Doctor of Nursing Practice Application

Most Recent School Attended

School Name

Level of Study

Attended Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Degree Obtained?

Additional Schools

School #2 Name

Level of Study

Start Date

End Date

Degree Obtained?

School #3 Name

Level of Study

Start Date

End Date

Degree Obtained?

School #4 Name

Level of Study

Start Date

End Date

Degree Obtained?

School #5 Name

Level of Study

Start Date

End Date

Degree Obtained?

Disciplinary Questions

Have you previously been dismissed from any academic program or university?

Yes

Please explain the situation:

Have you ever been adjudicated guilty or convicted of a misdemeanor or felony? Note that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential.

Yes

Please explain the situation:

Additional Program Requirements

The DNP requires that all applicants hold an active, unencumbered license as a Registered Nurse in the state in which nursing practice will occur.

RN License must be active and unencumbered by the end of the first semester of the DNP program
RN License must be active and unencumbered throughout the DNP program

The Post-Graduate APRN Certificate Program requires that all applicants hold an active, unencumbered licenses as a Registered Nurse in the state in which nursing practice will occur.

RN License must be active and unencumbered throughout the DNP program

Do you currently hold an active, unencumbered RN License in the state in which your nursing practice will occur?

Yes

If "No," when will you receive your RN license

Signature

I acknowledge that every school that I have attended may release all requested records and recommendations to Chaminade University of Honolulu. I also understand that employees at CUH may confidentially contact my current and former schools should they have questions about the information submitted on my behalf.

I certify that all information submitted in the admission process, including this application and any other supporting materials, is my own work, factually true, and honestly presented, and that these documents will become the property of Chaminade University of Honolulu and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree should the information I have certified be false.

I agree to notify the institutions to which I am applying immediately should there be any change to the information requested in this application, including disciplinary history.

I understand that once my application has been submitted it may not be altered in any way; I will need to contact Chaminade University of Honolulu directly if I wish to provide additional information.

I understand that all offers of admission are conditional, pending receipt of official final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.

I have read and agree to the above.

Applicant Signature