BSN 423 Clinical/Open U application

This application is for two types of applicants:

Non-Dominguez Hills students who are requesting to take BSN 423 to obtain clinical hours for a PHN Certificate
- Those seeking a PHN certificate must have received a Letter of Deficiency from the CA Board of Registered Nursing before applying to take BSN 423. (Click here to review the process for those with a non-DH BSN seeking a PHN.)
Non-Dominguez Hills students who are requesting to take BSN 423 as a Pre-requisite for another program.
- Those applying to take BSN 423 as a pre-requisite to another program must upload unofficial transcripts showing the completion of an Associate's Degree in Nursing program and verification of Health Assessment & lab and Pathophysiology. (Click here to review the process for those seeking BSN 423 as a Pre-requisite to another program)

Pre-requisites to BSN 423 Health Assessment & lab and Pathophysiology for all applicants.

The BSN 423 clinical has strict deadlines so applicants must plan accordingly.

The BSN 423 Clinical application deadlines are:

Fall term = June 1
Spring term = October 1
Summer term - April 1

1. Upload BRN Letter of Deficiency here if you have a non-DH BSN and are seeking a PHN Certificate.

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2. Upload unofficial transcripts showing the completion of an ADN program and the successful completion of Health Assessment & Lab and Pathophysiology if you are requesting to take BSN 423 as a Pre-requisite to another program. This does not apply to those who are only seeking to take BSN 423 for PHN Certification.

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3. CSUDH Student ID# - if applicable

4. Personal Information *This question is required.

First Name

Last Name

Street Address

City

State

Zip

Email Address

Phone Number

Date of Birth *This question is required.

RN License # *This question is required.

5. What is your reason for requesting this course? (PHN Certificate, Pre-req to another program etc...) *This question is required.

Applicants are required to secure a preceptor and site willing and able to precept them. If you have not yet secured a preceptor and site do not complete this form until you have.

Please Note: If CSUDH SON does not have an active contract with a site, it may take up to 6 months to secure a contract, delaying enrollment in BSN 423.

Therefore, it is advisable students find a site from our active site list: BSN 423 sites.

8. Please provide Preceptor information below: *This question is required.

Preceptor First Name

Preceptor Last Name

Preceptor Title

Preceptor Email Address

Preceptor Phone Number

9. Please provide site information below: *This question is required.

Site Name

Street Address

Apt/Suite/Office

City

State

Zip

10. Please sign below confirming you have reviewed the BSN Clinical Handbook

*This question is required.

Clear

Signature of

11. Approval of BSN Coordinator (For Office Use Only)