CRUSOE-HOLIFIELD PRACTICAL NURSING PROGRAM APPLICATION FOR JANUARY 2017 ADMISSION: DAY ONLY DEADLINE: NOVEMBER 10, 2016 by 4:00pm
Crusoe-Holifield Practical Nursing Program Application Packet PROGRAM DESCRIPTION: The Crusoe-Holifield Practical Nursing Program is designed to prepare students for successful passage of the NCLEX-PN and future employment as a Licensed Practical Nurse. Clinical experiences are included as an integral part of this program. The program is approved by the Florida State Board of Nursing. PROGRAM BEGINS: PROGRAM LENGTH: PROGRAM HOURS: January 2017 (Day Program) No Evening classes Day program: Three semesters Evening program: Four semesters Day program (30 hrs/wk): Classroom: M-Th, 8am-4pm Clinical: 7.5 hours between 6:45am and 11:15pm 1 4 days a week Externship: 30 hrs/wk variable Evening program (24 hrs/wk): Basic Healthcare Worker: M-F, 6pm-10pm Remainder of program: M-W, 6pm-10pm (classroom/clinical) F, 6-10; Sat., 6:45am-3:15pm (clinical) PROGRAM LOCATION: Lively Technical Center Health Education Department, Building 15 500 North Appleyard Drive Tallahassee, FL 32304 Clinical Locations Various Externship Locations Various GENERAL REQUIREMENTS (Please READ) Applicants seeking admission to the Practical Nursing Program must: Be at least 18 years of age. Complete and return the application to the Lively Health Education Department. Have a high school diploma or equivalent. Provide three references. Attend a General Information Program Session. (after the application deadline) Provide proof of current immunizations, including the Hepatitis B series, MMRx2, Varicella and Tetanus. We can no longer accept a history of chicken pox as proof of immunity. If you do not have current
immunizations for MMR or Varicella, then you need a titer as proof of immunity. An annual PPD (tuberculin skin test) is also required. Students with a history of positive PPD will need a current negative chest x-ray. Take CPR for Healthcare Providers (BLS) on campus during the first course of the program, no exceptions. Certification must be maintained throughout the duration of the Program. Be able to pass random drug screenings during the length of the program. Students with positive drug screen results will not continue in the program. Pass a Level 2 criminal background screening prior to enrollment, at the student s expense. In order to participate in the mandatory clinical practicum, as well as to obtain licensure, students must have a clear background. Applicants must successfully complete all of the required criteria and have all relevant documentation on file with the Lively Technical Center (LTC) Health Education Department, by the specific date on the application. Meeting the criteria for selection does not guarantee admission to the Crusoe-Holifield Practical Nursing program. Final selection will be based on the qualified applicant pool and space available. Note: #1 through #5 below must be completed and submitted by the application deadline. Late and/or incomplete packets will not be considered. 1. PERSONAL INFORMATION FORM Please complete the Personal Information Form that is included in this packet. 2. TESTING For more information, please contact The Testing Center at: 850-487-7467 A. Prospective students must take the Test of Adult Basic Education (TABE), Level A. TABE exit requirements for the Practical Nursing Program are 11.0 in Reading, Language and Total Math. TABE scores are valid for two (2) years. Prospective students will go to the Registration window in Building 8 to pay for the exam then report to the Testing Center. Prospective students with an Associate Degree or higher, have successfully completed the College Level Academic Skills Test (CLAST), or have already met the minimum scores, within the past two years, on the CPT, ACT, MAPS, SAT or ASSET are exempt from the TABE exam with the appropriate official documentation. NEW as of 3/1/2014, you may also be exempt from TABE if you earned a valid Florida Standard high school diploma since 2008 or if you are an active duty member of any branch of the US Armed Services. You must have proof of the appropriate documentation to be exempt. B. ATI-TEAS (ASSESSMENT TECHNOLOGY INSTITUTE - TEST OF ESSENTIAL ACADEMIC SKILLS) ALL applicants must take the ATI-TEAS Nursing Entrance Exam. ATI- TEAS scores are valid for two (2) years; however, only the most recent score will be considered for admission. Applicants are encouraged to test early. There is a *$80.00 fee for this exam. Applicants will go to the Registration window in Building 8 to pay for the exam then report to the Testing Center. Once accepted, students will also be required to take ATI Standardized NCLEX- PN Testing Preparation Exams throughout the Program. The current desired proficiency level for the PN program is 55.0. 3. HEALTH REQUIREMENTS Applicants are required to be in good mental and physical health and must submit proof of a recent medical evaluation (not more than 6 months old; see attached form). If, after acceptance, a student s health status changes, further documentation may be required stating the student is physically able to continue the Program. Applicants are also required to provide proof of the following current immunizations: Tetanus, within the past 10 years (Td or Tdap) MMR x2 (given on or after the applicant s first birthday). Official documentation of immunity is also acceptable. Hepatitis B series. Official documentation of immunity is also acceptable. Varivax x2 or proof of immunity. We NO LONGER accept that you have had a history of having
