EOSC School of Nursing Application


The Eastern Oklahoma State College School of Nursing is approved by the Oklahoma Board of Nursing.
Graduates of this state-approved program are eligible to apply to write the National Council
Licensure Examination (NCLEX) for (registered or practical) nurses.

Applicants for Oklahoma licensure must meet all state and federal requirements to hold an
Oklahoma license to practice nursing.

In addition to completing a state-approved nursing education program that meets educational
requirements and successfully passing the licensure examination, requirements include
submission of an application for licensure, a criminal history records search, and
evidence of citizenship or qualified alien status [59 O.S. §§567.5 & 567.6].

To be granted a license, an applicant must have the legal right to be in the United States
(United States Code Chapter 8, Section 1621). In addition, Oklahoma law only allows
a license to be issued to U.S. citizens, U.S. nationals, and legal permanent resident aliens.
Other qualified aliens may be issued a temporary license that is valid until the expiration
of their visa status, or if there is no expiration date, for one year.

Applicants who are qualified aliens must present to the Board office, in person, valid documentary
evidence of:

1. A valid, unexpired immigrant or nonimmigrant visa status for admission into the United
States;

2. A pending or approved application for asylum in the United States;

3. Admission into the United States in refugee status;

4. A pending or approved application for temporary protected status in the United
States;

5. Approved deferred action status; or

6. A pending application for adjustment of status to legal permanent resident status or
conditional resident status.

The Board has the authority to deny a license, recognition or certificate; issue a license,
recognition or certificate with conditions and/or an administrative penalty; or to
issue and otherwise discipline a license, recognition or certificate to an individual with a
history of criminal background, disciplinary action on any professional or occupational
license or certification, or judicial declaration of mental incompetence [59 O.S.
§567.8].

These cases are considered on an individual basis at the time application for licensure is
made, with the exception of felony convictions. Potential applicants to state-approved education
programs, with a criminal history, may obtain an initial determination of eligibility for
licensure or certification from the Oklahoma Board of Nursing for a fee.

The initial determination of eligibility for licensure petition can be accessed at
http://nursing.ok.gov/initialdeterm.pdf.

Date of Application
Desired Entrance Month



Desired Entrance Year
Please check the appropriate box:



First Name
Last Name
Middle Name
Other/Maiden Name
Address
City
State
Zip
Primary Phone
Alternate Phone
Email
Social Security Number
Date of Birth
Age
Gender


U.S. Citizen


Ethnic Group





I am a person with a disability


I am a veteran


Provide information concerning high school graduated from or high school equivalency (HiSET/GED)
Highschool Graduation Month/Year (MM/YYYY)
Upload High School transcript or High School equivalency scores
Provide information concerning any college, university, or any other school attended
Name and Location of School Dates of Attendance (Month/Year) Degree Received
Please zip and attach all transcripts (including Eastern). LPN and EMT must include vocational transcript
Are you currently a state certified CNA, LPN, or EMT?


If you have ever attended any RN school, provide the following information:
Name of school
city and state
month/year of entrance
reason for leaving *If transferring from another school of nursing, a reference letter from a dean or nursing faculty is required.
If you feel that there is additional information needed to further explain any item on your nursing application, please upload your explanation as a separate page with this application.
A national background check by QualifiedFirst by Verified Credentials, Inc. is required with this application. Please see separate instruction sheet included in the packet. This will be at the cost of the applicant and must be done within 90 days prior of application to the nursing program. Please be aware the background results may take a week or more to process
Background Check Instructions
Students applying for the transition program, must submit verification of 800 work hours. Please contact your nursing advisor or the nursing office to confirm your verification
In compliance with Oklahoma State Board of Nursing Registration and Nursing Education, the following information is necessary in order to take the National Council Licensure Examination for licensure as an RN.
Students applying for readmission to Eastern’s nursing program, must address, in writing, their exit interview action plan(s).
Have you taken the examination for registered nurse licensure in any other state?


Have you been licensed in any state as an LPN/LVN or EMT-P?


If yes, which state
Is your licensure currently unrestricted?


provide verification from each state
Indicate name on license (if different than application):
Have you ever had any action taken by a State Board of Nursing (LPN) or licensing body (EMT-P) regarding licensure?


Have you ever been arrested, convicted, or charged of a crime?


*Omission of information or falsification can result in non-acceptance. Please include all such incidents no matter how minor the infraction, whether guilty or not.
Please see the Oklahoma Board of Nursing rules in reference to felonies.
Have you ever been judicially declared incompetent


Do you have any physical limitations/disabilities that may interfere with your clinical performance?


If you answer YES to any of the above questions, you must submit details on a separate page or your application will not be reviewed.
According to the Oklahoma Board of Nursing, “An individual with a felony conviction or who had sentencing terms imposed by the court related to a deferred sentence for a felony offense cannot apply for licensure for at least five years after completion of all sentencing terms, including probation and suspended sentences, unless a presidential or gubernatorial pardon is reviewed [59 O.S. § 567.5 & 567.6
The nursing program abides by the school’s policy regarding misconduct and academic cheating. Have you ever been written up for misconduct or academic cheating?


The Oklahoma Board has the authority to deny a license, recognition or certificate; issue a license, recognition or certificate with conditions and/or an administrative penalty; or to issue and otherwise discipline a license, recognition or certificate to an individual with a history of criminal background, disciplinary action on any professional or occupational license or certification, or judicial declaration of mental incompetence [59 O.S. § 567.8]. These cases are considered on an individual basis at the time application for licensure is made, with the exception of felony convictions. Potential applicants to stateapproved education programs, with a criminal history, may obtain an initial determination of eligibility for licensure or certification from the Oklahoma Board of Nursing for a fee. The initial determination of eligibility for licensure petition can be accessed at:
Instructions and petition to request initial determination of eligibility for licensure or certification for individuals with history of criminal conviction
The Nursing Advisor I met with prior to submitting my application. (The Nursing Advisor list can be found at <a href='https://www.eosc.edu/academics/explore-programs-majors/health' style='color: blue' target='_blank'>Nursing Faculty</a> or calling 918.465.1794.)
Campus Selection Form




Please print the physical qualification form, sign, date and attach.
 Physical Qualification Form(required).





If you have not uploaded the required documents, your application is not complete!!
Please contact your advisor for assistance with the attachments.