ADN Mobility Program Information Brochure

Transcription

1 ADN Mobility Program Information Brochure Dear Prospective Applicant: Thank you for your inquiry about the LVN/Paramedic to ADN Mobility program at San Jacinto College- South Campus. The LVN/Paramedic to ADN Mobility program is a career mobility program designed specifically for licensed LVNs or Paramedics (working part-time) who desire to expand their healthcare career as a Registered Nurse (ADN-RN level). I have attached an information brochure for your review. It may answer many questions that you currently have. We are located at: San Jacinto College-South Campus Beamer Rd. Houston, TX Allied Health/Science Building RM. S-1.253B Office hours: Monday-Friday 8:30 AM - 5:30 PM If you have additional questions; please contact the ADN Mobility program office at EXT or via adn.mobility@sjcd.edu. Again, thank you for your inquiry. Sincerely, Dr. Karen E. Alexander, RN, PHD, CNOR Program Director, LVN/Paramedic to ADN Mobility Program adn.mobility@sjcd.edu ext Page 1

2 ADN Mobility Program Information Brochure Before your admittance to the ADN program the following pre-requisite course work must be completed (totaling 30 credit hours). The required course work can be completed within two semesters if taking at least 15 credit hours a semester. This coursework may be completed at San Jacinto College or transferred. However, a minimum of 24 (SJC) institutional credit hours must be obtained in order to graduate with an Associates of Applied Science degree in Nursing from San Jacinto College. **** Course ENGL 1301 Composition I ENGL 1302 Composition II* or ENGL 2311 Technical Report Writing PSYC 2301 General Psychology MATH 1314 College Algebra* or MATH 1333 Contemporary Mathematics BIOL 2401 Human Anatomy and Physiology I** BIOL 2402 Human Anatomy and Physiology II** BIOL 2420 Microbiology and Pathology** RNSG 1301 Pharmacology*** RNSG 1215 Health Assessment*** RNSG 1108 Dosage Calculations*** Total Credit Hours 3 credit hours 3 credit hours 3 credit hours 3 or 4* credit hours (*depending on the institution completed ) 4 credit hours 4 credit hours 4 credit hours 3 credit hours 2 credit hours 1 credit hours 30 credit hours Please note: * If you are seeking to move toward receiving a BSN-Nursing degree these courses should be taken. **Biology courses must be less than 5 years old at the time of enrollment in the Level One courses. (BIOL course completed prior to Spring 2009 will be expired) ***Pre-nursing (RNSG) courses must be less than 2 years old at the time of enrollment in the Level One courses (RNSG courses completed prior to Spring 2012 will be expired) **** If you completed your Vocational Nursing or Paramedic program here at San Jacinto College you have already met the institutional credit hour requirement. adn.mobility@sjcd.edu ext Page 2

3 ADN Mobility Program Information Brochure Steps to Apply The A.D.N. Mobility accepts applications for admissions in both Spring and Fall semesters of each year. Application periods are as follows: Semester Start Date Admissions Period Spring January August 15-October 1 Fall August February 15- April 1 Steps for applying for Admissions in to the LVN/Paramedic to ADN Mobility program at San Jacinto College-South Campus is as follows: (1.) Apply for admissions to San Jacinto College via our website Prospective Applicants must meet the requirements of acceptance to San Jacinto College prior to being able to submit an application for admissions into the A.D.N. Mobility program. Please Note: Acceptance into San Jacinto College does not grant you permission into the ADN Mobility Program. Prospective applicants must still apply and meet the admissions criteria for acceptance into ADN Mobility program. (2.) Ensure you meet all the required criteria for admissions into the LVN/Paramedic to ADN Mobility Program. Licensed LVN or Certified Paramedic in the State of Texas Successfully completed all of the required pre-requisite courses Have a minimum pre-requisite GPA of a 2.5 Has not failed out of a nursing program within the past 2 years Has not failed any (2) BIOL courses with grades of D or below in the past 5 years Has not failed any (2) RNSG courses with grades of D or below in the past 2 years (3.) Submit all official transcripts from non-san Jacinto College campuses to the Office of Enrollment Services and request a transcript evaluation be completed. (This needs to be completed prior to the admission application deadline to ensure all required pre-requisite courses have been transferred over properly.) adn.mobility@sjcd.edu ext Page 3

