MARCH 2019 Program Application Fee: $50.00 Once a year. NAME First Name MI Last Name PREVIOUS LAST NAME(S) ADDRESS ZIP *BIRTH DATE

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APPLICATION for ADMISSION to the Jackson College Nursing Program for PRACTICAL NURSE CERTIFICATE (PNC) 2018-2019 I wish to be considered for acceptance into the Jackson College Practical Nurse Certificate Program for the following year: I UNDERSTAND ADMISSION INTO THIS PROGRAM IS NOT GUARANTEED. MARCH 2019 Program Application Fee: $50.00 Once a year NAME First Name MI Last Name PREVIOUS LAST NAME(S) ADDRESS CITY STUDENT # ZIP *BIRTH DATE HOME/CELL PHONE(s) EMAIL ADDRESS Only student s JC e-mail address may be used COMPLETED OR BE ENROLLED IN BY THE APPLICATION DEADLINE: ENG 131, NUR 121/NRS 116 MAT 133 (See Pg. 5, # 5 for Details), Take the HESI A 2 * (HESI Admission Assessment): LPN 141/PNC 100/MOA 141 or BIO 253 & 254 (See Pg. 5, # 6 for Details) See the JC Web Site Nursing (See Pg. 5, #7 for Details), Department for sign up instructions For each criterion listed below, please fill in an appropriate response: If completed-indicate grade, if currently enrolled, or expected enrollment-indicate completion date. HESI A 2 LPN 141/PNC 100/MOA 141 NUR 121/NRS 116 ENG 131 or MAT 133 BIO 253 & BIO 254 ALL TRANSCRIPTS MUST BE RECEIVED BY THE APPLICATION DEADLINE Students MUST consult with a Student Success Navigator. The navigator s signature indicates that the point system has been reviewed with the applicant. The student s signature verifies that all the admission requirements have been met. JC Catalog Student Signature Student Success Navigator Signature of Entry Date Fee Collected &Receipt Attached: Have you ever applied to one of our nursing programs before? (Y/N) If so, which one & when? *Applicant must be 18 years of age by program start date* APPLICATION and TRANSCRIPT RECEIPT DEADLINE: October 1 st *HESI A 2 scores must be completed within the last 5 years. Admission Testing Only Allowed 2 Times (30 day remediation period between attempts)

Permission to Contact Student with JC Messages Jackson College is committed to providing the best customer service possible while protecting our students privacy. Exemplary customer service can include friendly reminders and messages. By providing this phone number, I consent to Jackson College leaving messages (voicemail, text messages and/or verbal messages with any person or automated device who answers this number) with specific information related to Jackson College (course enrollment, appointments, advising, financial aid, payments, admission, etc.). Phone Number Signature Student ID# Name Date Page 1

PRACTICAL NURSE CERTIFICATE The Practical Nursing Certificate (PNC) program begins in March of every year and concludes in May of the following year. The program consists of integrated lectures, labs, clinicals and simulations conducted in approved clinical education affiliates. The program prepares students to demonstrate competency in providing nursing care in a variety of health care settings and for employment in the field of licensed practical nursing. Candidates who successfully complete the PNC program are eligible to take the National Council Licensing Exam (NCLEX-PN). Passing the NCLEX-PN is required in order to become licensed as a professional licensed practical nurse (LPN). Overview of the Practical Nursing - Certificate Curriculum Minimum credits: 40 Minimum cumulative GPA: 2.0 Minimum Jackson College credits: 26 Minimum grades: 2.0 in all courses. MACRAO agreement: No STUDENTS MUST MEET THE FOLLOWING REQUIREMENTS GENERAL EDUCATION REQUIREMENTS: (7 credits) ENG 131 MAT 133 NURSING RELATED REQUIREMENTS: (7 credits) LPN/MOA 141/PNC 100 or BIO 253 and BIO 254 Writing Experience (3 credits) Intro to Probability & Statistics (preferred)/or higher (4 credits) Body Structure & Function/ (4 credits) Human Anatomy & Physiology I (4 credits) Human Anatomy & Physiology II (4 credits) NUR 121/NRS 116 Pharmacology (3 credits) PNC NURSING COURSE REQUIREMENTS: (26 credits) PNC 110 Foundations of Practical Nursing (5 credits) PNC 140 Medical-Surgical Nursing III (3 credits) PNC 111 Foundations Skills Lab (1 credits) PNC 150 Maternal/Newborn Concepts (2 credits) PNC 120 Medical-Surgical Nursing I (5.5 credits) PNC 160 Pediatric Concepts (2 credits) PNC 130 Medical-Surgical Nursing II (5.5 credits PNC 170 Entry into Practice (2 credits) Students are encouraged to work closely with their Student Success Navigator when developing a plan of study. The course load in nursing is very demanding and it may be in the student s best interest to take general education and other nursing related courses prior to admission. All Science classes, including Pharmacology, must be taken within 8 years of application. Withdrawals and repeats also have an 8 year limit. Nursing courses MUST be taken in sequence. 1 st Semester PNC classes are on a different academic calendar than other classes. It is referred to as a late start- Winter Semester with the 1 st semester courses starting in March. There is a short break from mid-july until late- August between the 1 st and 2 nd semesters. The 2 nd and 3 rd semesters align with the College academic calendar. Students are required to complete an ATI Review as part of the curriculum in order to graduate. The ATI preparation program is part of the 3 rd semester course work and the cost is included in the course fees of the 3 rd semester courses. Recommended: Completion of Medical Terminology (MOA 120) prior to entry into the PNC Program. The Nursing Department reserves the right to change admission requirements, the curriculum, program requirements and policies at any point in time. Students who remain in good standing will complete requirements in their catalog of entry. Page 2

