Pre-ADN Application

Welcome to our application! Please fill this out if you are looking to take prerequisite courses toward our part-time RN program. An admission officer will connect with you once you submit this application.

Questions about our application process? Please email Admissions at admit@bridgeport.edu.

Name

Prefix

First Name

Middle Name

Last Name

Suffix

Nickname/Preferred First Name

Maiden Name/Other Last Names Used

Contact Information

Permanent Address

Country

Street

City

Region

Postal Code

Mailing Address (if different than Permanent Address)

Country

Street

City

Region

Postal Code

Email Address

Mobile Phone

Home Phone

Biographical Information

Sex

Birthdate

Primary Citizenship

Residency Status

U.S. Permanent Resident

Social Security Number
Please add your social security number in this secure application to link your FAFSA (if applicable) to University of Bridgeport

Privacy Protection Policy

Program

Have you taken at least 4 college classes?

Yes

Select when you would like to begin taking classes

Other Required Information

Have you ever been charged or convicted of a felony, misdemeanor, or any other crime?

Yes

Explain the incident, state the charge(s) you were convicted of, and provide documentation explaining the nature of the offense (sentencing order, plea agreement, etc.).

Have you ever been sanctioned for disciplinary misconduct at any higher education institution for
academic or behavioral violations? For the purpose of this question, “sanctioned” includes but is not
limited to: dismissal, removal, expulsion, probation, or suspension.

Yes

Explain the incident, state the violations you were disciplined for, list the sanctions, and provide documentation (from the institution’s judicial process) explaining the nature of offense and final disposition.

Signature

My signature below indicates that all the information contained in this application is complete and
correct. I understand that I must contact the Office of Admissions with any modifications after I
submit my application. I authorize all schools which I attended to release my requested records
and authorize the review of my application, and understand any documents submitted to the
University cannot be returned to me. I am aware that any falsification in the completion of this
application form either by error (intentional or unintentional) or omission, may result in my denial of
acceptance by the University of Bridgeport or disciplinary action, up to and including, dismissal
from the University. I understand that an offer of admission is conditional pending receipt of final
transcripts.

By providing my signature, I grant the University of Bridgeport permission to obtain my official
transcript from my high school and/or university. I consent to receiving communication regarding
my account via email, call, or text.

Signature

Signature Date