Graduate Nursing Forms

Here’s a complete list of forms for future and current students of the Graduate Nursing program. You’ll find all the forms you need, including application forms for every program, student forms and graduation forms.

Practicum/clinical placement is arranged for all students admitted to the programs. Placement occurs in designated regional clinical affiliate sites. Admission to the Nurse Practitioner programs is considered on a regional basis, contingent upon the availability of regional clinical affiliate sites.

All Graduate Nursing applicants must first apply to WSU School of Graduate Studies using the Graduate Studies Online Application.

Information on how to apply to the School of Graduate Studies program is also available online for your convenience.

Graduate Programs in Nursing Application Process

Online Applications will be accepted August 15 – October 1. Graduate Programs in Nursing use an online application through NursingCAS.

The online application is available August 15 with a priority deadline for submission of October 1.

We have created a sample application (PDF) and invite you to review the Winona State University Graduate Programs in Nursing Application Checklist (PDF)

Please contact gradnursing@winona.edu with any questions.


Post-Master's Doctor of Nursing Practice Application

Graduate Programs in Nursing will be utilizing an online application through NursingCAS.

We have created a sample application (PDF): The NursingCAS application will be available beginning August 15, 2018. Please contact gradnursing@winona.edu with any questions.

 

Certificate of Baccalaureate Degree Form
(Office of School of Graduate Studies)

Intent to Return Form
(Office of School of Graduate Studies)
Complete this form if you plan to re-enroll in graduate courses.

 

Graduate Special Students

Graduate Special Student Online Form
Complete this form to request admission to Graduate Special courses. Graduate Special status will allow students to register for any graduate special courses available on both the main campus and the Rochester campus.

As a reminder, a maximum of twelve (12) semester credits may be earned a Graduate Special Student. Credits earned as a Graduate Special Student can be applied toward graduation requirements as outlined in the Graduate Catalog.

Courses open to Graduate Special Students include:  

Course Number Course Name Prerequisite and/or co-requisite

STAT 601 

Statistical Methods (3)

STAT 110 or equivalent 

NURS 604 

Health Care Policy/Quality Health
Care Delivery (3)

None

NURS 606 

Nursing Info. Mgmt. &
Decision-Making (3)

None

NURS 608 

Organizational & Systems
Leadership (3)

None

NURS 616

Molecular/Genetics
Immune Mechanisms (3)

None

NURS 617

Clinical Pharmacology (3)

NURS 618 - Advanced Pathophysiology or consent of instructor

NURS 618

Advanced Pathophysiology (2)

NURS 616 - Molecular/Genetics & Immune Mechanisms or consent of the instructor

Application for Candidacy - Worksheet (PDF) (Masters)

Application for Candidacy - Worksheet (PDF) (Doctor of Nursing Practice)

Application for Candidacy - Worksheet (PDF) (Graduate Certificate)

Application for Candidacy Forms page

Application to Graduate
Application for graduation must be submitted at least one term prior to graduation. It is the sole responsibility of the student to ensure that all incompletes and program requirements are completed and submitted to the Office of School of Graduate Studies within ten (10) working days following the end of the semester of graduation. Late completion and submission of requirements will result in postponement of graduation to a later semester.

Certificate Program Completion (Graduate Certificate Nursing Students Only)
Submission of this form activates a program completion review and mailing of a Certificate.

Clinical Log (PDF)

Graduate Assistantships
Graduate Assistant (Research Assistant [RA] and/or Teaching Assistant [TA]) positions may be available in the WSU-Rochester Graduate Programs in Nursing. Graduate Assistant Position Description(s) and Application for Graduate Assistantship may be found on the School of Graduate Studies website.

Graduate Nursing Policy Assurances Form (PDF)

Milestones in Graduation (PDF)

Name Badge Form & Procedures (PDF)

Nursing Leadership PM DNP Prerequisite Verification Form (PDF) - May 2014

Permission to Use Student Work (PDF)

Request for Exception (PDF)

Student Authorization of Release of Information Form (PDF)

Thesis Binding Information (PDF)      

Clinical Documentation Requirement Information

The State of Minnesota and our clinical agencies require proof of student immunizations, physical exam, health insurance, MN RN license, Background Check, liability insurance coverage, etc., for enrollment in all clinical courses, including DNP Scholarship project courses. Therefore, the WSU Department of Nursing requires proof of these requirements from each student. 

Admitted students are required to purchase a Typhon account subscription for tracking clinical documentation. This is an additional educational expense. 

Background Check – Minnesota (PDF)
View the link above to learn how to create your Minnesota Department of Human Services Applicant Background Study and to review the Background Study Notice of Privacy Practices.

Background Check – Wisconsin - Background Information Disclosure Instructions (PDF)

(PDF)
Please return signed form to WSU - Rochester, Graduate Programs in Nursing.

Functional Abilities Statement (Student and Health Care Provider) (PDF)

Health Information and Requirements for Participation in the Graduate Programs in Nursing (PDF)

HIPAA Certification (PDF)

Immunization Requirement (PDF)
This form must be completed by every student born after 1956 and enrolled in a public or private post-secondary university, college or other school. Registration will be blocked if this form is not on file.

Important Notices Form (PDF) (formerly: Reasonable Accommodations)
There are conditions for which accommodations may be appropriate under the Americans with Disabilities Act. The Nursing Program will make all reasonable accommodations required by law for otherwise qualified individuals.

Liability Insurance Form (PDF)
Malpractice Insurance is mandatory for all students who are enrolled in clinical courses for the Graduate Programs in Nursing at WSU.

Liability Insurance Providers Information (PDF)

Sim. Lab Waiver, Release & Indemnification Agreement (PDF)

Simulated Clinical Experiences Confidentiality Agreement (PDF)