GRADUATE PROGRAM APPLICATION

Please complete as much of this application as possible. Incomplete forms may not submit properly.

Some information on the application is required. You will receive an error message if you submit the application without entering all required information. The error message will prompt you to enter the required information before resubmitting the application.

GRADUATE APPLICATION

MASTERS DEGREE
Please select a Masters Degree program or Education Endorsement to begin your application.
Masters Degree Program*
Education/MAT Concentrations*
For Education and the MAT program, please also choose your concentration and area of interest.
- K-5 Licensure
- 6-12 Licensure
- K-12 Licensure
6-12 Licensure Concentration*
If you select the 6-12 Licensure concentration, please also select a Subject
- Biology (6-12)
- Business (6-12)
- English (6-12)
- Government (6-12)
- History (6-12)
- Mathematics (6-12)
K-12 Licensure Concentration*
If you select the K-12 Licensure concentration, please also select a Subject.
- Physical Education (K-12)
- Visual Arts (K-12)
- Instrumental and Vocal Music (K-12)
LOCATION
Please select the location you wish to attend. Some programs are offered online only.
SPED Location
Courses in the Special Education Emphasis are offered in Face to Face format in Morristown. Other courses are offered Online.
MASA Location
Online Location
Nursing Location
MBA Location*
Location*
START TERM
Please select the term you wish to begin.
Start Term:*
Fall Spring Start Term*
Education Endorsement Start Term*
Courses in the Education Endorsement Add-on are offered starting in Fall terms.
NURSING INFORMATION
CONFIDENTIAL INFORMATION
Clinical placements require background checks and drug screens. In certain situations, investigative background reports are ongoing and may be conducted at any time. Access to the program may be denied at any time by the clinical agency or Tusculum University.
Are you currently on probation, under court restriction, or have ever been convicted of a crime, other than a minor traffic violation?*
- YES
- NO
Explanation:*
Please provide an explanation.
REFERENCES
You are asked to submit references from a minimum of three healthcare professionals. At least two must be nursing professionals with a graduate degree. Please list the name, address and position of each.
1. Reference Name
First Last
1. Address
Street Address Address Line 2 City State ZIP Code
1. Position
2. Reference Name
First Last
2. Address
Street Address Address Line 2 City State ZIP Code
2. Position
3. Name
First Last
3. Address
Street Address Address Line 2 City State ZIP Code
3. Position:
LICENSURE INFORMATION & EXPERIENCE
An unencumbered Tennessee license or compact state is required prior to enrolling in clinical course. Clinical placement in neighboring states may require additional licensure.

Below, please select in which states you are licensed as a Registered Nurse.
License State:
License Number:
License Expiration Date:
MM slash DD slash YYYY
If you are licensed in another state, please enter the information below.
License State:
License Number:
License Expiration Date:
MM slash DD slash YYYY
Experience (Number of years/months)*
Please provide your experience in years and moths.
Where?*
Please provide the location where you earned your experience.
Basic Life Support Expiration Date
MM slash DD slash YYYY
DRUG SCREENING, IMMUNIZATION & BACKGROUND CHECK
The background check, drug screening, immunization and health assessment status are required by the clinical affiliate sites as a condition of participation in clinical education at their facility.

Based on the results of the criminal background check and/or drug screening, clinical affiliates may deny an applicant/student access to their facility. This could result in a student being unable to successfully complete the requirements of a course or the program. More information is available from the Dean of the MSN Program. If an applicant has a positive criminal background check and/or a positive drug screen and the clinical affiliates refuse to allow the applicant to participate in clinical experience at their facility, the applicant will not receive full admission into the nursing program and will not be allowed to enroll in nursing courses.

If an applicant has an incomplete immunization and/or health assessment, the applicant will not receive full admission into the nursing program and will not be allowed to enroll in nursing courses.

