Practical Nursing Program

Transcription

1 SCHUYLKILL TECHNOLOGY CENTER 101 Technology Drive, Frackville, PA (570) or Fax (570) Practical Nursing Program Date: School Year From: To: Mrs. Lisa Shustack, MSN, MS.Ed, RN Practical Nursing Coordinator Practical Nursing Program Applicants Subject: Practical Nursing Program Information Packet ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Thank you for your interest in our Practical Nursing Program at Schuylkill Technology Center~North Campus, Frackville, PA (STC). The Practical Nursing Program consists of one full time day program beginning in July of each calendar year and an 18 month part-time program which has various start times. Please contact the Practical Nursing Program at , Extension 4881 for the next available class being offered. The full time day program will take one year to complete and is comprised of four terms. Students attending the full time program receive theory at STC North Campus Monday thru Friday. The class days will be held from 8:00am 2:30pm and clinical will be held from 6:45am 3:15pm. The days for class and clinical will vary. The part time program is an 18 month day program with class and clinical being held three days per week, these days may vary throughout the week. However, students will be given sufficient notice prior to changing class/clinical days. Class and clinical hours are the same as the full time program. If you have any questions, please contact the Practical Nursing Program at , Extension An Equal Opportunity Educational Facility Accredited by Pennsylvania State Board of Vocational Education, Bureau of Career and Technical Education

2 SCHUYLKILL TECHNOLOGY CENTER 101 Technology Drive, Frackville, PA (570) or Fax (570) Practical Nursing Program Pre-Admission Assessment Exam ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ All applicants for the Schuylkill Technology Center Practical Nursing Program must take the Practical Nursing Pre-Admission Entrance Exam (TEAS) in Reading, Mathematics, and English. The purpose of the pre-admission exam is to evaluate whether you have the academic skills and aptitude necessary to successfully complete the program. The assessment will determine if academic remediation is necessary. Remediation and test preparation is available through the Lifelong Learning Center free of charge. If you would like to register for the next pre-admission exam preparation program, please contact Lifelong Learning Center at Please call this number for dates and locations for the program. This pre-admission preparation program consists of a two day session. There is no charge for the pre-admission assessment or academic remediation. You can proceed and contact the Practical Nursing Office once you feel prepared to take the TEAS at , Extension You can then submit your application/application fee to the Practical Nursing Office. A copy of your high school transcripts must be received before you can take the TEAS. You will then be scheduled for the next TEAS exam. A combined average in Reading, Math and English scores of 55% is needed in order to pass the TEAS. The TEAS may be rested up to two times. Thank you. An Equal Opportunity Educational Facility Accredited by Pennsylvania State Board of Vocational Education, Bureau of Career and Technical Education

3 Schuylkill Technology Center North Campus Practical Nursing Program Program Catalog Technology Drive Frackville, PA (570) , Extension 4881 FAX: (570) Practical Nursing Program

4 **********INSTITUTIONAL MISSION STATEMENT********** The mission of the Schuylkill Technology Center is to enable the student to acquire the attitudes, knowledge, skills, and values necessary to become a life-long learner and a productive citizen of a global economy by developing an educational pathway for excellence driven by a partnership with education, business, industry, government, family, and the community. **********INSTITUTIONAL BELIEF STATEMENT********** The Schuylkill Technology Center believes that: Education is the responsibility of the student, parent, teachers, and the community All individuals can learn, but learning occurs at different rates through diversified learning styles Individuals are more successful when they are active participants and demonstrate learning Individuals are more successful when they set goals, make choices, and accept responsibility Individuals enrich their learning by participating in family, school, and community activities Humanity prospers when people work together Diversity enhances growth and strengthens society Excellence is achievable and a worthwhile investment Learning is a life-long process that is essential for economic stability The future of our society depends on the effectiveness of a high-quality education **********INSTITUTIONAL OUTCOMES********** The Schuylkill Technology Center is an integral part of the educational process and is reflective of the local educational culture. The faculty and staff of the Schuylkill Technology Centers choose to articulate tomorrow s educational challenges through curriculum, human relations, business, industry, and the community as identified by the internal and external needs assessment. Therefore, the Schuylkill Technology Centers embrace the following institutional outcomes for each graduate: Mathematical, verbal, and written communication skills Rigorous performance-based skills Effective interpersonal and teamwork skills Work ethic and civic responsibility skills Lifelong learning skills *********ACCREDITIONALS/APPROVALS********** ACCREDITATION (For information about national and program accreditations, contact the institution.) Accredited by Pennsylvania State Board of Vocational Education, Bureau of Career and Technical Education APPROVALS Approved by the Pennsylvania Department of Education Pennsylvania State Board of Nursing United States Department of Education for Pell Grants and for participation in the Federal Family Education Loan Program Pennsylvania Department of Education for Veterans Training Bureau of Vocational Rehabilitation for training of rehabilitation students ********* Practical Nursing Program Coordinator********* Lisa Shustack ~ EdD, Indiana University of Pennsylvania, MSEd., Wilkes University ~ MSN, University of Phoenix ~ BSN, RN, Cedar Crest College ********* Practical Nursing Program Staff********* Kimberly O Neill~ BSN, RN Lycoming College Catherine Johnson BSN, Gwynedd Mercy College ~ ADN, Gwynedd Mercy College ******* Practical Nursing Program Part-Time Staff******* Amanda Gallagher BSN, RN, Penn State University Mary Scheetz BSN, Penn State University, RN, Pottsville Hospital School of Nursing Elizabeth Wolff, MSN, University of Phoenix ~ BSN, University of Phoenix ~ RN, AAS, Reading Area Community College ******* Practical Nursing Program Secretary******* Lisa Bickelman ******************************* 1

