Certificate Program Practical Nursing Application Spring 2018

Transcription

1 Moving Mountains Transforming Lives Practical Nursing Application Spring 2018 Open date: July 2017 Applicants can begin submitting program applications. Close date: Thursday, January 4, 2018 All required documentation listed on the application checklist must be received by the Admissions, Registration and Records office no later than 5 p.m. No postmark date allowed. No exceptions. Please note: This application is for a restricted entry program, must be hand signed and submitted along with supporting documents and payment. People requiring accommodations due to disability should contact the Disability Services Office at or dsoweb@mhcc.edu. Submit by Mail: Submit in Person: Mt. Hood Community College, Admissions, Registration and Records Practical Nursing SE Stark St Gresham OR Student Services (room AC2253, Gresham Campus) DO NOT include this page with your application documents.

2 APPLICATION PACKET CHECKLIST Every item on this checklist needs to be submitted by the application deadline January 4, Only completed applications containing all the required documents will be considered for review. Incomplete or late applications will not be considered. You will not be given notification if items are missing. It is the full responsibility of the applicant to make sure everything is received by the deadline. The following items must be submitted as part of a completed application: 1. General Admission Application, Apply Online at Select general studies as your major. It will change to Practical Nursing if/when you are admitted into the program. 2. Application Packet Checklist Page 2 3. Health Professions Division Application Page 3 4. Prerequisite Course Planning Sheet Page 4 5. Signed Practical Nursing Statement of Understanding Page 5 In addition to the documents above, applicants must also submit the following: 1. Current CNA Certification showing details and disciplinary actions (downloadable from your State Board of Nursing) OR Official Military Corpsman/Medic Documents (students must keep an active CNA through the whole program.) Can be completed by March 2, $35 Application Fee Make check payable to MHCC. Bank card/cash is only payable in person in Student Services (Room AC2253). 3. Official (in a sealed envelope) College Transcript(s) from EVERY COLLEGE EVER ATTENDED except MHCC transcript. Courses may be in progress at the time of application submission but an updated transcript showing posted grades for the required coursework for Fall term 2017 and prior terms must be received by the application deadline. By signing below I acknowledge/agree to the following: 1. MHCC s Admissions, Registration and Records office will send all application notification by . It is my responsibility to set my spam filter system to accept addresses Do this even if you are currently receiving s from MHCC. We cannot be responsible for notices which are not received due to spam or junk mail handling. Make sure to to your safe senders list. Applicants should be checking their on a computer and NOT on a smart phone. 2. I understand it is my responsibility to ensure all items are received by the application deadline and that only complete applications will be evaluated for admission. Furthermore, I have read and understand the admission requirements and procedures for admissions. I understand that withholding information or giving untruthful answers to questions on this application could be cause for non-acceptance or dismissal from the program. 3. I confirm each item on the checklist is included with my application or I have confirmed they are already on file at MHCC. I understand it is my sole responsibility to submit the required documents, and I will not be given notice if my application is incomplete until after the deadline, at which time it will be too late to submit missing documents. Printed Name: MHCC Student ID: Signature: Date: / / For Office Use Only Date Received: Received By: Mt. Hood Community College Rvsd Page 2 of 6

3 HEALTH PROFESSIONS DIVISION APPLICATION Name: SSN or MHCC ID: Previous last name(s): Current mailing address: ALL notifications will be sent via to this address. Phone number and alternate phone: Education Record: List ALL colleges attended, including for-profit schools (include MHCC if you have attended). Omission of any college transcript may result in non-admittance or dismissal from the program. ALL transcripts must be submitted regardless of age, program relevancy, or length of study (you do not need to submit an MHCC transcript). College Did you earn a degree? Are current transcripts on file or have they been ordered? Previous Applications: List all medical programs you have previously been accepted to. Program Title Year College Did you attend?* Did you finish?* *Applicants who have been previously admitted, started, but did not finish a medical program must: 1. Obtain a letter from the head of the department indicating the year(s) you attended, that you exited the program in good standing, and can speak to your ability to be successful in another medical program. 2. Submit a completed Nursing program Instructor Recommendation Form on page 6 as part of a complete application. Applicants who were dismissed or withdrew from programs may not be eligible to apply. Previous/Current Licensure: Have you worked in a medical field and/or held a license? If yes, print license off verification from your state board showing details and disciplinary actions and submit with your application. State License No. License Type Expiration / Lapse Date / Revoke Date Explanation / Comments Mt. Hood Community College Rvsd Page 3 of 6