NOTE: Applicants/Students who have been convicted of a crime other than a minor traffic violation may be ineligible for licensure per state law. For more information, contact the Dean of the MSN Program. Any felony convictions and/or arrests must be reported to the Dean of the MSN Program at the time they occur while enrolled in nursing courses. Failure to report an arrest or conviction will result in immediate withdrawal from the MSN Program and nursing courses.
Acknowledgement*
- I acknowledge that I have read the information on and understand the requirements for background check, drug screening, immunization and health status assessments are required by the clinical affiliate sites as a condition of participation in clinical education at their facility.
LETTER TO GRADUATE NURSING ADMISSIONS COMMITTEE
Upload Letter
Submit a two to three page letter addressed to the Graduate Nursing Admissions Committee describing the applicant’s professional goals
Accepted file types: txt, pdf, doc, docx, Max. file size: 2 MB.
PERSONAL INFORMATION
I live in the United States*
- YES
- NO
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Please provide your Home or a Mobile telephone number.
Phone Type*
- Home
- Mobile
Business Phone Number
Please provide your Business phone number
Email*
Please provide your Email address
Date of Birth*
Please select your date of birth
MM slash DD slash YYYY
Marital Status
Are you a US Citizen?*
- YES
- NO
Social Security Number*
Please select your Country of Citizenship*
FEDERAL REPORTING
The following are intended for federal reporting purposes only.
What is your gender?
- Male
- Female
Are you Hispanic/Latino/Latina?
- YES
- NO
Please select one or more of the following races:
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawiian or Other Pacific Islander
- White
ENROLLMENT INFORMATION
College Credits Earned*
Please enter the estimated number of college credits you have earned.
Military Involvement*
Please select your military involvement.
Separation Date*
If you are a Veteran, please select the Date of Separation
MM slash DD slash YYYY
Are you a First Generation Student?*
- Yes
- No
Have you previously attended Tusculum?*
- Yes
- No
Last Date of Attendance*
MM slash DD slash YYYY
TEST SCORES
Have you taken the GRE?*
- YES
- NO
GRE SCORE*
GRE TEST Date*
MM slash DD slash YYYY
PREVIOUS COLLEGE EXPERIENCE
College & University Information
Please list all colleges and universities where have enrolled, dates of attendance and degrees earned.
1. Institution Name*
Attended From:*
Attended To:*
Degree Earned*
2. Institution Name
Attended From:
Attended To:
Degree Earned
3. Institution Name
Attended From:
Attended To:
Degree Earned:
JUDICIAL SECTION
I.
1) You are not required to answer "Yes" to the below questions, or provide an explanation, if the criminal conviction or adjudication has been sealed, expunged, annulled, pardoned, or otherwise ordered by a court to be kept confidential,
2) except for the above, any pleas of guilt/no contest/nolo contendre, an Alford plea, a finding or verdict of guilt or responsibility, or acceptance of responsibility for the commission of a crime, regardless of whether sentence was imposed by a court equal a conviction for purposes of this inquiry:
- Do you have any criminal charges pending against you or have you ever been convicted of a felony?
- Do you have any criminal charges pending against you or have you been convicted of a misdemeanor other than a parking matter in the last 7 years,
  - or at any time for: an offense that required you to register in a sex offender database or registry, an offense related to sexual harassment (including abuse/assault/stalking), an offense of violence (including bullying and/or intimate partner/domestic violence), an offense of theft or forgery, or a drug-related offense?
I. Answer:*
I. Explanation:*
II.
Do you have any disciplinary charges pending against you or have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by any school, college, or university?
II. Answer:*
II. Explanation*
III.
If you have ever served in the military, did you receive any type of discharge other than an honorable discharge?
III. Answer*
III. Explanation*
HONOR PLEDGE
As an educational community, members of the Tusculum campus and sites respect and encourage the development of individual virtues, such as integrity, rationality, compassion, self-discipline and personal responsibility. If you become a member of the student body at Tusculum, adherence to the Codes of Conduct ( http://web.tusculum.edu/life/pdf/StudentHandbook.pdf, p. 29) will be considered an understood prerequisite for acceptance to, and ongoing membership in, the Tusculum community.
If enrolled at Tusculum, would you be able to make this commitment?*
NOTICE TO APPLICANT
Students who enroll in the Adult and Online Studies programs are responsible for having access to a computer with email capabilities and Internet connectivity capable of linking to the Tusculum website. Tusculum provides for computer/Internet accessibility either at its instructional sites or within a convenient distance of its instructional sites. If any students are unable to obtain access to Internet connectivity or email capabilities either on their own or through the use of Tusculum supplied facilities, Tusculum will assist them in identifying other convenient Internet access locations.
STATEMENT OF NON-DISCRIMINATION
In compliance with Section 504 of the Rehabilitation Act of 1973, Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972 and the Age Discrimination Act of 1975 as amended, and with its own policies and philosophy, Tusculum does not discriminate on the basis of race, religion, age, sex, national origin, sexual orientation, military or veteran status, disability, genetic information, or any other protected discriminatory factor, in its employment practices or in the provision of, or access to, educational programs and services, except where sex, age, or ability represent bona fide educational or employment qualifications.
STATEMENT OF APPLICANT
If admitted, I agree to comply with all the policies and regulations of Tusculum, to perform my work and assigned duties to the best of my ability, and at all times to uphold the honor and best interests of Tusculum. By typing my name in the box below, I certify that all information I have presented on this application is true to the best of my knowledge and represents my own work.
Signature*
Signature Date*
MM slash DD slash YYYY

Save and Continue Later

Accreditation

UNDERGRADUATE

GRADUATE

GRADUATE APPLICATION

MASTERS DEGREE

LOCATION

START TERM

NURSING INFORMATION

CONFIDENTIAL INFORMATION

REFERENCES

LICENSURE INFORMATION & EXPERIENCE

DRUG SCREENING, IMMUNIZATION & BACKGROUND CHECK

LETTER TO GRADUATE NURSING ADMISSIONS COMMITTEE

PERSONAL INFORMATION

FEDERAL REPORTING

ENROLLMENT INFORMATION

TEST SCORES

PREVIOUS COLLEGE EXPERIENCE

College & University Information

JUDICIAL SECTION

I.

II.

III.

HONOR PLEDGE

NOTICE TO APPLICANT

STATEMENT OF NON-DISCRIMINATION

STATEMENT OF APPLICANT

CONTACT TUSCULUM ADMISSIONS