5 STC Practical Nursing Program *********ADMISSIONS********* Practical Nursing Program Requirements In order to be considered for admissions to the Schuylkill Technology Center s (STC) Practical Nursing Program, you must be a graduate of an accredited high school or possess a General Education Diploma (GED) and successfully complete STC s admission/application process. Full time classes begin in July of each year. A part time program begins every 18 months. ADMISSION PROCESS I. Pre-Admission Assessment Exam Applicants for the Practical Nursing Program will have the option to take a free pre-admission remediation course in preparation for the Reading, Mathematics, and English admission exam. The purpose of the pre-admission exam (TEAS) is to evaluate whether you have the academic skills and aptitude necessary to successfully complete the program. If you choose to take the free pre-admission remediation course, it is usually a 2 day process. Once you feel prepared, you may contact the Practical Nursing office and submit your application and money order so that you can schedule your TEAS. 1. Step One: Register for the Pre-Admission Program by calling the Lifelong Learning Center at or by contacting the Practical Nursing office to schedule your TEAS at x If you choose, attend the Pre-Admission Program at the Lifelong Learning Center, 2221 W/ Market St, Pottsville from 8:30-2:30 on two consecutive Fridays. 3. Upon completion of the Pre-admission Program, you will have the option to register to take the TEAS test or to first attend a more intensive TEAS Prep-Remediation day. The purpose of the Pre-Admission Program is to help you evaluate whether you have the academic skills necessary to successfully complete the Practical Nursing Program. Not only will you be assessed in the areas of Reading, Mathematics and Language skills, but you will also receive a condensed refresher in subject areas which will help to strengthen your TEAS scores. Additional remediation will be available to you once you have completed the 2 day Pre- Admission Program. Upon successful completion of remediation, if needed, you will be required to retest. When appropriate or if remediation is not required, you can proceed and contact the Practical Nursing Office at , ext.4881 for application information. II. Application Process A. At this time you may request an application by calling the Practical Nursing Office at , Extension Submit your $30.00 application fee and STC PN application to STC-Practical Nursing Program, 101 Technology Drive, Frackville, PA Money order (NO CASH) should be made payable to Schuylkill Technology Center. B. Request official copies of your high school transcript or GED scores to be sent to the PN Office. C. Upon receipt application/application fee, and high school transcript or GED scores you will be notified of a testing date for the Test of Essential Academic Skills (TEAS), which will be administered as a computerized test at the Schuylkill Technology Center, Frackville and will take approximately 3 hours. The testing fee is $ and must be paid when you schedule your test with the nursing office. D. The Test of Essential Academic Skills (TEAS) measures basic essential skills in the academic domains of Reading, Mathematics, and English and language usage. The test is intended for use primarily with adult nursing program applicant populations. The objectives assessed on TEAS are those which nurse educators deemed most appropriate and relevant to measure entry level skills and abilities of nursing program applicants. The TEAS is a 170-item, four option, and multiple-choice assessment. To prepare in an organized and efficient manner, you should know what to expect from the real assessment. Content Area Number of Test Items Amount of Time Allotted Reading minutes Mathematics minutes English and Language Usage minutes TOTAL MINUTES A combined average in Reading, Math and English scores of 55% is needed for all three components in order to pass the TEAS.