4 PREREQUISITE COURSE PLANNING SHEET Applicant Name MHCC ID Practical Nursing For point assessment, only courses completed by the end of Fall term 2017 with a C grade or higher will be used. List the courses as they appear on your transcript. For transfer courses, DO NOT use the MHCC equivalency or convert to quarter credits. If the course is currently in progress, put IP in the term/year box. Submit updated transcripts documenting your grade once the course is completed (do not include an MHCC transcript). If courses are in progress and an updated transcript is not received by the application deadline, your application will be incomplete and not considered for admission. Prerequisite GPA must be at least a 2.5. There is no expiration date on science, math or other required prerequisite courses. List courses with the best grade. For transfer courses, if more than one course equates to the prerequisite course, list all transfer course information in the boxes provided. LPN Prerequisites Course Term/Year Grade/Credit Hours Institution EXAMPLE BI121 WI/12 A/4 MHCC Coursework required to apply Must be completed by the application deadline January 4, 2018 BI121 OR BI231 AND BI Anatomy & Physiology I and Anatomy & Physiology ll MTH065 - Beginning Algebra (or higher) OR CPT 2 placement into MTH095. WR121 English Composition CIS120L Computer Concepts RD115 3 Reading for College Success OR placement into RD117 Critical Reading Supporting Coursework required to start program if not yet already completed Must be completed by the end of Winter term, March 2018 BI122 Anatomy & Physiology II OR BI233 - Anatomy & Physiology III MTH065 - Beginning Algebra (or higher) (placement test scores do not fulfill this requirement). Practical Nursing Program Coursework Can be completed prior to starting the program or during the specified term within the program PSY237 Human Development 4 AH110 - Medical Language for Healthcare Settings 1 If the applicant enrolls in a 3-term sequence A&P course, the first 2 terms (BI231 and BI232) must be completed by the application deadline. By the start of this program, Spring term 2018, the entire sequence must be completed. 2 If using placement scores to meet the math requirement, applicant must complete MTH065 or higher by Winter term, March A writing course does not satisfy the reading requirement. 4 PSY201 General Psychology is a prerequisite to taking PSY237 at MHCC. Mt. Hood Community College Rvsd Page 4 of 6