4 ADN Mobility Program Information Brochure (4.) Complete the Mandatory Online Information Session. The online information session is required in order to submit your application for admissions into the LVN/Paramedic to ADN Mobility Program. Please sign the Online Information Session Acknowledgement Statement included in the Admissions Application Packet. (5.) Sign up for the required HESI Admissions (A2) exam by ing the requested date to with HESI Date in the subject line. Note: The HESI exam can only be taken at San Jacinto College-South Campus. Exam scores taken outside of San Jacinto College-South Campus will not be accepted. (Please see the HESI Testing Packet for more information.) The HESI Exam is reserved only for students who are applying for the ADN Mobility program. Please sign the HESI Admissions A2 Acknowledgement Statement included in the Admissions Application Packet. (6.) Complete the mandatory criminal background check and drug screening via Instructions are attached. This needs to be completed prior to admission application deadline. Please know that in the event, you have a hit on your background check you will need to contact the Texas Board of Nursing to complete a Declatory Order. You will NOT be allowed to register for courses until notification from the Texas Board of Nursing has been received. Please sign the Criminal Background Acknowledgement Statement included in the Admissions Application Packet. For more information regarding a Declatory Order process please contact the Texas Board of Nursing at or at (7.) Complete and submit all the required immunizations and documentation via Instructions Attached. (8.) Complete the admissions application and its entirety and submit it to the ADN Mobility department by the application deadline. The application is available for print via our website or in person in RM. S-1.253B located on the 2 nd floor of the new Allied Health/Science Building. adn.mobility@sjcd.edu ext Page 4

5 ADN Mobility Program Information Brochure The ADN Mobility department will accept applications for the Fall 2014 semester on the following schedule only: Tuesday and Thursday: 1:00 PM- 4:00 PM Wednesday: 9:00 AM- 12:00 PM Fridays: 9:00 AM- 5:00 PM Final acceptance will be determined based on the applicants overall GPA and Composite HESI Scores. Letter of Acceptance or declined notice will be sent via to all applicants; please be sure to monitor your account. You may also choose to save San Jacinto College in your contacts to avoid notifications being sent to Spam/Junk folders. s will be sent from the following address If you have questions or need further information, please contact the A.D.N. Mobility office at ext or ext Page 5

6 Attention A.D.N. Mobility Prospective Applicants: Effective Spring 2011 admission, the LVN/Paramedic to A.D.N. Mobility program now requires the HESI Admission Assessment Exam (A2) as part of the admission requirements. All students are required to take this exam and meet the required score of 75% in each section listed below: 1. Math: Focuses on math skills needed for health care fields, including basic addition, subtraction, multiplication, fractions, decimals, ratio and proportion, household measures, general math facts, etc. 2. Reading Comprehension: Provides reading scenarios in order to measure reading comprehension, including: identifying the main idea, finding meaning of words in context, passage comprehension, making logical inferences, etc. 3. Vocabulary and General Knowledge: Contains basic vocabulary terms that are commonly used in both general English speaking and in the health care fields. 4. Grammar: Contains basic grammar, including: parts of speech, important terms and their uses in grammar, commonly occurring grammatical errors, etc. 5. Anatomy and Physiology (A&P): Quick assessment of A&P knowledge. Provides coverage of general terminology and anatomical structures and systems. Effective Spring 2013 Admissions, two new sections will now be required with the HESI Admissions Exam (A2); please see the sections listed below. 6. Personality Profile: Uses concepts related to introversion and extroversion to classify the student s personality styles. 7. Learning Styles: Assesses the preferred learning style of the applicant and offers test- taking and study tips suited to the learning style. Although not recommended or required; there are a number of study guides available to prepare for this exam (see attached). Please note the HESI A2 Admissions Exam for entrance into the ADN Mobility program can only be taken at San Jacinto College-South Campus. Exams taken outside on San Jacinto College-South Campus will not be accepted.