6 E. Two products are available to help as you prepare for the TEAS Assessment: TEAS Study Manual (highly recommended) and the Online Practice Assessment. For a complete student package, both may be purchased at or review the free practice site on ATI s website. 2 III. Acceptance Process A. Admission to the Practical Nursing Program is competitive based upon the TEAS results and educational background. Students will be notified of their admission by mail. B. In order to be considered for selection/acceptance, applicants will be required to submit a completed PA State Police Criminal Record Check, FBI Background Check (Fingerprinting), a PA Child Abuse History Clearance and a 10 panel Drug Screening. Please note: Individuals who have a positive criminal history may be denied admission to the Practical Nursing Program. Please review the enclosed Background Checks Previous Employment for Student Clinical Placement Disclosure Also a criminal record may be a potential barrier to completing the program, receiving permission to take the state licensing examination and obtaining a practical nursing license. It is the student s responsibility to inform the program coordinator of any criminal infraction which occurs while a student is attending STC. Please note: applicants who have not lived in the state of Pennsylvania for at least 2 years may have extended time in obtaining fingerprinting. Please visit to review the procedure for non-pennsylvania residents. C. Once an applicant is selected they will need to submit a non-refundable enrollment deposit (currently $275.00) in order to be accepted.

7 STC Practical Nursing Program Program of Learning Anatomy & Physiology ~ 97hr. A study of basic anatomy and physiology of all body systems is prefaced with a brief introduction to the principles of chemistry, microbiology and physics as they relate to body physiology. Family Centered Health Care ~ 60hr. This course deals with the normal physical, psychological, and social patterns of development from conception through adolescence. Included are theory and related clinical experience in the care of mothers, newborn infants, and children. Geriatrics ~ 32hr. A study of the concepts, theories and characteristics of aging. The student is introduced to the programs available to help the elderly maintain quality of life. Death and dying are presented with an emphasis on the role of the care provider as he/she relates to the event and significant other. Mental Health Nursing ~ 24hr. An introduction of basic mental health nursing as it relates to the total health of the patients. Theories of crisis intervention, mental defense mechanisms, and basic communication techniques are presented. The student is introduced to the more common mental health disorders and their treatment modalities, including medications. Nursing I ~ 110hr. A study of theory and clinical practice of basic bedside nursing care. Course emphasizes the principles underlying procedures, development of skills in patient observation, effective communication and utilization of principles of teaching to help achieve patient, family and community health. Note: Includes 24 hours of lab/clinical hours. Nursing II ~ 36hr. A study of theory and clinical practice of advanced nursing care. This course emphasizes the principles underlying procedures, development of skills in therapeutic measures, and preparation of the patient for diagnostic tests. Note: Includes 18 hours of lab/clinical hours. Nursing III ~ 206hr. A study of specific diseases and disorders affecting the various body systems of adults and children that includes common symptoms, diagnostic studies, treatment regimens (including diet therapy and related pharmacology), and nursing care as it relates to that specific disorder. Nursing IV ~ 43hr. A study of basic leadership skills in geriatric settings is discussed as well as legal and ethical issues. Observations of roles of Treatment Nurse, Clinical Manager and/or Charge Nurse are scheduled for the students. Various cultural aspects will be studied, as well as community services available to the public. Immunological disorders, cancer & HIV are discussed, including the pathology, etiology and treatment options. The process of applying for licensure and the NCLEX are included. Pharmacology ~ 126hr. Students will learn the fundamental principles of drug action; develop skills to administer specific drugs used in the treatment, prevention, and diagnosis of disease; and develop the ability to implement appropriate nursing actions to maximize the desired outcomes of therapy. Note: Includes 12 hours of lab/clinical hours. Personal and Vocational Relations ~ 40hr. The student is oriented to Practical Nursing and the health delivery system in term I. In term IV students will study vocational aspects of nursing preparation for the world of work; An 18 hours NCLEX Review is also provided in Term IV to help the study prepare for the NCLEX exam upon graduation. Clinical Practicum ~ 771hr. Each clinical term is an entity unto itself with unique experiences that enable the student to apply skills in a specific clinical setting. 3

