Pierpont Community & Technical College School of Health Careers Practical Nursing Program

Pierpont Community & Technical College School of Health Careers Practical Nursing Program ADMISSION PROCESS 1. Complete and submit Pierpont Community & Technical College application including: a. Submit high school transcript or GED scores. b. Submit college transcripts if applicable. c. Submit immunization record. 2. Complete Practical Nursing Program application. The application deadline is April 1 to be considered for acceptance into the LPN program in the following fall semester. Applications will be accepted after the deadline date if a class is not filled. Applicants who are not admitted must reapply if they wish to be considered for the next academic year. NOTE: Please make sure you mark the application for the first choice of your cohort location; ie: Braxton or Fairmont. 3. A non-refundable application fee of $20 made payable to Pierpont Community & Technical College must be received in the Enrollment Services Office before your application will be processed. Please submit all documents to Pierpont Community & Technical College, Enrollment Services 1201 Locust Ave., Fairmont, WV 26554. 4. Submit three letters of personal reference. Reference forms should be completed by someone who has known the applicant for one year or more. For example: employer(s), teacher(s), and clergy. Employer s references are preferred. References from friends or family are not acceptable. 5. Applicant registers for the TEAS Test. Information on TEAS testing can be found on the website at http://www.pierpont.edu/ce/teasfaq or http://www.atitesting.com. Register at a convenient place and time. Be sure PC&TC receives a copy of your score sheet. The cost of the pre-entrance test is the responsibility of the applicant. All fees must be paid prior to taking the pre-entrance test. Photo identification will be required on testing days. Acceptable forms of identification include a pictured driver s license, military card, or passport. 6. Applicants must make acceptable scores (adjusted individual total score of 40%) for consideration 7. Selection committee evaluates the applicant s records, TEAS testing and submitted documents. Applicants will be scored by GPA (most recent high school or college), GED scores, TEAS scores, personal reference forms and experience in the health care field. The highest scoring applicants will be offered admission into the LPN program according to available seating per location. 8. Qualified applicants will be notified of tentative acceptance into the LPN program by official letter. 9. Once applicants recommended for admission into the LPN program receive official notice they will receive notice of a mandatory orientation meeting. This orientation is a special meeting only for LPN students. It is different than the general orientation for new Pierpont students. At this meeting they will receive the necessary forms and information to complete the next phase which includes: a. Physical examination to be completed by his/her physician that includes blood screening, 7-panel urine drug screen, and any other tests or x-rays that may be necessary to clear your health status. Forms are only handed out at LPN Orientation. All applicant s completed physical examination

form must state the applicant is physically and emotionally able to participate in all classroom and clinical experiences. b. Required immunizations/titers include: Hepatitis B proof of immunity or initial dose by August 1, Hepatitis B positive titer at least 6 months after last injection or an HBV booster if titer is negative, 2 step PPD, proof of Varicella immunization and a positive titer, MMR immunization and proof of positive titer for all 3 components, and Rubeola vaccination with proof of positive titer. Also recommended are a DPT booster, and influenza vaccine (they are required by some clinical sites). If required proof of immunization is not submitted by August 1, you will be dropped from the program. c. Dental examination. Forms are only handed out at LPN Orientation. d. Criminal background check. Cost to be paid by student at time check is made. Fingerprinting may be required. Only reports made and given by the authorized examiner are accepted and they must be recent. Notification of the LPN Program examining authority will be given at the LPN Orientation. e. CPR certification must be current and remain current through the entire program. Application Deadline The application deadline is April 1 to be considered for acceptance into the LPN program in the following fall semester. Applications will be accepted after the deadline date if a class has an opening. Applicants who are not admitted must reapply if they wish to be considered for the next academic year. Readmission is granted per guidelines in the LPN Handbook.

School of Health Careers Practical Nursing Program 200 Jerry Burton Drive / P O Box 97 Flatwoods, WV 26621 Telephone: (304)-765-7300 Fax: (304) 765-7724 STUDENT APPLICATION Type or Print legibly to minimize delays in processing your application Please indicate campus preference by checkmark below; Fairmont Campus Braxton Campus Either Campus PERSONAL DATA Last Name First Name MI Suffix Mailing Address City State Zip Home Phone Number Cell Phone Number County Email Address Birth Date Social Security number EDUCATION List chronologically every college, university, high school or any other institution(s) you have attended. Official/sealed transcripts must be sent to Enrollment Services 1201 Locust Ave., Fairmont, WV 26554. Complete Name of High School City, State Graduation Year or GED Score Complete Name of Current & Prior Colleges City, State Degree Obtained/Expected Attendance Dates GED

List all previous medical training. If you have a certificate of completion please attach a copy. List work experience for the last 5 years (attach additional sheets if necessary) All applicants must answer questions #1-7 of the application by circling YES or NO. The applicant is to provide a letter of explanation regarding any convictions 1. Have you EVER committed an act of academic dishonesty resulting in disciplinary action by a school? YES NO 2. Have you EVER been convicted of a felony or a misdemeanor, pled guilty, or pled no contest to any crime, had records expunged or been pardoned? (List speeding tickets only if you have received three (3) speeding tickets in the last two (2) years). YES NO 3. Are you currently abusing prescription or over-the-counter medication? YES NO 4. Are you currently using illegal drugs? YES NO 5. Is there any reason why your access to narcotics or substances of abuse should be restricted or limited? YES NO 6. Do you currently possess any condition which may in any way impair your ability to practice or otherwise alter your behavior as it relates to the practice of licensed practical nursing? YES NO 7. Have you ever been or applied as a student in a Practical Nursing Program? YES NO If so, when and where?. 8. Have you ever been place on an abuse registry or otherwise had a license or certificate against which you have had any type of disciplinary action? YES NO DRUG SCREENING Applicants must test negative for drug/alcohol screening. Pierpont C&TC is a drug free community. To that end, students enrolled in all health career programs will be required to submit to randomized, mandatory drug screening without notice. Failure to cooperate will result in administrative dismissal from the program.