SAMPLE CURRICULUM FOR PRACTICAL NURSE CERTIFICATE (PNC) NOTE: All courses must be completed with a 2.0. Point calculations start with a grade of 2.5. PREREQUISITES COURSE CREDITS CONTACT INSTRUCTIONAL LPN/MOA 141/PNC 100 Body Structure and Function 4 4 60 MAT 133 Intro to Probability and Statistics (preferred)/or higher 4 4 60 8 CREDITS 8 120 SEMESTER 1 COURSE CREDITS CONTACT INSTRUCTIONAL PNC 110 Foundations of Practical Nursing 5 7 105 PNC 111 Foundations Skills Lab 1 3 45 NUR 121/NRS 116 Pharmacology (if not taken prior to admission) 3 3 45 ENG 131 Writing Experience (if not taken prior to admission) 3 3 45 12 CREDITS 16 240 SEMESTER 2 COURSE CREDITS CONTACT INSTRUCTIONAL PNC 120 Medical-Surgical Nursing I 5.5 9.5 142.5 PNC 130 Medical-Surgical Nursing II 5.5 9.5 142.5 11 CREDITS 19 285 SEMESTER 3 COURSE CREDITS CONTACT INSTRUCTIONAL PNC 140 Medical-Surgical Nursing III 3 3 45 PNC 150 Maternal/Newborn Concepts 2 3.1 46 PNC 160 Pediatric Concepts 2 2.8 42 PNC 170 Entry Into Practice 2 4 60 9 CREDITS 12.9 193 Total 40 CREDITS 55.9 838 Page 3

APPLICATION INFORMATION Students must apply for admission to the PNC program and must do so by the application deadline. Admission to the nursing program is highly competitive and is not guaranteed. There are specific admission criteria and it is the student s responsibility to understand the requirements and to adhere to them. Admission is based on a point system. Points are awarded for prerequisite course grades, and the number of withdrawals, repeats or course failures. Students with the highest points will be admitted based on space availability. The selection process is subject to change. Students are required to meet with a Student Success Navigator prior to beginning pre-requisite courses and each semester thereafter. A navigator s signature is required on the application form. The navigator s and student s signatures on the application indicate that the point system has been explained by the navigator and that the student understands the system. Navigators are available in Student Services or any Extension Center. Students may call 517 796-8425 for an appointment. Most of JC s clinical sites are subject to Act 303 of the Public Acts of 2002, amended April 1, 2006, of the State of Michigan which restricts persons with certain criminal convictions from having access to vulnerable populations. Therefore, the agreements that Jackson College has with these organizations require that as a condition of admission, all students will be subject to a fingerprint based Criminal Background Check, including an FBI check. Some criminal convictions may be cause for a student to NOT be admitted into any nursing program at Jackson College. The same stipulation would also apply after admission. Should a current nursing student be convicted of an exclusionary crime, dismissal from the program would result. Following graduation, application for licensure may be denied should a conviction occur. Exclusion periods are based on the nature of the conviction and range from 1 year to permanent. The Michigan Long Term Care Partnership has prepared a legal guide to help with your questions. Visit their web site at www.miltcpartnership.com/mainsite/w1.aspx and click on the legal guide for more information. If you have questions about this requirement, contact Jeff Whipple, Facilities Safety and Security Coordinator at 517-796-8620. In addition, all nursing students must pass a drug screen as a condition of admission to the PNC nursing program. Some clinical settings require periodic or random drug testing. While enrolled in the program, a student may be asked to submit to a drug test if there is reason to believe the student is under the influence of alcohol or other drugs. If there is evidence that a student is under the influence of alcohol or other drugs while in the classroom or during clinical assignment, the nursing student will be: Immediately removed from the classroom or clinical area; Subject to drug & alcohol testing and; Experience disciplinary action - up to and including dismissal from the program. Students Bear the Cost of any additional Drug Screen. Following graduation, applicants for nursing licensure will be subjected to another criminal background check and will be asked about substance use. Page 4