7 The A.D.N. Mobility department has scheduled the following dates for the HESI Admission (A2) Exam for Fall 2014 and Spring 2015 Admissions. HESI Admission (A2) Assessment Dates Please note: Please allow at least 4 hours to complete the HESI Admissions Exam. Students are not allowed to sit for the exam once the exam has started. Fall 2014 HESI A2 Admissions Assessment Dates DATE TIME ROOM Monday, February 10, :30 AM S Wednesday, February 19, :00 PM S Thursday, February 27, :30 AM S Thursday, March 06, :00 PM S Monday, March 17, :30 AM S Wednesday, March 26, :00 PM S Monday, March 31, :30 AM S Spring 2015 HESI A2 Admissions Assessment Dates DATE TIME ROOM Monday, August 04, :30 AM S Wednesday, August 13, :00 PM S Monday, August 18, :30 AM S Monday, September 08, :30 AM S Wednesday, September 17, :00 PM S Friday, September 26, :30 AM S The cost will be $34.00 for the HESI entrance exam. Please make payment at least 24 hours before exam. Be prepared to stay for at least 4 hours. You may leave as soon as you are finished. Please the A.D.N. Mobility department at adn.mobility@sjcd.edu with HESI Date in the subject line to sign up for one of the testing dates and to receive further instruction to register and pay. Please note registration for the HESI exam must be completed by 12:00 pm the business day before the exam is scheduled. (IE. If you are taken the exam scheduled for Monday, February 10, 2014 then your payment and registration must be completed by 12:00 pm, Friday, February 07, 2014.) If your name is not on the student roster for the scheduled exam the testing center will not allow you to test. So please ensure you register for the exam as soon as you receive the Payment and Registration from Shaterica.washington@sjcd.edu.

8 Testing fees are NON-REFUNDABLE. If you pay for a specific testing date and do not show for any reason, you will be required to pay again in order to test. In order to sit for the HESI exam; you must show your payment receipt and photo identification. Please see the attached instructions on how to register for an evolve account. You will need to complete the evolve registration prior to testing date and make note of your username and password. Students will be using the information to take all future HESI exams once you enter the program. HESI Admission Assessment Study Guides Available

9 Paperback: 184 pages Publisher: Elsevier; 3 edition (March 20, 2012) Language: English ISBN-10: ISBN-13: Paperback Publisher: Mometrix Media LLC (2011) ISBN-10: ISBN-13: ASIN: B0010YQDEW Paperback: 272 pages Publisher: Cliffs Notes (July 30, 2004) Language: English ISBN-10: ISBN-13:

10 Steps to Creating a Student Evolve Account STEP 1 Go go to either website website STEP 2 STEP 2 STEP 3 STEP 4 Create a Password STEP 5 STEP 6 STEP 7 Required information: a. First Name b. Last Name c. Address (entered twice) d. Institution (School Name) e. Year of Graduation f. Program Type Final Result!

11 Dear Applicant, Attached is your application packet to the LVN/Paramedic to A.D.N. Mobility Program. Please complete and return the following documents in a manila envelope: Incomplete applications will not be accepted or considered Prospective Applicant Checklist Online Information Session Acknowledgement Form Program Admissions Application Official copy of ALL your transcript(s) and evaluation to the Enrollment Services Department and the A.D.N. Mobility program department Degree Evaluation (instructions attached) HESI A2 Admission Exam Scores and HESI A2 Acknowledgement Form In order to register for the HESI admission exam the prospective applicant must send an to adn.mobility@sjcd.edu with HESI Date in the subject line. All students are required to take the HESI admission exam and meet the required scores prior to submitting an application for admissions. You must score a minimum of 75% or higher on each of the required sections of the HESI Exam. The exam can only be taken at San Jacinto College-South Campus. All students must have a minimum G.P.A. of 2.5 or above in required pre-requisites in order to be eligible for admission. Applications should be returned to Shaterica Washington, in the Allied Health/Science Building in RM. S-1.253B. Fall Admission February 15 -April 1 (deadline) Applications for Fall 2014 Admissions will be accepted as follows: Tuesday and Thursday: 1:00 PM- 4:00 PM Wednesdays: 9:00 AM-12:00 PM Fridays: 9:00 AM- 5:00 PM If you have any questions, please call us at x3315 or via at adn.mobility@sjcd.edu.