Students who test positive for alcohol, illegal usage of a controlled substance, or illicit drugs will be immediately dismissed from the program and will not be eligible for readmission to any health careers program. Costs associated with the screenings will be the responsibility of the student. Any student who demonstrates behaviors of reasonable suspicion or impaired capacity will be required to undergo immediate drug/alcohol testing. All costs incurred because of this action are the responsibility of the student. BACKGROUND CHECK All students entering the program should be aware that criminal history checks are required. Applicants to the LPN program, who have been convicted, pled guilty or pled no contest to a felony or misdemeanor must contact the office of the West Virginia State Board of Examiners for Licensed Practical Nurses to discuss the potential of obtaining licensure as an LPN after graduation. Costs associated with the state and federal criminal background checks will be the responsibility of the student. ESSENTIAL PROGRAM REQUIREMENTS All applicants are expected to meet the following non-academic criteria (essential functions) in order to participate in the LPN program. In addition to being essential to the successful completion of the requirements of a practical nursing degree, these skills and functions are necessary to ensure the health and safety of patients, fellow students, faculty and other health care providers. A. Sensory Abilities The student must possess visual acuity sufficient to allow each of the following: Hearing: 1. Recognize and respond to auditory assessments, instructions and requests with or without assistance devices. Visual Acuity: 1. Identify correct patient. 2. Perform visual assessments of patients through inspection 3. Read written instruction, labels, and records 4. Differentiate the color spectrum Speech: 1. Clearly and succinctly, explain procedures, provide client education, and communicate patient status to appropriate persons. 2. Communicate in English clearly enough for most patients to understand. 3. Understand the verbal communication of English speaking patients. Touch: 1. Perform physical assessments through palpation 2. Discriminate between sharp, dull, hot and cold. B. Communication Abilities The student must possess communications skills sufficient to permit: 1. Verbal and nonverbal skills adequate for transmitting to and receiving information from patients and workplace personnel. 2. Read in English with comprehension

C. Physical Abilities The student must possess motor functions sufficient to permit each of the following: 1. Provide nursing care for patients for 6-8 hours 2. Perform one man CPR 3. Lift and move patients and objects of thirty (30) pounds or more 4. Move from one room to another quickly 5. Maneuver in limited spaces 6. Demonstrate a high level of manual dexterity and use both hands simultaneously 7. Work at different heights and levels 8. Produce clear written materials D. Behavioral, Interpersonal and Emotional Abilities The student must exhibit behavioral and social attributes that are acceptable in the college and workplace including: 1. Function safely under stressful conditions 2. Adapt to ever changing environments inherent in clinical situations involving patient care 3. Provide service to all patients regardless of race, age, color, sex, religion, disability, national origin, veteran status, or disease process. 4. Demonstrate emotional stability and effective coping when providing patient care. 5. Display integrity, compassion, concern for others. 6. Ability to function in a group setting E. Cognitive, Conceptual and Quantitative Abilities The student must possess intellectual skills sufficient to permit each of the following: 1. Utilize algebra in solving mathematical problems 2. Interpret graphs, numerical tables and charts 3. Analyze data and solve problems 4. Communicate effectively in writing 5. Communicate verbally using appropriate grammar, vocabulary and word usage. Please list any medical or personal information that you feel may have an impact on your participation in the practical nursing program classes or clinicals (i.e. pregnancy)

ADMISSION TO THE NURSING PROGRAM Applicants to the practical nursing program must be eligible to meet the requirements for licensure in the state of West Virginia as stated in the West Virginia Code. These conditions include: 1. At least a tenth grade education or its equivalent. 2. Complete a course of study in an accredited program of practical nursing. 3. The Board of Examiners for Licensed Practical Nurses may deny testing to any applicant proved guilty of certain infractions as, but not limited to, fraud, felony, or moral misconduct. In admitting a student to the practical nursing program, Pierpont C&CT is not promising that the State of West Virginia will grant the student licensure. The decision to grant licensure is within the sole discretion of The West Virginia Board of Examiners for Licensed Practical Nurses. I affirm that the information I have provided on this application form and all other admission application materials are complete, accurate, and true to the best of my knowledge. I give my permission for Pierpont Community & Technical College to contact any institution or person listed to verify this information. Providing false information on this application is grounds for denial of admission or dismissal from the program. Signature of Applicant Date of application Office Use Only Date Received Initials Please submit all five (5) pages of this application. To: Pierpont Community & Technical College Enrollment Services 1201 Locust Ave., Fairmont, WV 26554 Revised 3-2017