Health Services - Specialty Option

Admission Application

We are no longer accepting printed applications. Please fill out the online form.

* Indicates required fields.

Prerequisite Declarations

The Health Services Core and Specialty prerequisites must be completed prior to consideration for admission. Until an admission decision has been made, the student will be in a Pre-Specialty status. Admission decisions will be based on a minimum 2.75 GPA overall at USI. Maximum specialty capacity is forty (40) students per cohort. If an excess number of applications are received for a specialty, the student’s overall GPA in the Health Services Core and Specialty Prerequisites will be the deciding factor. The Degree Completion or Generalist Options also are available should the student prefer.

Specialties

Specialty Options: Gerontology, Health Administration, Health Promotion & Worksite Wellness, Long-Term Care Administration, and Public Health

  1. Specialty Option Selection: *
Contact Information
  1. Permanent Address *
  1. Send correspondence to: *
Post Secondary Education (Since high school)
  1. First Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA
  2. Second Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA
  3. Third Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA

Official transcripts of high school or GED scores and all post high school education must be submitted to the Office of Admission, 8600 University Boulevard, Evansville, IN 47712.

Employment History

List present or most recent employment first.

  1. First Position
    1. Date From
    2. Date To
    3. Title of Position
    4. Employer
    5. City and State
  2. Second Position
    1. Date From
    2. Date To
    3. Title of Position
    4. Employer
    5. City and State
  3. Third Position
    1. Date From
    2. Date To
    3. Title of Position
    4. Employer
    5. City and State
Community Activities

List community organizations, board memberships, offices held, and professional activities that serve the community. Include activities during the last three years.

  1. First Position
    1. Organization/Association
    2. Description of Duties
    3. Date From
    4. Date To
  2. Second Position
    1. Organization/Association
    2. Description of Duties
    3. Date From
    4. Date To

Career Questionnaire
  1. Do you hold any professional health care certifications and/or licensures? *
    1. If yes, please list:
  2. Have you previously applied to a USI College of Nursing and Health Professions program or another university/college health services program? *
  3. Have you started a health services program at another university/college and not complete the program? *
USI Environment

USI works to maintain a safe environment for all members of the University community. The following questions will help us better maintain this environment.

  1. Have you ever been convicted of a misdemeanor, felony or other crime (excluding routine traffic offenses and convictions expunged or sealed by the sentencing court or juvenile court or otherwise protected from disclosure by the specific authority of law)? *
  2. Are any criminal charges currently pending against you? *

If your answer is "Yes" to any of these questions, you will be asked to provide additional information. Being convicted of a crime, pending criminal charges, probation, suspension, dismissal or expulsion do not serve as an absolute bar to admission, but will require additional evaluation.

  1. Have you been convicted of a sex offense against children? *
    (Requirements of Indiana Public Law 11-1994.)
Restrictions
  1. Has any action been taken or is there action being considered by an agency of government against your licensure/certification?
    If yes, please attach a letter to explain.
  2. Have you entered into or are you currently discussing an agreement with any agency of government concerning your licensure/certification?
    If yes, please attach a letter to explain.
  3. Have any restrictions been imposed by an agency or government on your ability to practice your profession, or are restrictions currently being considered?
    If yes, please attach a letter to explain.
Emergency Contact
Signature

By signing below I am verifying that all the above information is true and accurate to the best of my knowledge. I also authorize the Admission Committee to review and verify my application and academic records.

Submit Application
Important

Please return this application to:

USI Health Services Program Admissions

University of Southern Indiana
College of Nursing and Health Professions
8600 University Boulevard, HP 2145
Evansville, IN 47712

All application materials must be received by the University of Southern Indiana before an admission decision can be made.

Application Deadline: March 1

Application ID: AB9CB8819816EF20A070F51CCDE75B01