in a sealed envelope with the recommender’s signature across the sealed flap. Envelopes not sealed or without a signature across the flap will not be accepted. Recommenders are to return the completed form in a signed and sealed envelope to the applicant. The applicant is responsible to check and make sure the envelope has been sealed and signed by the recommender. The applicant is also responsible to submit the signed and sealed envelopes along with the rest of their supplemental materials. Recommendation forms must meet the following criteria:

If employed in a nursing capacity: one must be from the applicant's current supervisor If still in school: one must be from a nursing faculty member If still in school, but not currently employed in a nursing capacity: two must be from nursing

faculty members At least two of the three references must be from health care professionals At least two of the three references must hold a Master’s degree or higher Family and friends are not appropriate to use for recommendations.

Applicants are responsible for making sure the individuals they select as recommenders meet the above requirements. Do not assume that your recommender, including direct supervisors, hold a Master’s degree or higher. If you are unsure of your recommender’s highest level of education, ask them.

Ball State University - Master’s Nursing Program—Fall 2015

All of your supplemental materials required for the School of Nursing should be submitted to the address listed below prior to the application deadline. Materials must be received in the School of Nursing by the close of business day on the last day of the application deadline. If the application deadline falls on a weekend all application materials must be received in the School of Nursing by close of the business day on the following Monday. Close of business day is 5 p.m. (September - April) and 4 p.m. (May—August). Please allow adequate time for mailing and delivery of the materials. It is strongly recommended that you submit your application packet (2-3 weeks) prior to the deadline so there is time to resubmit any incomplete items if necessary. It is also recommended that you purchase a tracking option when mailing your supplemental materials to ensure your package was received. Please do not submit extra materials with your application packet such as resumes, awards, certifications, extra reference letters or forms, etc.

How to Submit Your Supplemental Materials for the School of Nursing

1) Due to the volume of applications received, in order to accurately track and process your application, items #1, #2, #3, & #4, listed on the previous page, must be mailed together in one envelope. Failure to include all items in one envelope will result in an incomplete application packet and will not be considered for admission.

2) Any supplemental nursing materials submitted prior to the start of an application cycle or after an application cycle has ended will be discarded.

The application deadline for the fall 2015 semester is January 9, 2015.

Address to submit Supplemental Material

Shantelle Estes, Graduate Advisor School of Nursing, CN 419D Ball State University 2111 W. Riverside Ave Muncie, IN 47306

Ball State University - Master’s Nursing Program—Fall 2015

Items required for a complete application:

Submit Graduate School application online

Pay Graduate School application fee

Submit official copy of all transcripts to the to Graduate School.

PLEASE NOTE: Submitting the Graduate School application and supplemental materials early is strongly recommended, as the Graduate School has a review and clearing process for each application that must be completed by the School of Nursing application deadline. Meeting the requirements of the Graduate School does not guarantee admission into the School of Nursing. Transcripts are to be submitted directly to the Graduate School, not the School of Nursing. Sub-mitting transcripts to any other office other than the Graduate School will delay your application process.

Submit School of Nursing application online

Print out of license e-verification with my name, license number, expiration date, current status, and disciplinary action from my states e-verification website.

Entry Disclosure of Criminal Background Form

Essay - APA format and maximum of 3 pages

Reference #1 - envelope has been sealed and signed by recommender

Reference #2 - envelope has been sealed and signed by recommender

Reference #3 - envelope has been sealed and signed by recommender

Below is a check sheet that will help you make sure that you have submitted all of your required materials so that your file will be ready for the review committee once the School of Nursing deadline arrives. This checklist is for your personal use. Please do not submit it with your materials to the School of Nursing.

Application Checklist

Ball State University - Master’s Nursing Program—Fall 2015

What to Expect After the Deadline

After the January 9th deadline all complete applications will be collected, and given to the Admissions & Progressions Committee. They will review the applications and make all admission decisions. Please allow a minimum of 6-8 weeks after the January 9th deadline before are contacted about your admission decision. Applicants will be notified of their admission status via the email address provided on their School of Nursing application. Applicants are responsible to monitor their “junk” folder in their email as sometimes the emails are delivered there instead of to their inbox. Students accepted into the program will be required to accept or decline their seat by the deadline set by the committee. Deadline extensions or exceptions are not given for emails delivered to junk folders or non-working email addresses

After students have officially accepted their seat in the program they will receive additional information about the next items to be completed, including watching an admission video, attending the mandatory orientation with the program director (a webcam and microphone will be required for the orientation), and completing their health clearance requirements. Below is a of the items that are currently required by the School of Nursing for health clearance purposes. Additional information about each of theses will be provided once admitted into the program.

T-DAP (Tetanus, Diphtheria, Annual influenza, Pertussis)

Varicella One of the following is required: 2 vaccinations OR positive antibody titer (lab report required)

Hepatitis B One of the following is required: 3 vaccinations OR positive antibody titer (lab report required)

Measles, Mumps & Rubella (MMR) One of the following is required: 2 vaccinations OR positive antibody titer for all 3 components (lab report required).

TB Skin Test One of the following is required: A 2 step test OR a clear Chest X-Ray (with lab report).

CPR Certification Must be the American Heart Association Healthcare Provider course OR American Red Cross Professional Rescuer course.

HIPAA Annually complete form and upload or upload proof of current training without expiring.

