Faculty Degree Plan jQuery UI Datepicker – Default functionality Name of Appointee Date (mm/dd/yyyy) Nursing License # & State (if other than Kansas) Program of Employment Name of Program in which Enrolled Degree to be obtained Date of Enrollment (must be currently enrolled for Degree plan to be approved) Projected Date of Completion (completed within six years) You Must attach degree plan from the school where enrolled. This can be uploaded on the next page. Notification and rationale should be submitted when the degree plan is not followed. Upon completion of the degree, a transcript showing completion of the program should be submitted. PROGRAM ADMINISTRATOR INFORMATION Name of Program Administrator Email Address for correspondence of this form. Attestation I realize that this application is a legal document and by pressing the Submit button I am declaring under penalty of perjury under the laws of the State of Kansas that the information I have provided is true and correct to the best of my knowledge. If all the above information is correct please press the Submit button . Otherwise please go back and correct any information that is necessary. SUBMIT WILL CONTINUE YOU ON TO THE FILE UPLOAD PAGE