12 Application for admission to: LVN/Paramedic to ADN Mobility Program San Jacinto College District does not discriminate on the basis of race, color, creed, national origin, religion, age, gender, sexual orientation, political affiliation, or physical disability. Applications to ADN Mobility programs are NOT accepted without documentation of COMPLETED program immunization requirements. All application documents must be submitted together in a Manila envelope. Please specify whether you are a LVN or Paramedic. Mobility Track Program: LVN Paramedic PLEASE PRINT OR TYPE Application Date / / Name in Full: Home Address: Home Phone: Last First Middle Number & Street County City State Zip Alternate Phone: Social Security No.: - - G 00 Number *SJC Date of Birth: *(SJC mail will be the only communications sent to and from students as required by SJC) Have you recently failed (within the past 2 years) out of an Academic Nursing Program? Yes No If yes, what school? It is the student s responsibility to: When: (Semester ) 1. Return this application in person to the Associate Degree Nursing Program (ADN Mobility) located at the South Campus, Beamer Rd., RM. S-1.253B, Houston, TX DO NOT FOLD! If further assistance is needed, contact the ADN Mobility Departmental Office at the South Campus by calling (281) ext or by at adn.mobility@sjcd.edu Additional information is available on the web at Application Received: Accepted Rejected: Date For Office Use Only Received By: Student advised of status: Reason for rejection Date Initials Print Name and Phone Extension

13 Please state whether the following courses where completed at San Jacinto College (Please include official transcripts) Course Yes or No? If no, what school? Semester Completed? BIOL 2401 Anatomy and Physiology I BIOL 2402 Anatomy and Physiology II BIOL 2420 Microbiology and Pathology RNSG 1108 Dosage Calculations RNSG 1215 Health Assessment RNSG 1301 Pharmacology Provide information concerning college, university, vocational schools and/or allied health schools attended: Name of Institution City & State Number of Credits Earned All OFFICIAL transcripts must be submitted with this application and to SJC Enrollment Services before any courses taken outside of SJC can be reviewed or used towards the program (including application ranking). Licensure: Current Status: Active Inactive Number and Expiration Date: (Must provide a copy of license) Person to Notify in Case of Emergency: Name: Telephone: Address Street City State Zip Code Relationship of this person to you:

14 Certain minimum physical abilities and characteristics are required for acceptance into the LVN/Paramedic to ADN Mobility Program. See pages 5 and 6 of application. Are you able to meet the minimum technical skills standards for the program to which you are applying? Yes No If No, explain: How did you first hear about San Jacinto College South LVN to ADN Mobility Program for which you are applying? 1. Newspaper/TV 2. Through Work 3. Friend 4. Your Own Research 5. Other (Specify) *Ethnicity: Caucasian Hispanic Black American Asian Native American Foreign Unknown *Marital Status: Single Married Separated Divorced Widowed *Number of Children (If applicable) Give Ages: Current Employer Address Employer Phone Supervisor Position Type of Unit (i.e. Med-Surg, Maternity, etc)

15 Criminal Background Check Please read the following questions. After you have read the questions, please sign your name below indicating your knowledge of the questions. For any criminal offense, including those pending appeal, have you: A. Been convicted of a misdemeanor? B. Been convicted of a felony? C. Pled nolo contendere, no contest, or guilty? D. Received deferred adjudication? E. Been placed on community supervision or court-ordered probation, whether or not adjudicated guilty? F. Been sentenced to serve jail time or prison time? Court-ordered confinement? G. Been granted pre-trial diversion? H. Been arrested or any pending criminal charges? I. Been cited or charged with any violation of the law? J. Been subject of a court-martial; Article 15 violation; or received any form of military judgment/punishment/action? (You may only exclude Class C misdemeanor traffic violations.) NOTE: Expunged and Sealed Offenses: While expunged or sealed offenses, arrests, tickets, or citations need not be disclosed, it is your responsibility to ensure the offense, arrest, ticket or citation has, in fact, been expunged or sealed. It is recommended that you submit a copy of the Court Order expunging or sealing the record in question to our office with your application. Failure to reveal an offense arrest, ticket, or citation that is not in fact expunged or sealed, will at a minimum, subject your license to a disciplinary fine. Non-disclosure of relevant offenses raises questions related to truthfulness and character. NOTE: Orders of Non-Disclosure: Pursuant to Tex. Gov t Code (b), if you have criminal matters that are the subject of an order of non-disclosure you are not required to reveal those criminal matters on this form. However, a criminal matter that is the subject of an order of non-disclosure may become a character and fitness issue. Pursuant to other sections of the Gov t Code chapter 411, the Texas Nursing Board is entitled to access criminal history record information that is the subject of an order of nondisclosure. If the Board discovers a criminal matter that is the subject of an order of non-disclosure, even if you properly did not reveal that matter, the Board may require you to provide information about that criminal matter. Are you currently the target or subject of a grand jury or governmental agency investigation? Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of, suspended, placed on probation, refused to renew a professional license, certificate or multi-state privilege held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you? Within the past five (5) years have you been addicted to and/or treated for the use of alcohol or any other drug? Within the past five (5) years have you been diagnosed with, treated, or hospitalized for schizophrenia and/or psychotic disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder? NPA , , and Rule If your response is yes to any of the questions listed above, there is a POSSIBILITY YOU MAY BE DENIED the opportunity to take the licensure examination (NCLEX-RN). You are required to submit a petition for Declaratory Order to the Board of Nursing prior to being registered for any courses with the ADN Mobility Program. For information or guidance in this process to determine eligibility for licensure by examination, contact the Board of Nursing at or go to the web site: The Declaratory Order form can be accessed at ftp:// I have read and understand the above statements. Signature: Date: Application cannot be accepted without the above signature.

