Life Care Planner Certificate Program - Application Form

  • INSTRUCTIONS 

    Congratulations on taking the first step towards a new and exciting career by submitting an application for the Life
    Care Planner Certificate program at Capital University Law School. The LCP program will explore how your skills
    can be put to use in the legal environment, and also features a unique interdisciplinary opportunity for the
    Life Care Planner to be a member of the legal team and to gain the knowledge of developing a Life Care Plan as a
    comprehensive, systematic method of determining the individual care needs and related costs for someone who has
    experienced a catastrophic injury, accident, or chronic illness.

    Please follow these instructions for completing the application process for admission to the Capital University Law
    School LCP program.

    I. Request official transcripts from ALL undergraduate and graduate institutions, regardless of whether a degree
    was completed be sent directly to Capital University Law School Life Care Planner Program – Paralegal
    Programs Office 
    II. Submit a resume or curriculum vita with your application.
    III. Submit the names of three references who have knowledge related to your academic/clinical skills and your
    potential for success in the LCP program. Possible references include former faculty and your current
    clinical associates/supervisor/employer.
    IV. Submit a 200-300 word essay in which you state your reasons for applying to the Life Care Planner 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 of the criteria for admission.
    V. Enclose a check in the amount of $30.00 made out to Capital University Law School for the application fee.


    Additional Admission Requirements for LCP Program if Registered Nurse 

    (1) Copy of RN licensure.
    (2) A minimum of 5000 hours of clinical experience.
    (3) A bachelor’s degree.*

    Additional Admission Requirements for the LCP Program for Non-R.N. Professional 

    (1) Copy of Rehabilitation Certificate (ie: CRC, CDMS, COHN, CCM, CCRN, ABVE, LPT, OTL, LPC etc)
    (2) A minimum of 3-5 years rehabilitation work experience
    (3) Bachelor’s degree in related field from an accredited four-year institution.

    The admissions committee also will consider your undergraduate GPA, community involvement, professional
    experience and all other relevant factors.
     

     

    Address all correspondence to: Capital University Law School
    Life Care Planning Program – Paralegal Programs Office
    303 E. Broad Street
    Columbus, Ohio 43215-3200

     
    Questions? Call 614-236-6885 or lcp@law.capital.edu 

    *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.

    Start Term:
     

    I. Biographical Information      

    1.  Last name:
     
    First name:
     
    MI: 
     
    2.    
     
    Street address:
     
     City:
     
     
     
    State:
     
     ZIP:
     
    3.  Date of birth:
      
    4.  Name as listed in telephone directory:
     
    5. Last four digits of applicant's social security number:
     
    6.  Home phone:
     
    7.  Employer:
     
    8.  Employer street address:
     
    Employer city:
     
       State:
        
     ZIP:
     
      
     
    9.  Date employed:
     
    10.  Work phone number:
     
    11.  Fax number (if appropriate):
     
    12.  Email address:
     
    13.

     License: state type and number:
     

    14.  Other license number (please specifiy:
     
    15.

    Have you previously applied for admission to any of the following:  The CULS Paralegal Program, the Capital University School of Nursing or the Capital University Law School?
     

    If so, which program?
      

    What year?
     

    Accepted or Denied?
     

    16.  Predominant ethnic background (optional) NOTE:  Response to this question is optional.  This information is used for statistical purposes and will not adversely affect the outcome of your application.
       
     
     
      Indian Tribal Registration No.:  
     

    Religious Preference: (optional) NOTE: Response to this question is Optional. This information is used for statistical purposes and will not adversely affect the outcome of your application.

     
    17. If there are no openings during the term preferred, do you wish to be considered for admission to the following term?
     


    II.  Educational Background  

    1.

    Have you previously attended a life care planner program?
     

    If yes provide name of program and any degree/certificate obtained.
     

    2. List chronologically ALL accreduted undergraduate and graduate institutions attended.
     
     

    Dates of Attendance
     

     

     

     

     

     

     

    Name of Institution
     

     

     

     

     

     

     

    Degree Date & Title 
     

     

      

     

     

     

     

    GPA
     

     

     

     

     

     

     

    3.

    Have you ever been on probation, suspended, or dismissed from any college(s), graduate  or professional school(s)?
     

    If yes you will need to complete the supplemental statement link presented at the end of this form,
    giving the name of the institution(s), action, date of action, and final disposition

    4.

    Academic honors, awards, scholarships received:

     

     

     

     

     

     

    5.

    Extracurricular activities:

     

     

     

    III. Employment History 

    1. List your last five positions of employment including part-time (please list in chronological order with your most recent first).
      Employer: Location: Nature of position: Dates:
                    
                  
                  
                
               
     
    2. Provide approximate total numbers of hours (or years) of clinical experience:   

     

    IV. Financial Aid Information 

    Are you interested in Stafford Loan 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?  

    V. Legal History 

    PLEASE ANSWER EACH OF THE FOLLOWING QUESTIONS.  IF YOUR ANSWER IS "Yes" TO ANY OF THESE QUESTIONS YOU WILL NEED TO COMPLETE A SUPPLEMENTAL FORM (link provided once this form is submitted).

     

    a. Have you ever been arrested?    
    b. Have you ever been discharged or requested to resign from any employment?  If so why? (Complete on Supplemental Form)  
    c. Have you ever been charged with any crime (except minor traffic violations)? If so what was the outcome? (Complete on Supplemental Form)  
    d. Do you have any unsatisfied judgments against you?  If so give reason(s) on supplemental form.  
    e.     Have you ever been charged with fraud, formally or informally?  If so what was the outcome?  (Complete on Supplemental Form)  
    f. Have you ever been a ward of any court, or declared incompetent by any court or committed to any institution?  If so give details on Supplemental Form.  
    g. Have you ever had a license denied, suspended or revoked?  If so why? (Complete on Supplemental Form)  
    h. Have you ever been suspended or expelled, as a disciplinary measure, from any professional organization or from public office?  If so give reasons on Supplemental Form.  
    i. Have you ever had a bond cancelled?  If so give reasons on Supplemental Form.  

    VI.  References 

    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.
     
    Name

    Title

    Mailing Address
    (including ZIP code

    Daytime Phone
    (including area code)
    1.             
    2.          
    3.         

     

    SUBMISSION 

    I certify this information is true and complete to the best of my knowledge.  Misrepresentation or omission of information on this application may jeopardize acceptance and enrollment.  I authorize my current and former employers and any schools, colleges or universities I have previously attened to release personal and academic information to Capital University Law School in connection with this application.

     

    Full Name: Date: Agree