Nursing Symposium Application 2026

Student Information

First Name

Chosen First Name - if different from the above name.

Last Name

Date of Birth

Legal Sex

Female

Male

Personal Information - Optional

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:

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

Permanent 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?

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 Agreement

By typing your full name below, you confirm that you understand and agree to the following:

You will attend the SCSU Nursing Summer Symposium in person from Monday, July 6, 2026 through Friday, July 10, 2026, including one day at Yale New Haven Hospital.
Transportation to and from campus is your responsibility or that of your parent/guardian, and other activities during these dates are not recommended.
If accepted, you will submit all required health forms and comply with program policies. Misconduct or non-compliance may result in removal.
Program details may change based on guidance from the CT Department of Health, SCSU, and YNHH, and you will be notified of any updates.
Your application responses are truthful and your essays are your own work. False or misleading information may result in removal.
You consent to having your image captured during the program for use in social media and promotional materials, as funding is provided by external partners.

I have read and agree with the above statements.
Application Signature - please type your full name