Green River Student ID:

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1 STUDENT INFORMATION Green River Student ID: Phone: BEFORE YOU TURN IN THE APPLICATION q Attend a Required Admission Meeting. This is different from the Information Sessions put on by advising staff. q Complete the Kaplan Nursing School Entrance Exam at the Assessment and Testing Center. q Complete the required prerequisite courses with a 2.5 or higher. q Submit Transcript Evaluation Request form to Enrollment Services if you submit offcial transcripts q For non-green River courses, submit all offcial transcripts to Enrollment Services Offcial transcripts are documents listing the courses you have taken at a college. They are ordered from each college you attended. A college can send it directly to Green River or send it to you. If a college sends it to you, it needs to stay in the original sealed envelope, and you turn it in to Enrollment Services located on the 2nd foor of the Lindbloom Center. You need to contact each college and request the offcial transcript. Colleges may charge you money for offcial transcripts. The Green River College Practical Nursing Program is a four-quarter program beginning each Fall Quarter and concluding at the end of Summer Quarter. Program capacity is 40 students, which is determined by available faculty. APPLICATION REQUIREMENTS Prerequisite courses Applicants must complete the following prerequisites at the time of application to the program. Most prerequisite courses must be taken within seven years of starting the Practical Nursing Program. Applicants must have a minimum grade of a 2.5 in each prerequisite to be eligible to apply. For the following prerequisites, students will only be able to repeat two courses from the list one time each within 5 years. Repeat policy includes all grades below 2.5 from all colleges attended. PRE-REQUISITE COURSES Course Title Green River Course Number Specifc Information Anatomy and Physiology 1** Biol 241 Must have been completed after 8/31/2011 Anatomy and Physiology 2** Biol 242 Must have been completed after 8/31/2011 Pre-Algebra or higher Completion of Math 107 or higher Must have been completed after 8/31/2011 Human Development Psych 100 & Psych 200 Must have been completed after 8/31/2011 Nutrition Nutr& 101 Must have been completed after 8/31/2011 English Composition Engl& 101 No Expiration date Speech Communications CMST& 210 or &220 or &230 No Expiration date **The two-quarter sequence of A&P must be taken at the same level (100 or 200) and from the same college. 1 of 7

2 KAPLAN: Kaplan Admissions Test is a tool to determine if students have the academic skills necessary to perform effectively in a school of nursing. The test consists of 91 questions that evaluate basic reading, math, writing, and science skills of students seeking entry into a nursing program. For testing information please visit the Assessment and Testing Center at assessment-testing-center/. Required immunizations and tests In order to participate in the Community Lab/clinical courses, students need to have all of the immunizations and tests complete. Documentation must be from a healthcare provider and include signature, credentials, and date (mm/dd/yyyy). For the complete details, please refer to page 3. Required Admission Meeting Applicants need to attend an Admissions Meeting prior to submitting the application. The dates of these meetings can be found at greenriver.edu/academics/areas-of-study/details/practical-nursing.htm. Be prepared to write a short essay and complete up to fve math calculations at the meeting. Healthcare provider CPR All applicants must be Healthcare Provider CPR certifed by American Heart Association (AHA BLS) in order to apply. Please note that this is different from the standard CPR commonly offered. It is the student s responsibility to maintain current AHA BLS certifcation throughout the duration of the program. Failure to do so will result in failure to progress in the program. Background check Community Lab courses include but are not limited to: residential care, long term care, drop-in medical clinics, school district health care screening, health room experience, and medical centers. A criminal record may prohibit a student from participation in the Community Lab/clinical courses and the nursing program. As part of the application packet, each applicant should completely fll out the background check forms located in this packet and include it in their application. In compliance with the Child/Adult Abuse Information Act, before formal admission, a Certifed Background Check of each applicant will be required (RCW and RCW ). Final admission to the program is dependent upon the results of this background check. See Washington State DSHS Secretary s List of Crimes and Negative Actions. Drug screening All students will be required to submit a drug screen after acceptance into the program and prior to attending community clinical. The student will be provided with the name and location of an authorized agency who will conduct the screening. The student is responsible for all costs associated with the drug screening. If the screen comes back ineligible, a medical review may be done for an additional cost (some RX drugs will cause a positive drug screen). If a student fails to produce the requested sample by the date and time designated, the student will be ineligible. Employment as a NA-C or Other Healthcare Professional (OPTIONAL) If an applicant has been employed as a Certifed Nursing Assistant (NA-C or NA-R), Medical Assistant (MA), Health Care Assistant (HCA), they may include proof of employment by having their employer fll out an Employment Verifcation form found at the end of this packet. If the applicant has worked as an NA-C, they must also include a copy of their license as well. An applicant who has not been employed as a NA-C but has the license may also include a copy of their license to possibly improve their chances. 2 of 7