5 PRACTICAL NURSING STATEMENT OF UNDERSTANDING Applicant Name MHCC ID Please indicate that you have read and agree to each paragraph by checking each line. I have read and understand the admission criteria for the Practical Nursing (LPN) program at Mt. Hood Community College. I understand it is my responsibility to meet all program and application criteria. I verify that all statements on this application are complete and true, and I understand that falsification of any information may lead to disqualification or dismissal from the program. I understand I must have at least a 2.5 GPA in all of the required, supporting, and in program coursework. I understand if accepted to the LPN program, I am required to complete: BI122 or BI233 (completion of anatomy and physiology series with lab) and MTH065 or higher (if I have not already completed the course) with a C grade or better while still meeting the 2.5 GPA requirement by the end of Winter term, March Failure to complete any of these courses will result in revoking my acceptance offer. I understand if accepted to the LPN program, I am required to submit the CNA certification document by Friday, March 2, Failure to complete this requirement will result in revoking my acceptance offer. I understand if I am accepted into the program, I will be expected to demonstrate the MHCC LPN program academic and essential functions (mhcc.edu/practicalnursingfaq/) with or without reasonable accommodations based on disability and approval from the Disability Services Office. I understand that clinical facilities may require a criminal history check be completed while the student is enrolled in the LPN program. I understand that if I am accepted into the program, for the purposes of public safety and health, if I have or develop any type of psychological, medical, drug or alcohol problem that impairs my ability to provide safe client care, or if I have an arrest or conviction history that would disqualify me from patient care in a clinical facility or licensure by the Oregon State Board of Nursing (OSBN), the LPN faculty/selection committee may consult with legal counsel and/or the OSBN and reject or dismiss me from the program. Upon application for licensure, applicants will be subject to a criminal background check performed by the Oregon State Board of Nursing (OSBN). Certain crimes may disqualify an applicant from licensure. Any individual who supplies false or incomplete information to the Board regarding the individual's criminal conviction record will be denied licensure. Specific questions regarding these issues should be directed to the OSBN at SW Upper Boones Ferry Road, Portland, OR 97224, (971) , or oregon.gov/osbn. I understand the college uses a management learning system called Blackboard which is an integral part of all LPN courses and that accepted students must have access to a computer with software that includes Microsoft Word 2010 and Power Point. Internet access will be required on a daily basis. I understand that a mandatory orientation will be held for admitted and alternate students on Thursday, March 8, 2018, 9 am 4:00 pm, no exceptions. My attendance at the mandatory orientation is required, and I will attend this mandatory orientation or the next eligible alternate will be given my assigned place in the program. I understand that, as an accepted student I will submit my required immunizations, CPR card, and all other required documents by March 15, If I am an alternate student, I will have these documents ready to submit by this date should a position become available. I understand that, as an accepted or alternate student, I must provide a current Healthcare Provider CPR card approved by the American Heart Association. This program will accept only Healthcare Provider CPR cards from the American Heart Association, and I will obtain the appropriate card type. The CPR course must have been completed (and submitted) by March 15, 2018 (no exceptions) and must be valid for the duration of the program. I understand that if accepted into the Practical Nursing program, my acceptance will be provisional until I pass a national criminal background check through (Please note: The accepted applicant pays for the background check, and the background check process requires a social security number.) I understand all admitted students are required to complete a Drug Screen prior to starting the Practical Nursing courses. Please note, this drug screening may also check for prescription drugs that contain amphetamines, barbiturates, opioids, benzodiazepines and marijuana. If you are taking any prescribed medication that may contain these drugs you will need to meet with the program director before completing the drug screen. I understand that if I have applied to the LPN or other restricted entry health profession programs at MHCC in the same admission year, and I accept a position in the LPN program, my application to other restricted entry health profession programs will not be considered for that year. Applicant Signature Date Mt. Hood Community College Rvsd Page 5 of 6

6 NURSING PROGRAM INSTRUCTOR RECOMMENDATION FORM Only required of applicants who have been previously admitted, started, but did not finish a medical program, see Previous Applications section of page 3. Please thoroughly read the instructions on this form. Applicant Instruction You are required to submit this form unopened from the faculty with your application documents and agree to the statement below. By submitting the Practical Nursing application, I understand that I am waiving my rights to review or request a copy of this recommendation form and letter from the department head. Applicant Signature Print Name Date: / / Nursing Faculty Instruction Thank you for assisting the MHCC Practical Nursing Program Selection Committee. We are appreciative of your time and effort in providing us this important information. We ask that a nursing program faculty who has worked with the applicant be the person to complete this recommendation. Once complete, please enclose this form in one of your institution envelopes and sign your name across seal on the back of the envelope. Give the sealed envelope back to the applicant to be included with the applicant s application packet. All recommendations must be received in the Admissions, Registration and Records office (located within Student Services, room AC2253) by 5:00pm on January 4, 2018 in order for this to be considered in the applicant s completed application packet. For the Nursing Faculty Instructor Points WILL NOT be awarded unless this form is filled out COMPLETELY by the Nursing Faculty. College: Dates of Attendance: Using the rubric below, please give an honest appraisal of the applicant in each of the following categories: Below Average (50%) Average (50-75%) Good (75-90%) Outstanding (90-98%) Exceptional (Top 2%) Not Observed or Not Applicable Intellectual Ability Verbal Communication Written Communication Ability to understand and follow directions Potential for Clinical Competence and Safety Motivation/Ambition Conscientiousness/Responsibility Integrity Interpersonal Skills Multicultural Sensitivity Recommender s Printed Name Signature Date Title Phone Number Mt. Hood Community College Rvsd Page 6 of 6