16 ADN Mobility Application Packet Checklist: Student will turn in a complete application packet to the ADN Mobility Program prior to the listed application deadlines. Incomplete packets will not be accepted. Each step below must be completed and checked before applications are accepted. It is your responsibility to check the ADN website for any changes/updates in requirements. Admission to the college: I am a San Jacinto College District Student. *NOTE: Admission to San Jacinto College District does not guarantee admission to the ADN Mobility Program. Applying to the Program: I have completed the Online Information Session. I have included my Information Session Acknowledgement Form. I have completed all program required immunizations and submitted documentation I have completed all 10 pre-requisite courses with a minimum 2.5GPA. I further understand that the GPA is not rounded up, it must be 2.5. My pre-requisite GPA is: BIOL 2401 Anatomy and Physiology I (must have been completed with 5 years of semester start date) BIOL 2402 Anatomy and Physiology II (must have been completed within 5 years of semester start date) BIOL 2420 Microbiology with lab (must have been completed within 5 years of semester start date) MATH 1314 College Algebra PSYC 2301 Intro to Psychology RNSG 1301 Pharmacology (must have been completed within 2 years of semester start date) RNSG 1215 Health Assessment (must have been completed within 2 years of semester start date) RNSG 1108 Dosage Calculations (must have been completed within 2 years of semester start date) ENGL 1301 Composition I ENGL 1302 Composition II or ENGL 2311 Technical Report and Writing I have submitted all official transcripts to San Jacinto College for all degree coursework taken outside of SJC and I have included all official transcripts including SJC with my application packet. I further understand that those courses will not be reviewed until an official transcript has been received. I have completed the HESI A2 Admissions Test and included a copy of my reports, including the HESI A2 Acknowledgement Form. Submit ADN Mobility application only during application periods ( ) with the following items: Information Session Statement of Acknowledgement HESI Test Report All official transcripts including San Jacinto College. Copy of current license and CPR and/or ACLS card Application Signature Sheets Degree Evaluation All Application Acknowledgement Forms I hereby certify that the information contained in this application is true and complete to the best of my knowledge, and I have completed all the steps in the application process listed above. I understand that any misrepresentation or falsification of information is cause for denial of admission. I understand that the information contained in this application will be read by the faculty and staff of SJC, as is appropriate. Signature of Applicant Date Rev. 09/03/2013