8 STC Practical Nursing Program Program of Learning The Practical Nursing Program consists of 1545 hours. Students receive 720 hours of theory and 825 hours of clinical and lab experience. This program encompasses the giving of direct patient care, recording data, performing treatments, assisting with restoration of function, and administration of medications. Practical Nursing also involves participation in assessment of planning, implementation, and evaluation of nursing care in all settings where nursing takes place. Theory and laboratory sessions are held at the Schuylkill Technology Center ~ North Campus in Frackville. Clinical experience is concurrent and/or sequential to theory, and is scheduled at Rosewood Rehabilitation and Nursing Center in Schuylkill Haven, Schuylkill Center Genesis Eldercare, Schuylkill Medical Center-East Norwegian Street and Schuylkill Medical Center-South Jackson Street in Pottsville, Broad Mt. Manor Nursing & Rehab Center and STC School Nurse, Frackville, Schuylkill IU 29 Early Intervention Preschool, Schuylkill IU 29 Maple Avenue, Schuylkill Learning Academy Maple Avenue, Marlin. Ridgeview Nursing & Rehab Center, Shenandoah, Shenandoah Manor Nursing Home, Shenandoah, Hometown Nursing & Rehab Center, Hometown, Mount Carmel Nursing & Rehab Center, Mount Carmel, PSA Homecare, Schuylkill Have. Reliable transportation is imperative to proper learning. *********GRADING********* Students are required to complete each Term with a satisfactory minimum grade of 80% in each Theory course of study, and satisfactory grade in the Clinical Practicum for the term. Passing Grade - 80% in Theory Performance 1. Grading Scale: = A = B = C 79 - Failure 2. Numerical grades are used for theory achievement, as well as reports, and care plans, pass or fail is used for clinical achievement. 3. Final grade for Academic Achievement is determined by: A. Written Exams B. Class Presentations C. Class Projects This grading policy is refined to meet program guidelines and all requirements of the Schuylkill Technology Center s grading policy. The student must achieve an 80% in all theory courses required, as well as a satisfactory grade in the clinical practicum in each term. Students who have failed or withdrawn are readmitted on a space-available basis only in accordance with the Practical Nursing Program policies. *********FINANCIAL AID********* The Schuylkill Technology Center recognizes the expense of a quality education and encourages students to apply for all available financial aid. The Financial Aid Office assists students in applying for federal grants, loans, and the Veterans Administration Program. Other agencies providing funding are Team PA Career Link and the Office of Vocational Rehabilitation. Financing opportunities available to qualified students include: Federal Pell Grants, Subsidized Federal Stafford Loans, Unsubsidized Federal Stafford Loans, and Federal Plus Loans. *Tuition and fees are established by the Schuylkill Intermediate Unit Board of Directors. The tuition and fee schedule for the current year is listed below *Tuition & Fee Schedule Program Start Date Length Cost Practical Nursing Full Time Day 12 months $ (Includes enrollment deposit, application fee, tuition, July to June (1545 hours) textbooks, uniforms, clearances, medical, lab, computer & test fees) Part-Time Day 18 months $ (Includes enrollment deposit, application fee, tuition, 1545 hours textbooks, uniforms, clearances, medical, lab, computer & test fees) *The tuition and fee schedule is subject to change on June/July 1 of each year. In the event that a student fails to pay the term tuition payment in full (less any approved PELL, GSL, or Scholarship Awards), the student will not be permitted to continue attending classes. Definition of an Academic Year: PN Program 48 weeks/1545 clock hours. When determining refunds, the following fees will be considered NON-REFUNDABLE $100* ($30 Application Fee and $70 Pre-entrance Test Fee) $275.00* Enrollment Deposit Fee (Lab/Test Fees) All books, uniforms, medical, lab, and test fees For more information about our graduation rates, the median debt of students who completed the program, and other important information, please visit our website at 4

9 Schuylkill Technology Center Post~Secondary Schuylkill Technology Center ~ North Campus 101 Technology Drive Frackville, PA (570) FAX: (570) Schuylkill Technology Center ~ South Campus 17 Maple Avenue Marlin, PA (570) FAX: (570) Important Telephone Numbers North Campus (570) South Campus (570) Pre-Admissions Testing Admissions: Ext Job Placement: Ext Student Accounts Office Fax: Job Placement: Ext Practical Nursing Office Ext Fax Financial Aid Coordinator address: adullinger@lcctc.org Ext Airport Campus Tractor Trailer Program Fax Heavy Equipment Operator Fax Fax Fax *********NON-DISCRIMINATION POLICY********** The Schuylkill Intermediate Unit #29 will not discriminate in its educational programs, activities, or employment practices, based on race, color, national origin, sex, sexual orientation, disability, age, religion, ancestry, union membership, or any other legally protected category. This policy is in accordance with state law, including the Pennsylvania Human Relations Act, and with federal law, including Title VI and Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Sections 504 of the Rehabilitation Act of 1973, the Age Discrimination in Employment Act of 1975, and the Americans with Disabilities Act of The Schuylkill Intermediate Unit s commitment to non-discriminatory practices extends to prospective students and employees, current students and employees, parents of students, community members, and representatives of outside agencies. Schuylkill Intermediate Unit employees, community members, and agency representatives who have a complaint of harassment or discrimination or who seek information about accommodations for individuals with disabilities should contact Dr. Gregory Koons, Executive Director, Equal Rights and Opportunities Director, Schuylkill Intermediate Unit #29, PO Box 130, 17 Maple Avenue, MarLin, PA 17951, telephone number , or fax number Visit our website at