Entry Into Program 7 Year Disclosure of Criminal Background Form

1 Year Disclosure of Criminal Background Form

Informed Consent

Standard Precautions

Influenza Vaccine

RN License

Ball State University - Master’s Nursing Program—Fall 2015

Supplemental Forms

To Be Submitted 1) Criminal history disclosure (1 page)

2) Reference form (2 pages)

Ball State University - Master’s Nursing Program—Fall 2015

Please read and be honest when completing disclosure. Complete disclosure in ink.

___________________________________________________________________________________________________________

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Entry Disclosure of Criminal Background for Master’s Program

1) NAME OF STUDENT (print): ____________________________________________________________

2) MAIDEN NAME IF APPLICABLE (print): ___________________________________________________

3) ENTER ALL OTHER NAMES USED (print): __________________________________________________

4) DATE OF BIRTH: __________________________________________________

5) List all States, Counties, and Countries you have resided in for the past seven (7) years to current and the dates of residency. Dates should include month and year. Dates must cover entire period of seven (7) years to present.

State County Country (other than U.S.A.) Date by Years (FROM date—TO date/present)

6) Have you even been arrested or received a citation for any misdemeanor charges ? (Circle) YES / NO

7) Have you even been convicted of any misdemeanor charges? (Circle) YES / NO

8) Are there any current pending misdemeanor charges that have been filed against you? (Circle) YES / NO

9) Have you even been arrested or received a citation for any felony charges? (Circle) YES / NO

10) Have you even been convicted of any felony charges? (Circle) YES / NO

11) Are there any current pending felony charges that have been filed against you? (Circle) YES / NO

12) If you answered yes to any of the above questions, list all criminal arrests, citations, and convictions you have received by year, as well as any current pending criminal charges that have been filed against you. State requirement of probation, deferral program or diversion program if applicable.

13) If you answered “yes” to any questions above, when was the case dismissed? __________________________________ A) You are required to submit official document from court stating “case dismissed” with date of dismissal. All case dismissed documents must be submitted with the rest of your supplemental materials for the School of Nursing.

14) I understand that providing false information regarding my criminal history, failing to disclose requested information regard-ing my criminal history, or not successfully passing any required criminal history check may result in the my offer of admission being rescinded, or a failure to be approved for required placement assignments, and as such may result in my inability to progress through the BSU School of Nursing programs, as such required placements are prerequisites to the completion of any School of Nursing degree.

Date: ________________ Signature: _______________________________________________

Ball State University - Master’s Nursing Program—Fall 2015

Track applying for: (check one) Family Nurse Practitioner Administrator Educator

Fall 2015 - Recommendation Form for Master’s Nursing Program

Right to Access: Under the Federal Family Educational Rights and Privacy Act of 1974, students are entitled to review their records, including letters of recommendation. However, those persons writing recommendations and those assessing recommendations may attach more significance to them if it is known that the recommendations will remain confidential. It is the applicant’s option to waive the right to access these recommendations or to decline to do so. Please indicate your choice below and sign.

NAME: __________________________________________________

(please print)

______ I waive my right to review this recommendation. ______ I do not waive my right to review this recommendation.

Applicant Signature: _________________________________________________________ Date: _______________________________________________

TO BE COMPLETED BY APPLICANT

TO BE COMPLETED BY RECOMMENDER

You are requested to complete the information below, seal it in an envelope with your signature across the flap, then return it to the applicant for submission. Please note, envelopes not sealed or without a signature across the flap will not be accepted.

NAME: __________________________________________________________

(please print)

DATE: __________________________

EMPLOYEER: ______________________________________________ POSITION: _____________________________________

Please circle your association to the applicant:

SIGNATURE OF RECOMMENDER: _________________________________________

Why do you believe the above applicant should be selected for Ball State University’s Nursing Masters Program?

ADDRESS: ___________________________________________________________________________________________________

Additional comments:

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

How long have you know the applicant in the above indicated capacity? _________________________________________

HIGHEST LEVEL OF EDUCATION OBTAINED: _________________________ DAYTIME PHONE: ________________________

Current Supervisor

Nursing Faculty Co-Worker Other (list):__________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Ball State University - Master’s Nursing Program—Fall 2015

Track applying for: (check one) Family Nurse Practitioner Administrator Educator

CRITERIA: CANNOT JUDGE

INADEQUATE BELOW

AVERAGE

SATISFACTORY ABOVE AVERAGE

OUTSTANDING

Leadership ability

Community involvement

Self-confidence

Ability to accept

responsibility for actions

Enthusiasm

Ability to accept criticism

Current nursing

knowledge

Communication skills

Ability to make sound

judgment decisions

Ability to read and follow

instructions

Ability to meet deadlines

Maturity

Ability to adapt to change

Technology skills

Critical reading skills

Teaching ability

Cooperativeness

Ability to work

independently

Reliability

Interactions with clients

and families

Interactions with

co-workers

Depth of knowledge in

proposed field of study

Overall, I expect the

applicant’s Graduate

work to be:

Please rate the applicant on the following professional, academic, and personal attributes by placing a in the box that best

reflects your assessment of the applicant.

Overall Recommendation (check one):

□ I do not recommend this applicant

□ I recommend this applicant with some reservations

□ I recommend this applicant without any reservations

Ball State University - Master’s Nursing Program—Fall 2015