Nursing Symposium Application 2024

Student Information

Level - HIDDEN

Type - HIDDEN

Inquiry - HIDDEN

First Name

Last Name

Chosen First Name

Date of Birth

Legal Sex

Female

Male

The following questions are optional and have no bearing on the applicant’s candidacy or eligibility to participate in the program

Are you Hispanic?

Yes

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific

White

Gender Identity

agender

female / woman

genderfluid

genderqueer

male / man

non-binary including non-conforming

transgender male / man

transgender female / woman

not listed

prefer not to answer

Preferred Pronouns

Any / All

He / Him / His

Please use name

Prefer not to answer

Prefer to be asked

She / Her / Hers

They / Them / Theirs

Xe / Xem / Xyrs

Ze / Zem / Zirs

Country of Citizenship

Other Language Spoken 1

Other Language Spoken 2

Contact Information

Email Address

Confirm Email Address

Mobile Phone Number

Would you like to receive admissions information, event invitations, and learn more about SCSU?

You can opt-out at any time by contacting admissions@southernct.edu

Would you like to receive admissions information, event invitations, and learn more about SCSU?

You can opt-out at any time by contacting admissions@southernct.edu

Yes

Opt-in HIDDEN

Yes

Mailing Address

Country

Street

City

Region

Postal Code

Academic Information

HIDDEN Academic Interest - Nursing

Current High School You Attend

High School Graduation Year

Please list any academic honors, awards, recognitions or certificates you have received while attending high school.

Please list the Science Classes you have taken in High School

Please list the Math Classes you have taken in High School

Parent/Guardian Information

Parent/Guardian 1 - Relationship Type

Parent/Guardian 1 - First Name

Parent/Guardian 1 - Last Name

Parent/Guardian 1 - Email

Parent/Guardian 1 - Phone

Parent/Guardian 1 - Birthdate

Parent/Guardian 1 - Highest Level of Education

Parent/Guardian 1 - Occupation

Is this Parent or Guardian your Emergency Contact?

Yes

Would you like to add another Parent or Guardian?

Yes

Parent/Guardian 2 - Relationship Type

Parent/Guardian 2 - First Name

Parent/Guardian 2 - Last Name

Parent/Guardian 2 - Email

Parent/Guardian 2 - Phone

Parent/Guardian 2 - Birthdate

Parent/Guardian 2 - Highest Level of Education

Parent/Guardian 2 - Occupation

Is this Parent or Guardian your Emergency Contact?

Yes

Would you like to add another Parent or Guardian?

Yes

Parent/Guardian 3 - Relationship Type

Parent/Guardian 3 - First Name

Parent/Guardian 3 - Last Name

Parent/Guardian 3 - Email

Parent/Guardian 3 - Phone

Parent/Guardian 3 - Birthdate

Parent/Guardian 3 - Highest Level of Education

Parent/Guardian 3 - Occupation

Is this Parent or Guardian your Emergency Contact?

Yes

Parent Questions

Has any parent worked in the healthcare field?

Yes

Have any of your children, excluding this applicant, attended college or vocational school?

Yes

What would prevent this applicant from attending college or vocational school?

Does this applicant have health insurance?

Yes

What type of insurance does the applicant have?

Additional Student Information

Do you or Will you have a Certified Nursing Assistant (CNA) license by the start of the Summer Symposium?
(A CNA license is not a requirement. This information is used to determine YNHH shadowing placement.)

Yes

Do you plan to attend any other summer programs in 2024?

Yes

Please list any jobs (paid or volunteer) you have had while attending high school.

Which activities are you interested in? (Select all that apply).

Academic Clubs

Art

Baseball

Basketball

Campus Tour Guide

Cheerleading

Clubs and Organizations

Community Service groups

Coop or Internships

Cross Country

Dance

Debate

Drama/Theater

Esports

Field Hockey

Football

Fraternity or Sorority

Golf

Gymnastics

Honors College

Ice Hockey

Intramural Athletics

Lacrosse

Literary Publications

Music - Band

Music - Chorus

Music - Concert Band

Music - Drumline

Music - Gospel Choir

Music - Instrumental

Music - Orchestra

Music - Pep Band

Music - Vocal

Political Organizations

Racial or Ethnic Organizations

Radio-TV

Religious Organizations

Rugby

Soccer

Social Justice Activism

Softball

Student Government

Study Abroad

Swimming

Symphonic Pulse Dance Company

Track

Ultimate Frisbee

Varsity Athletics

Veterans Affairs

Volleyball

Essay

We are interested in why you are seeking a career in nursing and how an experience such as the SCSU Nursing Symposium can be of benefit to you. Please provide detailed answers for the following questions.

1. Why are you interested in nursing? What is unique about you, your life experiences, your talents, your personality that makes you – uniquely you, that makes this a good career choice for you? (150-250 words)

2. Describe a health problem you have observed in your community. What are some strategies that could be used to combat this problem? (150-250 words)

3. The SCSU Nursing Summer Symposium is intended for students who are from underrepresented minorities of disadvantaged backgrounds or circumstances. Describe, if any, what barriers or circumstances you face that would keep you from attending college or completing a college degree. (150-250 words)

4. How did you hear about the Southern CT State University Nursing Summer Symposium?

Confirmation and Signature

Participation in the SCSU Nursing Summer Symposium demands a commitment of attendance from Monday, July 8^th to Friday 12^th on campus and Monday, July 15^th to Friday, July 19^th at Yale New Haven Hospital.

The Symposium is being planned to be offered on the SCSU campus and transportation to and from campus will be the responsibility of the applicant or applicant’s parent/guardian. Other summer activities or programs during this scheduled time are not recommended.

Upon acceptance into the SCSU Nursing Summer Symposium, admission forms will be required. Southern CT State University, School of Nursing, SCSU Nursing Summer Symposium reserves the right to remove students from the program at any time due to misconduct or non-compliance with policies and procedures. Any changes to the delivery or location of the Symposium will be based off CT Department of Health, SCSU campus, and CDC due to the COVID-19 pandemic. Participants will be notified accordingly.

By typing you full name below, you agree to the following statements:
I certify that my answers are true and complete to the best of my knowledge. I certify that the submitted essay responses are my own words, and ideas were written solely by me without assistance.
If this application leads to acceptance into the SCSU Nursing Summer Symposium, I understand that false or misleading information in my application may result in my release.

Application Signature - please type your full name