3 DETAILS REGARDING IMMUNIZATIONS AND TESTS Documentation must be from a healthcare provider and include signature, credentials, and date (mm/dd/yyyy). General questions regarding immunizations may be directed to Kara LaValley, Nursing Director, , ext Measles (rubeola), Mumps, & Rubella Proof of vaccination (2 doses at appropriate intervals) and proof of immunity by titer, showing immunity to all three. Tuberculin Status [PPD(TB)] If no records or more than 12 months since last Two-Step TST, a Two-Step TST must be done prior to enrollment in the program. The 2-step process is explained as follows: First visit: Get the TB shot (make sure you get documentation for this date and signature). Second visit: Two days after visit #1 you go back to get the TB Test Reading (results) this should be given in millimeters (mm), which will determine whether the test is positive or negative. Third visit: No sooner than one week after visit #1 (1st TB shot), no later than two weeks after visit #1. You will get the whole process done over again. This visit you get your 2nd TB shot. Fourth (fnal) visit: Two days after visit #3 you will get the 2nd TB shot reading. Again, you need documentation stating the results in millimeters (mm) and whether the result is positive or negative. Note of Caution: Do not make the mistake of thinking that because a normal TB Test has 2 components (TB shot and TB reading) that it will fulfll the 2-Step TB Test requirement. You must actually have 2 separate TB Tests. The tests must be done within the proper timeframe. If an applicant has a medically documented history of prior BCG vaccine, or IGRA test will need to be obtained. If the results are positive they will be required to obtain a clear chest x-ray and provide a negative symptom check from a healthcare provider. (IGRA should be drawn on the same day as live-virus vaccines or 4-6 weeks after administration of live-virus vaccines.) Students with a history of positive TB results must provide proof of a clear chest x-ray and submit an annual negative symptom check from a healthcare provider. Hepatitis B Documentation of HEP B series of immunizations and immunity is required for clinical placement. Tetanus, diphtheria, pertussis (Tdap) Tdap required once. Td required every 10 years after Tdap. Varicella (Chickenpox) Proof of vaccination (2 doses at appropriate intervals) and proof of immunity by titer Flu Season Flu vaccination is required for community clinical. Clinical sites may not allow you to learn at sites without vaccination and Green River College will not attempt to locate an alternative site. Medical Insurance - Provide a copy of your medical insurance card. Liability Insurance - Students will purchase insurance prior to the start of fall quarter. 3 of 7

4 APPLICATION PROCESS Selection and submission Selection is based on the following system (not in order of priorities): Grades in AP1, AP2, English, Communications, Math, Nutrition, and Human Development KAPLAN testing scores Prior work as a NA-C, NA-R, MA, or HCA Essay score Additional points for service in the Military and/or being a Green River student* Students assume all responsibility for reading and following instructions. There will be no exceptions to the admission process. Applications will be accepted beginning May 15, Applications must be received by 4:00 pm on June 25, Late or incomplete applications are denied. Mail or hand deliver the application in a white 9 x 12 inch envelope to: Green River College Enrollment Services c/o: Admission/Practical Nursing Application SE 320th St. Auburn, WA Notifcation and mandatory orientation Applicants will be notifed of acceptance into the program during the week of July 16, Admitted students and the top 10 waitlisted applicants are required to attend a mandatory orientation held August 9, 2018, in SC 137. Those who fail to attend forfeit their seat to the next applicant on the waitlist. Before formal admission, a Certifed Background Check of each applicant will be required (RCW and RCW ). Final admission to the program is dependent upon the results of this background check.(see Washington State DSHS Secretary s List of Crimes and Negative Actions 4 of 7

