CAPITAL UNIVERSITY LAW SCHOOL
303 E. Broad Street Columbus, OH 43215 Phone: (614) 236-6886 Fax: (614) 236-6978
LEGAL NURSE CONSULTANT PROGRAM APPLICATION FOR ADMISSION
Congratulations on taking the first step towards a new and exciting application of your nursing education and expertise in the Capital University Law School Legal Nurse Consultant (LNC) Program. This program allows the experienced BSN registered nurse to explore how his/her skills can be put to use in the legal environment, and also features a unique interdisciplinary opportunity for the experienced RN looking to complete his/her bachelor’s degree.
Please follow these instructions for completing the application process for admission to the Capital University Law School LNC program and, if applicable, the Capital University School of Nursing’s Bachelors Completion Program.
Additional Admission Requirements:
The admissions committee also will consider your undergraduate GPA, community involvement, professional experience and all other relevant factors.
*Note: Consideration will be given for a limited number of seats to nurses with a current RN license who have a minimum of 15 years of clinical experience combined with an associate’s degree or at least 60 hours of college credit.
Last Name: Last Four Digits of Applicant's Social Security Number: Email Address:
If there are no openings during the term preferred, do you wish to be considered for admission to the following term?
Birth date (enter MM/DD/YYYY):
Place of Birth:
Country of Citizenship:
Former Last Name (if any):
Ohio RN License Number:
Other RN License Number (please specify):
Predominant Ethnic Background (Optional): Note: Response to this request is optional. This information is used for statistical purposes and will not adversely affect the outcome of your application.
Are you Hispanic or Latino?
Select one or more races:
American Indian or Alaska Native
Black or African American
Native Hawaiian or other Pacific Islander
Religious Preference: (Note: Response to this question is optional. This information is used for statistical purposes only and will not adversely affect the outcome of your application.)
Lutheran - Other
No Current Church Affiliation
Religion Not Reported
United Church of Christ
Answer each of the following questions yes or no. If you answer yes to any question, give dates and details on a supplementary form linked to this application. If, after you submit this application, your circumstances change or there are new events resulting in new or additional information to that previously submitted, you must submit a signed and dated explanation of the change or changes. It is of critical importance that all questions below be answered truthfully and fully.
a. Have you ever been arrested, charged, apprehended, cited, given a ticket, or convicted of any crime, offense, felony or misdemeanor (except for minor traffic offenses not connected with the use, abuse, or possession of alcohol, drugs, or other chemicals)? Have you ever been court-martialed or charged with fraud?
b. Have you ever been suspended, expelled, discharged, or asked to resign from any school, employment, professional organization or public office?
c. Have you ever been in bankruptcy, had a license denied, suspended or revoked, had a bond cancelled or been declared incompetent by any court?
d. Have you previously attended any law, legal nurse consultant, or paralegal program?
If you answered yes to any of the above four questions, complete the supplemental form linked to this application.
List chronologically all undergraduate and professional institutions you have attended (Institution/Location, Dates, Major/Degree, Semester Hours, Approx. GPA)
Undergraduate:1. 2. 3. 4.
List all academic honors and awards after high school:
List extracurricular and community activities:
Financial Aid InformationAre you interested in Stafford Load information?
Have you filed the Free Application for Federal Student Aid (FAFSA)?
If yes, date forms were submitted: If no, do you need these forms:
Have you previously applied for admission to any of the following Capital University Paralegal Programs: Paralegal/LNC/LCP
*If yes, year and outcome (accepted or denied):
Employers (include any military experience here):1. Employer/Location: Position Held: Dates 2. Employer/Location: Position Held: Dates: 3. Employer/Location: Position Held: Dates: 4. Employer/Location: Position Held: Dates:
Names of three references (former or current faculty or employers) who may be contacted regarding your academic/clinical skills and your potential for success in this program.1. Reference Name: Reference Title: Reference Mailing Address: Reference Daytime Phone: Reference Email:
2. Reference Name: Reference Title: Reference Mailing Address: Reference Daytime Phone: Reference Email:
3. Reference Name: Reference Title: Reference Mailing Address: Reference Daytime Phone: Reference Email:
Please prepare a 200-300 word essay in which you state your reasons for applying to the Legal Nurse Consultant Program and your overall professional goals. This essay will be used to evaluate your writing ability and will be considered by the Admissions Committee as one criteria for admission.
Please email your resume/CV to email@example.com.
Please describe any special circumstances in your background that would help us evaluate your application.
I certify that all of the information given here is complete and accurate and given for the purpose of having action taken in reliance thereon. I understand that an inaccurate or incomplete application may be the basis for denial of admission, or if I am admitted in reliance on inaccurate or incomplete information, this may be the basis for dismissal. Any changes in the above responses require an amendment to the application.
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