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5001 W. 41ST Street | Sioux Falls, SD | 1-605-362-0100 | www.mtmc.edu

Mount Marty College

Doctor of Nurse Anesthesia Practice Masters to DNAP Application

MMC Nurse AnesthesiaAdmission Requirements and Application Procedure

Admission RequirementsTo be accepted/admitted into the Doctor of Nurse Anesthesia Practice post master’s program, the applicant must meet the following requirements: • Master’s degree in nursing or other appropriate Master’s degree that provided the ability for the graduatetoobtaincertificationasaCertifiedRegisteredNurseAnesthetist •Graduationfromanaccredited(COA)NurseAnesthesiaprogram •CurrentlicensureasanRNandcurrentcertificationasaCRNA •CumulativeGPAof3.00ona4.0scale •Completedhealthquestionnaire,physicialexamination,andimmunizationrecordpriortothestartof thefirstsemester,ifadmittedtotheprogram.Selection ProcessTheAdmissionsCommitteewillcarefullyreviewthecompletedapplicationandsupportingmaterial,academicperformance,andreferences.Becauseclasssizeislimited,notallcandidateswhomeetminimumrequirementswillbeinvitedforaninterview.InvitationstoattendapersonalinterviewwillbemailedinlateOctober.InterviewsaregenerallyconductedinNovemberorDecember.ApplicantswillbenotifiedoftheAdmissionsCommitteedecisionregardingacceptanceintotheprogramwithin4weeksofthepersonalinterview.ApplicantsreceivingaletterofappointmentmustreturntheAcceptanceFormanda$750.00non-refundableenrollmentfeewithinthetimespecified.Incompleteapplications,orapplicationsreceivedaftertheSeptember15deadline,willbereviewedonlyatthediscretionofAdmissionsCommittee.

Re-Application ProcessAllapplicationmaterialsbeingre-submittedmustbereceivednolaterthanSeptember15fortheclassstartingthefollowingAugust.Incompleteapplications,orapplicationsreceivedaftertheSeptember15deadline,willbereviewedonlyatthediscretionofAdmissionsCommittee.Ifreapplying,applicationmaterialsthatMUST be resubmitted include: • STEP 1: OnlineApplication • STEP 2: Applicationpacketcontentsandchecklist(exceptapplicationfee)The following items DO NOT need to be resubmitted: • Application fee •Transcripts(unlessachangehasoccurred)

International StudentsInternationalstudentsareaskedtofollowtheadditionaladmissionsproceduresonlineat:http://www.mtmc.edu/admissions/app-process/international.aspx/

MMC Nurse AnesthesiaApplication Instructions and Checklist

All application materials must be received no later than September 15 for the class starting the following August.Incompleteapplications,orapplicationsreceivedaftertheSeptember15deadline,willbereviewedonlyatthediscretionofAdmissionsCommittee.

STEP 1: COMPLETE ONLINE NURSE ANESTHESIA APPLICATION Date submitted ______________A.Completetheonlineapplicationbeforemailingthecompletedadmissionpacketorforwardingmaterials.Supportingapplicationmaterialscannotbeprocessedunlesstheonlineapplicationhasbeencompletedandyouraccountestablished.

STEP 2: APPLICATION PACKET CONTENTS AND CHECKLISTSubmitthefollowingitemstogetherina9x13envelopetotheNurseAnesthesiaProgramOfficeinSiouxFalls,SD.

❑ CompletedChecklist ❑ $35non-refundableapplicationfeemadepayabletoMountMartyCollege ❑ SupplementalForms

r Educational Data Form ❑ Currentresume ❑ Personal essay which describes your goals for doctoral study, motivations for entering the nurse anesthesiafield,whatyouhavetooffertheprofession,andreasonswhyyouchoseMountMarty College.Essayshouldbetypedandnomorethan600words. ❑ PhotocopyofyourcurrentRNlicenseandCRNAcertification

B.Three(3)professionalreferencesarerequired:1fromtheapplicant’sImmediateSupervisor,and2 from colleagues who can attest to the applicant’s preparation, initiative, and aptitude for successful completion ofdoctoraleducation.Allreferencesshouldbeintheformofareferenceletter.Allreferencesmustbesentdirectlytotheprogramoffice.Itisrecommendedthattheapplicantprovideeachreferencewithaself-addressedstampedenvelopefordirectmailing.

Mail materials to: Mount Marty College, Nurse Anesthesia Program Office, 5001 West 41st Street, Sioux Falls, SD 57106

STEP 3: DOCUMENTS SENT DIRECTLY TO ADMISSIONS PleasehavethefollowingitemssentdirectlytotheNurseAnesthesiaProgramOffice,SiouxFalls,SD.

❑ Oneofficialtranscriptfromeachcollege/universityattended ❑ Officialtranscriptverificationofclassesinwhichyouarecurrentlyenrolled

MMC Nurse AnesthesiaEducational Data Form

Educational Data:Applicants must possess an appropriate Master’s degree from a regionally accredited college or university and havemaintainedanoverallGPAof3.0on4.0scale.DegreesmustbecompletedwithfinaltranscriptssubmittedpriortoenrollmentinAugust.Appropriatedegreesincludeabaccalaureatedegreeinnursingoranassociate/diplomainnursingplusabaccalaureatedegreeinanotherrelateddiscipline.

Nursing Education Institution Date Conferred GPADiploma in NursingAssociate Degree in NursingBachelorofScienceinNursingMaster’s Degree

Other Degrees Institution Date Conferred GPA

r Yes rNoHaveyouattendedanotherclinicaldoctorateprogram?Ifyes,useaseparatesheettofullyexplain.

Ifyes:Name: _____________________________ Address: ________________________________________

Dates of Attendance: _______________________ ReasonforLeaving: ______________________________

Answerthefollowingquestions.Ifyes,submitaletterofexplanation.r Yes r No Have you ever been on probation or suspended from any place of employment?r Yes rNo Withinthelastthreeyears,haveyoueverexperiencedaphysical,emotionalormentalcondition

that endangered the health or safety of persons entrusted in your care?

CERTIFICATES/PROFESSIONAL ORGANIZATIONS:Pleaseincludephotocopiesofallcertificationsheld.

CRNACertification r Yes rNo ExpirationDate: __________________OtherCertifications: ________________________________________________________________________

Listtheprofessionalorganizationsyouareamemberof: ____________________________________________________________________________________________________________________________________

State Status License # if active Expiration Date

r Active rInactive

r Active rInactive

r Active rInactive

r Active rInactive

r Active rInactive

r Yes rNoHaveyoueverhadanursinglicensesuspendedorrevoke?Ifsosubmitaletterofexplanation.

r Yes rNoHaveyoueverbeenthesubjectofaNursingBoarddisciplinaryaction?Ifyes,submitaletterofexplanation.

r Yes rNoHaveyoueverbeenrefusedanursinglicense?Ifyes,submitaletterofexplanation.

r Yes r No Are you aware of any disciplinary action pending on your nursing license?

ListthestateinwhichyouwereoriginallylicensedasanRN:

Iattestthattheinformationprovidedinthisapplicationisaccurate.

Signature:______________________________________________________Date:____________________

RN PROFESSIONAL LICENSE:ApplicantsmustprovideproofoflicensureasaprofessionalRegisteredNurse(RN).Pleasecompletetherequestedinformationbelow.Includeaphotocopyofyourcurrentnursinglicense(s).

ListallstateswhereyouhavelicensureasaprofessionalRegisteredNurse(RN)