10 The TEAS V (Test of Essential Academic Skills) Purpose of the TEAS V The Test of Essential Academic Skills (TEAS V) measures basic essential skills in the academic area domains of Reading, Mathematics, and English and language usage. The test is intended for use primarily with adult nursing program applicant populations. The objectives assessed on TEAS V are those which nurse educators deemed most appropriate and relevant to measure entry level skills and abilities of nursing program applicants. The TEAS V is a 116-item, three-option, multiple-choice assessment. To prepare in an organized and efficient manner, you should know what to expect from the real assessment. Content Area Number of Test Items Amount of Time Allotted Reading minutes Mathematics minutes English and Language Usage minutes Total minutes *116 questions will be scored. Two products are available to help as you prepare for the TEAS V Assessment: Test of Essential Academic Skills (TEAS V) Study Guide) The study manual is written specifically to address the needs of students preparing to take the TEAS V or those who need additional help after testing. Strategies: Your Guide to Classroom & Test Taking Success (This book is available for test taking strategies. Test of Essential Academic Skills (TEAS V) Online Practice Assessment The TEAS V Online Practice Assessment is available for students desiring additional test preparation material. For a complete student preparation package, the TEAS V Online Practice Assessment and the TEAS V Study Guide and book may be purchased at Answers your Important Questions The Guide will also answer your two most urgent questions: What is on the TEAS V examination? How can I best prepare for this test? Observance of a few simple test taking guidelines can improve your understanding of what is required on the test, without a great effort on your part. For example, numerous investigations have shown that applicants can often save from one fourth to one third of their test taking time if they systemize their efforts in accordance with well researched, but well know, principles of test taking. Reading & Math Skills The Guide will assess your reading comprehension and basic mathematics skills that are assessed on the TEAS V English and Language Usage Skills Grammar and Word Meanings in Context, Spelling and Punctuation, and Structure will be covered. Avoid Exam Stress With the Guide you can anticipate the test with fewer unknowns and, therefore, less stress and anxiety as you prepare for the TEAS V Prepare for Your New Career The Guide will also improve your basic academic processing skills of math, reading comprehension, and English and Language Usage which is absolutely essential for success in your chosen career. To order the TEAS V Study Guide visit or Call

11 Reading Sample Questions: Directions: Read the following passage and answer questions 1 and 2. The 2,315-mile Missouri River tops this year s list of the 10 Most Endangered Rivers in North America, compiled annually by the conversation group American Rivers. The Big Muddy has been dammed, channeled, and diked to the point that one-fifth of the species native to the river and its floodplain are now classified as endangered, threatened, or of special concern, according to American Rivers. The other nine rivers on the list are New York s Upper Hudson, Washington s White Salmon, California s San Joaquin, Wisconsin s Wolf River, Arizona s Pinto Creek and Potomac, Ohio s Mill Creek, the Lower Colorado and the Tennessee River. 1. Which of the following may be concluded from the passage? A. Wolf River is located in Washington, DC. B. Bodies of water with creek in their names are not rivers. C. The damming, diking, and channeling of a river is detrimental to the organisms that inhabit it. D. The rivers of North America have been found to be more endangered than those of South America. 2. A conservation group organizes for which of the following principle purposes? A. Collecting data for scientific research B. Saving rain forests C. Channeling rivers D. Preserving nature Mathematics Sample Questions: 3. Thirty percent of the students in a mathematics class received an A. If 18 students received an A, which of the following represents the number of students in the class? A. 18 B. 30 C. 54 D A student earns $1, each month at a part-time job. The student pays the following amounts for expenses each month: Rent. $ Food $ Utilities. $ Car expenses $ After paying the monthly expenses listed above, which of the following represents the amount of money the student has left for other expenses? A. $ B. $ C. $1, D. $1,125.60

