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1 Andrews Monahans Applicant Information: PLEASE PRINT Name (As it appears on Driver s License): Last Name First Name Middle Name Last 4 of S.S. Date of Birth U.S. Citizen (yes/no) Address: Street City State Zip Mailing Address if different from above: OC Home Other Name(s) on Transcript: Last First Middle Phone Number with Area Code Home: Work: Cell: Emergency Notify: Name Relationship Phone Number (s) with Area Code Educational Background: High School/GED Name of School Location Dates Attended Date Conferred College/University: List most recent first; list ALL attended Name of School Location Dates Attended Maj. Course of Study Degree Earned/Date List any health related work experience, beginning with the most recent: Certified as or Successfully Completed course for CNA (yes/no): Notice: Completion of the Nursing Program does not guarantee eligibility to take the licensing examination to become a vocational nurse (P.N.). Eligibility is determined by the Board of Nurse Examiners for the State of Texas (BNE). Some events, such as having a felony or misdemeanor conviction, including expunged offenses and deferred adjudication with or without prejudice of guilt, pleading no contest to any crime, having unresolved arrest, having pending criminal charges, having action taken against your health care provider license, having certain mental health disorders or a history of substance abuse MAY disqualify a candidate for licensure. The Vocational Nursing Program has selective admission criteria. Not all candidates who apply are accepted. See the Program Fact Sheet, advisory or school catalog for further information on admission criteria. I certify that all the information I have entered on this application is accurate and complete to the best of my knowledge. I understand that falsification of an application is cause for program rejection or dismissal. Date: Signature: does not discriminate in regard to race, color, age, ethnic/national origin, religion/creed, marital status, veteran status, or disability. Completed applications may be mailed to: Andrews Extension: 201 NW Ave D, Andrews Texas Odessa Dual Credit: 201 W. University Texas Monahans Extension: 806 S Dwight Monahans, Texas 79756

2 Immunization Record: Immunizations or screenings required by the State of Texas, and/or clinical affiliates. Please return immunization records with completed application. Immunization Date Comments Tetanus/Diphtheria (TD) Must have had one dose within 10 years Tetanus/Diphtheria/Pertussis (TDAP) Must have had one dose within 10 years Rubella (German Measles) One dose or screening titer Mumps Rubeola (Measles) MMR Polio Hepatitis B Varicella (Chicken Pox) One dose is sufficient. If given prior to age 13 year. Meningitis Tuberculosis Skin Test (PPD) if exempt form skin testing, CXR results on file recent in 12months prior to program admission One dose or screening titer If born on or after Jan1, 1957, proof of two doses at least 30 days apart is required after first birthday if born before Jan.1, 1957; proof of one does administered after first birthday. Titer may demonstrate immunity. Not required, but all students are encouraged to ascertain immunity. Vaccine recommended if immunity does not exist. Series of three does required over a 4 to 6 month span. Titer may demonstrate Immunity. In lieu of vaccines, a titer may document immunity. Must have vaccine if under 22 years of age and have never attended another Texas University or College. Must have had vaccine or booster within 5 years. Not required until student is admitted and in the LVN program. 2

3 Applicant Questionnaire: Please respond to the following statements and return with your application form. You may add additional pages if needed. 1. Describe your motivation for becoming a licensed vocational nurse. 2. Please state why you selected School of Vocational Nursing. 3. Describe the role of the nurse in society. 4. Describe the types of experiences you have had with nursing professionals. 5. Describe your professional plan five years after completion of the vocational nursing program. 6. Describe the particular field of nursing that interests you. 7. Describe your personal strengths that will make you an effective nurse. 8. Describe your personal weaknesses that you will need to overcome to be an effective nurse. 9. Describe the manner in which you learn best. 10. Describe how well you work with others. Signature Date 3

4 Pre-Admission Requirements: School of Vocational Nursing Program Fact Sheet Enrolled at as a Credit Student Minimum cumulative GPA of 2.0 is required from most recent college or high school work Submit all previous college/university/high school transcripts Maintain current American Heart Association CPR card. (Online CPR not accepted) Meet immunization requirements. See VN Application for complete list of immunizations. Provide proof of health which must be maintained throughout 12 month program. A satisfactory score on the TEAS Test must be achieved. Overall: 54 Math: 60 Reading: 60 [The TEAS Test is required for consideration for admission to the program. Reservations to take the test may be made by contacting the Testing Center at {432) or by walk in Monday- Thursday 8:00am- 3:00pm and Friday 8:00am-11:00am. The cost is $70.00 on the day of testing, payment may be made by debit or credit card ONLY. Picture identification is required. Please contact the Extension after the results are received.] Additional Information: Applications Accepted: May 1st through June 1st. Program Start Dates: Fall Term per Academic Calendar. A student has one year to complete the Licensed Vocational Nursing Certificate Level 1. Students will be expected to pay additional fees required for state mandatory background tests and national exams. We will provide most current list of extraneous expenses at Student Orientation. Number of Students Admitted to Program: Andrews: up to 40 Monahans: up to 36 Dual Credit: up to 20 Number of students admitted may vary by term based on program instructional and clinical resources. Post-Admission Requirements: Purchase of uniforms, supplies, and text books as required by the program. Authorize the Board of Nursing to conduct a criminal background check. This procedure is required for students to go to the various hospitals and agencies for clinical education. If the background check is positive for certain offenses, the student may not be able to do clinical education and therefore will not be able to complete the requirements for the nursing program and will be dismissed form the program. Liability insurance is required and is part of the college fee schedule. Obtain a physical examination with drug screen. Attend mandatory orientation at.

5 Program Length: The VN program runs from August to August each year. It is a 12 month program. The VN program consist of 3 long semesters: Fall, Spring, and Summer. The VN Academic Calendar runs concurrent with the Odessa College Academic Calendar. Ability to Work during the Program: It is very difficult for students to maintain good academic standing while working and attending school. The VN Program strongly discourages working during the program. Program Cost: The estimated cost to the program is approximately: In District: $7,100.00, Out of District: $8,900.00, Out of State: $10, This estimate includes books, uniforms and testing fees. Financial Aid: Financial Aid and scholarship assistance is available to the Vocational Nursing student on a first-come, firstserve basis. The prospective student is advised to contact the Financial Aid Office at. Job Description: The vocational nurse practices under the supervision of a Registered Nurse and/or licensed physician and performs treatments and procedures to meet client needs. The vocational nurse uses the nursing process when providing care to individuals with common health problems. Employment opportunities are available in many different health care settings such as Doctor's offices, hospital settings, home health, and specialty areas just to name a few. Salary: The annual salary range for a vocational nurse in the Permian Basin is $40,000. These figures do not include shift differential, weekend differential, or critical care pay. Certification and Licensure: Graduates who successfully complete the program are eligible to receive a Certificate of Completion for and take the NCLEX-PN (Licensure Examination) endorsed by the Board of Vocational Nurse Examiners of the State of Texas. Educational Options: Student completing the program and passing the NCLEX-PN Examination may go on to earn an Associate Degree or a diploma in nursing. See the Student Handbook for details. Questions: Andrews Extension: (432) Monahans Extension: (432) Odessa Dual Credit Extension: (432)