17 Core Performance Standards for Progression for the ADN Mobility Program Minimum abilities expected include but are not limited to: The following technical standards and essential functions outline reasonable expectations of a student in the ADN Program for the performance of common nursing functions. The ADN student must be able to apply the knowledge and skills necessary to function in a variety of classroom, lab and/or clinical situations while providing the essential competencies of the ADN program. The student must be able to meet the following requirements to apply for admission and continuation in the program: ISSUE STANDARD EXAMPLES (not inclusive) Critical Thinking Critical thinking sufficient for clinical reasoning and judgment. Independent decision- making which results in competent client assessment, accurate data analysis and problem identification, appropriate treatment plans and interventions, evaluation of client outcomes. Interpersonal Abilities Interpersonal abilities sufficient to interact with individuals, families, and groups from a variety of social, emotional, cultural, and intellectual backgrounds. Therapeutic interactions with clients and their families stressed by illness, death, life situations, and cultural differences. Communication Mobility Communication abilities sufficient for interaction with others in verbal and written form. Physical abilities sufficient to move from room to room, walk in hallways, maneuver in small spaces, and lift patients as needed. Accurate interpretation of verbal and/or written instructions, communication of patient responses, documentation of therapeutic procedures, health education, professional consultation with other health care providers. Ability to ambulate to and from departments and patient rooms, to care for all assigned clients, to assist in patient transport, to administer CPR. Motor Skills Gross and fine motor abilities sufficient to provide safe and effective nursing care. Performance of vital signs and psychomotor nursing skills, calibration and use equipment, physical assessment.

18 Hearing Auditory ability sufficient to monitor and assess health needs. Auscultation of BP, breath sounds, heart sounds, bowel sounds, ability to hear alarms, emergency signals, call bells, phones, cries for help; ability to converse with patients, family, and staff Visual Tactile Strength/Stamina Visual ability sufficient for observation and assessment necessary in nursing care. Tactile ability sufficient for physical assessment and to provide nursing intervention. Reading patient charts/flow sheet/monitors, preparation and administration of medications, assessment of patient skin color, reading thermometers. Performance of palpation, administration of injections, initiation of IVs and other therapeutic interventions Sufficient stamina to provide care and Ability to perform shift work, lift 25 related responsibilities for extended periods pounds from standing position, ability of time (8-12 hours) to bend, position, and lift In general, successful applicants possess qualities such as: Interest and aptitude for math and science A strong motivation to learn Well-developed study skills Good problem-solving and decision-making skills An ability to work with people with diverse backgrounds Applicant Signature Date

19 Online Information Session Statement of Acknowledgement I,, acknowledge that I am aware of the requirement of the mandatory online information session for admissions in to the LVN/Paramedic to ADN Mobility Program. I fully understand the requirements for eligibility and criteria for admissions into the LVN/Paramedic to ADN Mobility program. I do understand that as a prospective applicant it is my responsibility to contact the ADN Mobility department regarding clarification and any questions pertaining to admissions eligibility and criteria. I also understand that it is my responsibility to ensure all required application documents; immunizations, HESI exam, Criminal Background Check, and Drug Screen are received by the application deadline date as stated in the information session. Signature of Applicant Date

20 HESI A2 Admissions Exam Statement of Acknowledgement I,, acknowledge that I am aware of the of the HESI A2 Admissions Exam requirement for admissions into the LVN/Paramedic to ADN Mobility Program. I fully understand that the exam can only be taken at the San Jacinto College-South Campus and any exams taken outside of the San Jacinto College-South Campus will not satisfy the HESI A2 Admissions Exam requirement. I furthermore understand that I am only allowed to take the exam twice (2) per enrollment semester. I understand that I must score of minimum of a 75% or higher on each of the required sections which include the following: Math Reading Comprehension Vocabulary and General Knowledge Grammar Anatomy and Physiology I also understand that if I do not attain the minimum required score on any of the required sections after the 2 nd attempt, I will no longer be eligible for admissions into the LVN/Paramedic to ADN Mobility Program for that enrollment period. Signature of Applicant Date

21 Criminal Background Check Statement of Acknowledgement I,, acknowledge that I am aware of the Criminal Background Check requirement for admissions in to the LVN/Paramedic to ADN Mobility Program. I have read the Criminal Background check document that is included in the application packet and fully understand that if I answered yes to any of the questions asked there is a possibility that I may be denied the opportunity to sit for NCLEX-RN examination. Furthermore, I understand that it is the policy of the LVN/Paramedic to ADN Mobility Program and the Texas Board of Nursing that I will not be allowed to register for any courses in the LVN/Paramedic to ADN Mobility Program until successful completion of the Declatory Order process through the Texas Board of Nursing. I also understand upon completion of a Declatory Order I must submit one the following eligibility documents from the Texas Board of Nursing to the ADN Mobility Department in order to be deemed eligible for registration in the ADN Mobility Program. Eligible documents include the following: Blue Card Outcome Letter Letter of Eligibility Signature of Applicant Date