12 ATI Sample Question TEAS V English and Language Usage Sample Questions: 5. The rapacity of our vile, disgusting, and despicable stepfather was not satisfied until he had taken all that we had. Which of the following words are redundant in the sentence above? A. rapacity, vile B. vile, disgusting C. rapacity, despicable D. disgusting, despicable 6. Jennifer mailed a sympathy card to the family of the dead man in a hurry. Which of the following phrases is misplaced in the sentence above? A. in a hurry B. to the family C. of the dead man D. Jennifer mailed a sympathy card Solutions to sample questions 1 C 2 D 3 D 4 B 5 B 6 A ATI Sample Question TEAS V

13 SCHUYLKILL TECHNOLOGY CENTER 101 Technology Drive, Frackville, PA (570) or Fax (570) Practical Nursing Program ~ Fees and Tuition The following are current costs (subject to change) related to the Practical Nursing Office *Fees Entrance Term I 406 Hours 374Term II 374 Hours Term III 391.5Hours Term IV Hours Total 1545 Hours Tuition (hours by term) $ $ $ $ $ Lab/Test/Computer Fees $ $ $ $ $ Enrollment Deposit $ $ Application/Test Fee $ $ Background Checks $49.00 $49.00 Uniforms (Estimated) $ $ Medical Screening $ $ (Estimated Textbooks (Estimated) $ $ $ TOTAL $ $ $ $ $ $ Estimated Additional Term IV Costs Graduation Costs Graduate Nursing Pin $35.00 Cap $10.00 Graduate Uniform $60.00 PA Temporary Practice Permit $35.00 PA State Board of Nursing Licensure Fee $35.00 NCLEX Testing Fee $ Total Graduation Fees $ TOTAL ESTIMATED COST $ Please Note: Term I is the most costly term. Approximate cost is $ Tuition: Students are responsible for payment for their tuition amounts (less any approved Pell, GSL, or Scholarship Awards) within ten (10) days prior to the start of each new term. The Practical Nursing Program is comprised of four terms. Refer to your student handbook for term dates. Students are also responsible for the following: application/lab/test fees, clearances, uniforms, textbooks, immunizations, drug screening, and graduation expenses. In the event that a student fails to pay in full the term tuition payment (less any approved Pell, GSL or Scholarship Awards), the student will not be permitted to attend classes. Tuition Refund will be based on each term payment. If a student enrolled in a program withdraws or is terminated by the school, the following refund policy is applicable after the first full class day: Refund Due Practical Nursing Program 75% Day 2 to 10 50% Day 11 to 15 25% Day 16 to 30 No Refund After Day 30 Students receiving Pell or Loan money will be subject to additional refund policies set forth by each respective agency. The major factor in determining Title IV Funding is class attendance. Any money returned to these agencies will be charged to the student when applicable. STC students receive a complete FA Policy Handbook upon acceptance. *All costs are approximate and subject to change. Tuition and fee schedule is subject to change on July 1of each calendar year.

14 NOTE: You must submit an official copy of your high school transcripts along with this application in order to schedule the admission examination. SCHUYLKILL TECHNOLOGY CENTERS 101 Technology Drive, Frackville, PA (570) or Fax (570) A $ non-refundable application fee must accompany this application. Please print in ink or type all information. ALL APPLICATION FEES ARE NON-REFUNDABLE Please indicate which class you are applying for: Full-Time (12-month) Program Part-Time (18-month) Program PART I DEMOGRAPHICS Social Security Number: - - Name: ( ) First Middle Name Last Maiden Name Address: City: State: Zip Code: address: Home Phone ( ) - Cell Phone: ( ) - Work Phone: ( ) - School District: Birth Date: / / Gender: Male Female Ethnic Background: White (Non-Hispanic) Black (Non-Hispanic) Race/Ethnicity Unknown Hispanic American Indian/Alaskan Native Non-Resident Alien Have you been a resident of Pennsylvania for two or more years? Yes No *If you answered no please refer to the information regarding FBI fingerprinting. Applicants who are residents of Pennsylvania for less than 2 years may have an extended timeframe (8 10 weeks) for obtaining fingerprinting clearances which may impact your ability to enroll in the next class. Are you an American Citizen? Yes No If no, please complete: Permanent Resident Card No: Foreign Student (F1 Student Visa): Country of Citizenship: Other VISA (Please list): In Case of Emergency Contact: Name: Relationship: Address: Phone: ( ) -

