Nursing Prerequisite Evaluation Request

* denotes required element
*First Name:
*Last Name:
*Gender:	Male Female
*Mailing Address
Address:
City:
State:
Zip:
Country:

*Primary Phone:
*E-mail:
*Academic Status	I have:
Graduated from high school	Have not graduated from high school
*Intended Entry Term:

Indicate below all courses you have taken to meet the Department of Nursing prerequisite requirements. For classes you are currently taking indicate with "CT." A minimum of a 2.8 GPA is required to apply to the program, but the average GPA admitted is a 3.5. All prerequisites must be completed before you can apply to the nursing program.

BIOL 221 Human Anatomy and Physiology I Equivalent Course Number(s):

Equivalent Course Name(s):

College or University where taken:

Year Taken:

Number of Credits (per semester or qtr.):

Grade (for each semester or quarter taken):
Semester or quarter: Semester Quarter 1: 2:

BIOL 222 Human Anatomy and Physiology II Equivalent Course Number(s):

Equivalent Course Name(s):

College or University where taken:

Year Taken:

Number of Credits (per semester or qtr.):

Grade (for each semester or quarter taken):
Semester or quarter: Semester Quarter 1: 2:

CHEM 151 General, Organic, & Biological Chemistry I Equivalent Course Number(s):

Equivalent Course Name(s):

College or University where taken:

Year Taken:

Number of Credits (per semester or qtr.):

Grade (for each semester or quarter taken):
Semester or quarter: Semester Quarter 1: 2:

CHEM 152 General Organic & Biological Chemistry II Equivalent Course Number(s):

Equivalent Course Name(s):

College or University where taken:

Year Taken:

Number of Credits (per semester or qtr.):

Grade (for each semester or quarter taken):
Semester or quarter: Semester Quarter 1: 2:

WRIT 110 Freshman Composition Equivalent Course Number(s):

Equivalent Course Name(s):

College or University where taken:

Year Taken:

Number of Credits (per semester or qtr.):

Grade (for each semester or quarter taken):
Semester or quarter: Semester Quarter 1: 2:

COMM 100 Introduction to Communication Equivalent Course Number(s):

Equivalent Course Name(s):

College or University where taken:

Year Taken:

Number of Credits (per semester or qtr.):

Grade (for each semester or quarter taken):
Semester or quarter: Semester Quarter 1: 2:

MATH 180 College Algebra Equivalent Course Number(s):

Equivalent Course Name(s):

College or University where taken:

Year Taken:

Number of Credits (per semester or qtr.):

Grade (for each semester or quarter taken):
Semester or quarter: Semester Quarter 1: 2:

PSYC 150 General Psychology Equivalent Course Number(s):

Equivalent Course Name(s):

College or University where taken:

Year Taken:

Number of Credits (per semester or qtr.):

Grade (for each semester or quarter taken):
Semester or quarter: Semester Quarter 1: 2:

Please allow one week for processing. You will receive an email with the results of your evaluation. Questions can be directed to the Office of Undergraduate Admissions at (503) 554-2240.