Gap Application Template - Georgia Southwestern State University
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1OFFICE USE ONLY
GAP APPLICATION
Received by_____
(Guaranteed Acceptance Program)
Date__________
PLEASE RETURN VIA EMAIL TO:
son@gsw.edu
OR VIA MAIL TO:
GSW School of Nursing, Attn: Student Services Coordinator
800 Georgia southwestern State University Drive, Americus, GA 31709
1. Print Name in Full: _______________________________________________________________
Last
First
Middle
2. Telephone numbers: (home) _________________________ (cell) _________________________
3. Mailing Address: _________________________________________________________________
______________________________________________________________________________
City
County
State
Zip Code
4.
Electronic Mail Address: __________________________________________________________
Enter e-mail address you will check most often
5. Name of High School__________________________________ Graduation Date______________
Location____________________________________________ Current H.S. GPA____________
6. Complete the following test information:
SAT: Dates Taken____________ Highest Critical Reading _____ Highest Math _____ Highest Writing _____
ACT: Dates Taken____________ Highest English _______ Highest Math ______ Highest Composite ______
7. Have you applied to GSW: Yes ______No ______
Date accepted to GSW: __________________
8. Planning to start GSW: Fall _________ Spring _________Semester/Year: ___________________
9. How did you first learn about GSW School of Nursing? ___________________________________
10. Upon graduation from high school, do you intend to have any college credit completed through Move on
When Ready/dual enrollment, AP/IB courses, or other programs? _____ YES
_____ NO
If yes, how many courses? _________ From what institution and/or program? ____________________
Required Documents:
I. Two Academic Reference Forms
Both should be from academic sources (i.e. teacher, principal, guidance counselor, etc).
At least one reference should be from a science teacher.
Reference forms should be EITHER placed in a sealed envelope with the person of reference’s
signature across the seal and returned to the applicant OR can be returned via email directly to the
School of Nursing at
SON@gsw.edu
II. Personal Statement (one page in length)
Students should highlight unique characteristics and abilities of self, their personal interest and
involvement in healthcare as a profession, and any personal life events that have prompted their
interest in a nursing career.
I acknowledge that the information on this application is correct. I further acknowledge that I have fully read
and understand the GAP requirements. I also understand the School of Nursing will verify all admission
information as needed. I furthermore understand that the School of Nursing may require an interview and
that applicants who qualify for an interview will be contacted by the program’s admissions committee at a
later time.
______________
_________________________________________
____________
Signature
Date
Revised NOV 2015 JD
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