Chicken Pox PPD/Tuberculin skin test within past 12 months.* *PPD/Tuberculin skin testing is valid for one (1) year from date of administration. Students will be required to maintain current PPD/Tuberculin skin testing throughout the duration of the program. Students who test positive for tuberculosis must show proof of a negative chest x-ray taken within the past year to satisfy this requirement. 4. REFERENCES Applicants must submit three current reference letters: two professional references (recent employers, former teachers, counselors, etc.) and one personal reference (may not be family member). 5. OFFICIAL TRANSCRIPTS Students are required to submit proof of an academic high school diploma, general equivalency diploma (GED), or a validated foreign transcript equivalent to the LTC Health Education Department. You will need to provide the official transcript during the registration process if you accepted in the program. 6. GENERAL INFORMATION MEETING After submitting a completed application to the LTC Health Education Department, applicants will be notified about attending a mandatory General Information meeting. At least two meetings will be scheduled prior to student selection; the date and time of these meetings will be given to all applicants when the application is submitted. This meeting provides potential students with an overview of the Crusoe-Holifield Practical Nursing Program, registration process, financial aid, and general LTC campus information. This is also an opportunity for applicants to ask questions about the program. Further information may be obtained by calling the LTC Health Education Dept. at 850-487-7449. THINGS TO DO AFTER YOU HAVE BEEN ACCEPTED: 7. CRIMINAL BACKGROUND CHECK If accepted into the program, students must undergo a Level 2 criminal background check prior to registration for the program. All students must pass the background check. Instructions for obtaining the background screening will be included with the Practical Nursing Program acceptance letter. 8. DRUG SCREENING Drug screening is not required prior to admission into the program. However, all students must submit to and pass two random drug screenings after entering the Practical Nursing Program and prior to having access to the clinical health care facilities utilized in the Program. This is a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirement demanded of all acute care facilities in Florida. Students who do not pass a random drug screening will not be able to access the clinical facilities and therefore will not be able to continue in the program. DISABILITY SUPPORT SERVICES: If you have question regarding a disability accommodations, please contact LTC Student Services in Building 9. FINANCIAL AID: Financial Aid is available for this program based on eligibility. Qualifying students will receive the Federal Pell Grant. Loans and other financial arrangements are a personal decision and not handled at Lively Technical Center. The Financial Aid Office is located in Student Services, Building 9, phone number 850-487-7473. Please direct all financial aid questions directly to their office.
ACCEPTANCE INTO PROGRAM: Applicants who have met the requirements for placement will be placed into a selection pool and chosen based on the number of available slots. Should the number of eligible applicants exceed the number of openings offered; students will be admitted based on a defined point system. In the event of a tie, a lottery selection system will be used. ACCEPTANCE/REGISTRATION: Applicants who are selected will be notified approximately two weeks after the final information session is complete. If an applicant is selected and does not complete the registration process, the applicant must reapply and be considered based on the applicant pool at the time of reapplication. All expenses are incurred AFTER acceptance into the Crusoe-Holifield Practical Nursing Program EXCEPT for the physical exam, immunizations, ATI-TEAS and the TABE.
PERSONAL INFORMATION PLEASE PRINT BLUE OR BLACK INK ONLY Date of Birth Date Place of Birth Name Address City/State Zip Home # ( ) Work # ( ) Cell # ( ) Email Address Emergency Contact Phone# ( ) EDUCATION High School City/State Highest grade completed Year Circle one: Diploma GED Previous Nursing School College Degree awarded City/State City/State Military Education as Certified Nursing Assistant, Patient Care Assistant, Patient Care Technician or Medical Assistant Name of School Certification Awarded Yes No Date the Certificate was awarded Proof Required at time of Application EMPLOYMENT RECORD Present Title/Position Dates of Employment: From to Previous Title/Position Dates of Employment: From to Previous Title/Position Dates of Employment: From to The information on this application is true and factual. Signature: Date:
Crusoe-Holifield Practical Nursing Program Student Health Assessment Record THIS FORM MUST BE COMPLETED BY YOUR HEALTH CARE PROVIDER. Any falsification of this record will result in immediate dismissal from the program (if accepted). NAME (please print): Last First MI DATE OF BIRTH: / / Male Female 1. MMR (Need proof of two MMR vaccines or one mumps, two measles, and one rubella. Any person born before 1/1/57 will need proof of rubella immunization or positive titer.) Date of MMR #1: Date of MMR #2: OR Antibody titers: Mumps titer date: Results: Immunity/Not immune Rubeola titer date: Results: Immunity/Not immune Rubella titer date: Results: Immunity/Not immune If not immune, will require MMR x2. 2. Tetanus (Td or Tdap with the last ten years): Date: 3. Hepatitis B series: Hepatitis B #1 date Hepatitis B #2 date Hepatitis B #3 date OR Antibody titer date: Results: Immunity/Not immune 4. Varicella: History of having Chicken Pox is no longer accepted Date of 1 st dose: Date of 2 nd dose: OR Varicella titer date: Results: (Lab value) 5. PPD (TB Skin Test): Date taken: Results: Positive Negative Chest x-ray, if positive PPD: Date: Results: The signature below indicates that I have examined this candidate and find HIM/HER physically able to perform the duties of a Practical Nurse without limitations. Verified by: Name of Physician s Office/Health Center Address of Office Physician s Signature Date