5 WHAT MUST BE IN YOUR APPLICATION PACKET (IN THIS ORDER) Mail all materials together in a white 9 x 12 inch envelope in this order: q Practical Nursing Program Application Form (page 5) q Signed Washington State Patrol form (page 6) q Color copy of valid photo ID q All unoffcial transcripts (Green River included if attended) with pre-requisites highlighted. Unoffcial transcripts can be a copied or opened offcial transcript or an unoffcial transcript printed from the college s website. Unoffcial transcripts are turned in with the application packet. Offcial transcripts are submitted to Enrollment Services ahead of time along with the Transcript Evaluation Request form. q Copy of your KAPLAN scores q Copy of healthcare provider (AHA) BLS card q Copy of NA-C license (If applicable) q Letter of Recommendation or Verifcation and recommendation form by an employer (If applicable) (page 7) UPDATE YOUR CONTACT INFORMATION All communication will be done through your Green River student . If Green River College elects to contact you through other means, it will be done using the contact information already on record. q Activate your Green River student at q Confrm the accuracy of your contact information at Select the Student Info tab and select Student Address STUDENT INFORMATION Green River Student ID: SIGNATURE By signing below, I verify that: 1. My information for this application is accurate and complete as of this date. 2. I activated my Green River student and will be checking it regularly. 3. I checked my contact information to ensure is correct and will keep it up to date. Signature: Date: 5 of 7

6 CHILD/ADULT ABUSE INFORMATION ACT RCW THROUGH All students who will be placed in practicum education sites for Green River College s health occupation programs are requested to complete the below Washington State Patrol Abuse Clearance section. The purpose of this abuse clearance is to assure the safety and well-being of patients, clients and children who come into contact with students. Practicum education sites are expecting that Green River students will not pose undue risks to the safety of patients/children. The Washington State Patrol abuse clearance request is for the following: Child/Adult Abuse Information: Response limited to convictions against children or other persons, dependency proceedings, abuse of vulnerable adults, and DOL disciplinary board fnal decisions and any subsequent criminal charges associated with the conduct that is the subject of the disciplinary board fnal decision. Please be aware that information on other felony and misdemeanor convictions may be reported from the state patrol offce. This abuse clearance is used only for the purpose of practicum education placement determination and further dissemination or use of the record is prohibited. As stated earlier, all students are required to complete this form. Any student choosing not to complete this process must be aware that the ability of faculty to arrange practicum education experiences will be severely restricted and in some instances impossible. A large number of facilities (all of them for nursing) require proof of this clearance before students are allowed to participate in any practicum activities. STUDENT INFORMATION Last name: Alias/maiden name: Date of birth: SIGNATURE First name: Middle name: q I have read and understand this information about the Washington State Patrol Abuse Clearance. Signature: Date: Please attach a color copy of your driver s license for identifcation verifcation. 6 of 7

7 TO BE COMPLETED BY APPLICANT Address: City: State: Zip: Date range of employment: Hours completed: Select one: q I waive the right to view this recommendation/verifcation form in my fle at Greer River College. q I do not wish to waive this right; I wish to retain the right to view this letter in my fle at Green River College. TO BE COMPLETED BY EMPLOYER This section is to be completed by the practitioner who supervised the applicant. After completion, the form should be placed in a sealed envelope with the practitioner s signature across the seal and given to the applicant to be be submitted with the application packet. Discipline: 1. I verify that the above applicant has completed hours of work experience in the setting in which I work. 2. Please rate the applicant on a scale of 1 to 5 with 5 representing excellence and 1 representing unsatisfactory performance: q 5 q 4 q 3 q 2 q 1 q N/A Applicant arrives promptly and/or notifes supervisor if unable to attend experience at prearranged time. q 5 q 4 q 3 q 2 q 1 q N/A Applicant s appearance is neat, clean, and appropriate for clinical setting. q 5 q 4 q 3 q 2 q 1 q N/A Applicant demonstrates interest in nursing profession. q 5 q 4 q 3 q 2 q 1 q N/A Applicant asks questions appropriately. q 5 q 4 q 3 q 2 q 1 q N/A Applicant communicates effectively with staff and patients. q 5 q 4 q 3 q 2 q 1 q N/A Applicant demonstrates initiative to increase learning. 3. Please select only one of the following recommendations: q I highly recommend this applicant for a career in nursing q I recommend this applicant for a career in nursing q I recommend this applicant for a career in nursing with reservations q I do not recommend this applicant for a career in nursing 4. Comments: Signature: Date: 7 of 7