15 PART II EDUCATIONAL BACKGROUND 1. Are you a high school graduate? Yes What year did you graduate No Anticipated graduation date 2. Name of high school you attended or will graduate from: 3. Did you complete the following courses with a grade of 74% or better in high school: a. Two years of a math courses (Algebra I, Algebra II, Geometry, Trigonometry, etc.) Yes, I have had two years of high school math and earned an average of 74% or better. No, I have not had two years of high school math with an average of 74% or better. b. Two years of science courses (Biology, Anatomy & Physiology, Chemistry I, Chemistry II, Microbiology, Physics, etc.) Yes, I have had two years of high school science courses and earned a 74% or better. No, I have not had two years of high school science courses with an average of 74% or better. c. One science course that had a laboratory portion included. Yes, I have had a high school science course with a laboratory component. No, I have not had a high school science course with a laboratory component. 4. If you are not a high school graduate, do you possess a GED? Yes No 5. Have you previously attended STC? Yes No Dates attended 6. Have you attended another college or school? Yes No If yes name of college or school: 7. Have you completed? Certificate Program Associate Degree Bachelor s Degree Master s Degree Master s Degree Plus

16 PART III EDUCATIONAL GOALS Please indicated your primary educational goal at the STC (please check one): Improvement of existing job skills Preparation for a job Personal interest Preparation for articulation to Associate Degree Program PART IV EMPLOYMENT DATE List all present and past employment beginning with the most recent. Employer Name & Address Position Date Employed From To Other (specify) Reason for Leaving Please indicate where you obtained this application or where you heard about our program: College Fair High School Mail Social Media STC Admissions Office STC Career Fair Radio Friend/Relative Newspaper Other Signature Date The Schuylkill Intermediate Unit #29 will not discriminate in its educational programs, activities, or employment practices, based on race, color, national origin, sex, sexual orientation, disability, age, religion, ancestry, union membership, or any other legally protected classification. Announcement of this policy is in accordance with state and federal laws, including Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Americans with Disabilities Act of The Schuylkill Intermediate Unit s commitment to nondiscriminatory practices extends to prospective students and employees, current students and employees, parents of students, community members, and representatives of outside agencies. Schuylkill Intermediate Unit employees, community members, and agency representatives who have a complaint of harassment or discrimination or who seek information about accommodations for individuals with disabilities should contact Dr. Gregory Koons, Executive Director and Equal Rights and Opportunities Director, at Schuylkill Intermediate Unit 29, P.O. Box 130, 17 Maple Avenue, Mart-Lin, PA 17951, telephone number (570) , fax number (570) Revised: 5/10, 7/11, 7/13, 12/13, 2/14, 4/14, 08/15, 5/17 For Office Use only Date Application Received: Date of Application Fee Payment: Test Fee Payment Waived: Test Fee Waived: Form of Payment: Check#: Cash: Money Order#: Amount Paid: Comments:

17 SCHUYLKILL TECHNOLOGY CENTER Practical Nursing Program 101 Technology Drive, Frackville, PA (570) or Fax (570) Request for Secondary Education (High School) Transcript I am requesting an Official Transcript. Since this transcript is for educational purposes, please forward to: Schuylkill Technology Center~North Campus Practical Nursing Program 101 Technology Drive Frackville, PA , Extension , Extension My signature below authorizes you to send my transcripts. Please print the following information: Name: Other Name (if applicable): Current Address: City: State: Zip: Year of Graduation: Signature: Submit this form to your high school guidance counselor or principal. Most institutions require a fee for processing transcripts. It is your responsibility to contact the high school to determine the institutional policy and remit the proper amount with this request. 7/11 C:\Newstudent/HS/GED request form An Equal Opportunity Educational Facility Accredited by Pennsylvania State Board of Vocational Education, Bureau of Career and Technical Education Accredited by Pennsylvania State Board of Vocational Education, Bureau of Career and Technical Education

18 SCHUYLKILL TECHNOLOGY CENTER Practical Nursing Program 101 Technology Drive, Frackville, PA (570) or Fax (570) Request for Transcript of GED Test Scores In an effort to enhance services for individuals who receive the Commonwealth Secondary School Diploma, the Pennsylvania Department of Education is transferring all of its diploma and transcript processing services to DiplomaSender at Effective October, 1, 2016, all Pennsylvania high school equivalency diplomas and transcripts for the GED test, HiSET exam, as well as those awarded through the 30 College Credit Option, will be handled by DiplomaSender. To request a copy of a transcript, diploma, or letter of verification of high school equivalency, visit An Equal Opportunity Educational Facility Accredited by Pennsylvania State Board of Vocational Education, Bureau of Career and Technical Education