22 STUDENT INSTRUCTIONS FOR SAN JACINTO COLLEGE - SOUTH About CertifiedProfile ASSOCIATE DEGREE NURSING CertifiedProfile is a secure platform that allows you to order your background check, drug test and medical document manager online. Once you have placed your order, you may use your login to access additional features of CertifiedProfile, including document storage, portfolio builders and reference tools. CertifiedProfile also allows you to upload any additional documents required by your school. Order Summary Required Personal Information In addition to entering your full name and date of birth, you will be asked for your Social Security Number, current address, phone number and address. Drug Test (LabCorp) Within hours after you place your order, the electronic chain of custody form (echain) will be placed directly into your CertifiedProfile account. This echain will explain where you need to go to complete your drug test. Immunizations Document trackers provide secure online storage for all of your important documents. At the end of the online order process you will be prompted to upload specific documents required by your school for immunization, medical or certification records. Payment Information At the end of the online order process, you will be prompted to enter your Visa or Mastercard information. Money orders are also accepted but will result in a $10 fee and an additional turn-around-time. Place Your Order Go to: and enter package code: SV23 You will then be directed to set up your CertifiedProfile account. View Your Results Your results will be posted directly to your CertifiedProfile account. You will be notified if there is any missing information needed in order to process your order. Although 95% of background check results are completed within 3-5 business days, some results may take longer. Your order will show as In Process until it has been completed in its entirety. Your school's administrator can also securely view your results online with their unique username and password.

23 Immunization Requirements Measles, Mumps & Rubella (MMR) -There must be documentation of BOTH of the following: 2 vaccinations Positive antibody titers for all 3 components (lab reports or physician verification of results required) Varicella (Chicken Pox) -Positive antibody titer (lab report) is required. Hepatitis B -There must be documentation of one of the following: 3 vaccinations Positive antibody titer (lab report or physician verification of results required) TB Skin Test -There must be documentation of one of the following: 1 step TB Skin test If positive results, provide a clear Chest X-Ray (lab report required) Tetanus, Diphtheria & Pertussis (Tdap) -There must be documentation of a Tdap booster within the past 10 years. Influenza -There must be documentation of one of the following: Flu shot administered during the current flu season Declination waiver CPR Certification -Submit your American Heart Association Healthcare Provider card.. Physical Examination -Provide your physical examination completed and signed by a medical professional. Must be completed on school form. RN License -Provide a copy of your curretn Vocational Nursing license OR Paramedic Certification. I NEED HELP!!! If you need assistance please contact CertifiedProfile at or cpservicedesk@certifiedprofile.com and a Student Support Representative will be available Monday-Thursday 8am-8pm, Friday 8am-6pm & Sunday 10am-6:30pm EST.

24 Medical Record &Physical Examination This form should be completed by a physician/nurse practitioner/physician s assistant Name of Applicant: (Miss. Mrs. or Mr.) Last First Middle Date of Birth: / / Weight: Height: Allergies: include medications, latex, and environmental: Medical History of applicant Does patient have any of the following: Please answer yes or no and provide additional information when applicable. No Yes 1. Shortness of breath or moderate exertion 2. Hoarseness, excessive coughing 3. Tuberculosis 4. Seizure disorder 5. Mental disorders/ emotional instability 6. Frequent headaches 7. Diabetes 8. Heart disease 9. Hay fever/sinus infections 10. Asthma 11. Musculo-skeletal problems Please discuss any significant issues listed above on the following page. 12. Childhood diseases, list if significant 13. Medical conditions, list if significant 14. Surgeries, list if significant 15. Injuries, list if significant

25 Physical Examination 1. Vision Hearing 2. Heart rate BP Please note any abnormalities of the following systems. 3. Circulatory 4. Respiratory/ lungs 5. Muscluo-skeletal 6. Neuro 7. GI/GU 8. Reproductive Recommendations 1. In your professional judgment, is the applicant mentally and physically able to undertake the program? (Please check one) Yes No 2. Is the applicant fit with no restrictions? (Please check one) Yes No Remarks M.D. Signature Facility Address Please Print Name City State Zip Date Telephone