19 Schuylkill Technology Center Practical Nursing Program 101 Technology Drive Frackville, PA Ext Background Checks Previous Employment for Student Clinical Placement DISCLOSURE The Schuylkill Technology Center s Practical Nursing program utilizes a variety of different clinical sites throughout the academic program in order to provide the student practical nurse with a variety of learning experiences and opportunities. The following facilities are utilized as cooperating agencies as part of the clinical educational process: Schuylkill Medical Center South Jackson Street 420 South Jackson Street Pottsville, PA Broad Mountain Nursing & Rehabilitation Center 500 West Laurel Street Frackville, PA Schuylkill Technology Center North Campus 101 Technology Drive Frackville, PA Child Development, INC. Pottsville Center 701 MT. Hope Ave Pottsville, PA Schuylkill Technology Center South Campus 15 Maple Ave Mar Lin, PA Rosewood Rehabilitation and Nursing Center 401 University Drive Schuylkill Haven, PA Ridgeview Healthcare & Rehabilitation Center 200 Pennsylvania Avenue Shenandoah, PA Shenandoah Senior Living Community 101 East Washington Street Shenandoah, PA Schuylkill IU #29 Early Intervention Program 101 Technology Drive Frackville, PA Schuylkill Center Nursing Home 1000 Schuylkill Manor Road Pottsville, PA Schuylkill Intermediate Unit PO Box 130 Maple Ave Mar Lin, PA Schuylkill IU #29 Schuylkill Learning Academy 17 Maple Ave Mar Lin, PA Schuylkill Medical Center East Norwegian Street 700 East Norwegian Street Pottsville, PA Hometown Nursing & Rehabilitation Center 149 Lafayette Avenue Tamaqua, PA Mount Carmel Senior Living Community 2616 Locust Gap Highway Mount Carmel, PA PSA Healthcare 400 W. Columbia Ave ~ Ste 100 Schuylkill Haven, PA 17972

20 Practical Nursing Program 101 Technology Drive Frackville, PA Ext Background Checks - Previous Employment for Student Clinical Placement DISCLOSURE Clinical agencies have the right to establish criteria that would exclude a student from placement at their facility. A criminal record containing a felony, a felony related to a controlled substance, or a felony related to health care fraud and patient abuse may keep a potential student from participating in clinical at the cooperating agencies. Furthermore, a clinical agency has the right to refuse a student practical nurse to participate in a clinical experience at the cooperating agency if the student was a previously terminated employee. It is the responsibility of the student applicant to disclose any prior employment termination with any of the cooperating agencies during the application process to the STC PN program and prior to the first day of orientation. If a new cooperating agency is added to the list while enrolled in the Practical Nursing program, it remains the student s responsibility to immediately notify the Practical Nursing Coordinator of previous employment termination from that cooperating agency. The STC PN program will evaluate such student situations, in collaboration with the cooperating agency, to possibly find alternatives for the student to complete the objectives of the course. All students are expected to meet course objectives as defined by the course module. In the event another clinical alternative is not available to meet the specific term clinical objectives, the student may not be able to progress and complete the Practical Nursing program. Additionally, the Office of the Inspector General, U.S. Department of Health & Human Services, has the authority to exclude individuals and entities from federally funded health care programs pursuant to sections 1128 and 1156 of the Social Security Act and mandates a list of all currently excluded individual and entities called the List of Excluded Individuals and Entities (LEI). Any facility who hires an individual or entity on the LEIE may be subject to civil or monetary penalties. Therefore, any potential or current student who is on the list will not be permitted acceptance into the program or completion of the program. May 2017

21 Schuylkill Technology Center Practical Nursing Program 101 Technology Drive Frackville, PA Ext Background Checks - Previous Employment for Student Clinical Placement DISCLOSURE I acknowledge that having a previous criminal record containing a felony may prohibit my participation in clinical and may create a barrier to program completion. I agree to a private meeting to disclose any previous felony convictions as well as any previous employment termination from any of the listed cooperating clinical agencies prior to the start of the Practical Nursing program for which I am applying. I understand that failure to disclose prior to the start of the program or while enrolled, as new cooperating agencies are added to the list, may result in immediate termination from the Practical Nursing program. Printed Name Date Signature Date July, 2016