APPLICATION PROCEDURE BE SURE TO COMPLETE ALL THE STEPS 1) Meet with a Student Success Navigator. Submit your completed Jackson College admission application either online, fax or mail and indicate Practical Nursing-Certificate as the Jackson College program of study. It is important the program major is coded properly in the college computer system. Applicants must be a high school graduate or have high school equivalency such as a G.E.D. 2) As directed by the navigator, complete Jackson College course placement assessments in writing, reading and math. Utilize the results to register for the appropriate classes. Discuss with the navigator the sequence of courses to select. Students with limited or no prior science studies may need to take additional courses to prepare for the required science pre-requisite courses. Be advised, students without withdrawals, repeats or course failures are more likely to be selected for entry into the nursing program. 3) Send official transcripts from ALL colleges previously attended to Student Services Office. To better serve students, Jackson College utilizes the National Student Clearinghouse for transcript requests. Complete the entire process online and track the status of your order. You need an email account and a valid major credit or debit card for the fee. Click below to get started. https://secure.studentclearinghouse.org/tsorder/faces/transcriptorder?_afrloop=1877459698740119&_afrwindowm ode=0&_adf.ctrl-state=l5clipddi_4#firstload It is the student s responsibility to confirm that transcripts have arrived. Call the Transcript Line to check: 517 787-0800 (Ext. 8177) IF TRANSCRIPTS ARE NOT ON FILE BY THE APPLICATION DUE DATE THE APPLICATION WILL BE INVALID. 5) Math (MAT) Requirement: Students enrolling at Jackson College for the first time or who have not been continuously enrolled at Jackson College will be required to take a college level math course. MAT 133/Introduction to Probability and Statistics is the preferred Math course for nursing. However, MAT 133 or higher is acceptable. 6) After successfully completing all foundational course work, take the standardized HESI Admissions Assessment (A 2 ) Test. Students must achieve a minimum 75% in Math & 75% in the English Language Composite Selections. The English Language Composite score includes the reading comprehension, vocabulary, and grammar sections of the HESI A 2. Only two attempts will be allowed to obtain the decision scores, with a mandated 30 day remediation period between attempts. (see complete HESI A 2 policy in the Jackson College Nursing Handbook) 7) Satisfactorily complete the remaining prerequisite courses: ENG 131 NUR 121/NRS 116 (2.0 or higher) LPN 141/PNC 100 (2.0 or higher) or BIO 253 and BIO 254 (2.0 or higher)* *If a student anticipates applying to the LPN to ADN program in the future, a 3.0 or higher must be earned in both BIO 253 and BIO 254. PLEASE BE AWARE: POINT AWARDS START WITH A GRADE OF 2.5. 8) After your Student Success Navigator has signed the secondary PNC Application, (top sheet of this information packet), he/she will electronically submit it to the Nursing Coordinators Office. The student and the navigator will receive an email (Jackson College email only) acknowledging receipt of the application. Attach the $50.00 Program Application Fee receipt to the application. 9) Application Deadline: October 1 for late-start Winter Semester. 10) Meet Technical Standards for Admission to the Nursing Program. (see pages 9 & 10) Page 5

ACCEPTANCE PROCESS 1) The order of acceptance of qualified applicants will be determined by total points achieved. Those with highest point totals and who have met all criteria are offered a seat. 2) If there are fewer spaces available than the number of qualified applicants or more than one qualified applicant achieves the same point total in the point system for the last remaining seats, the acceptance into the PNC program will be based on the following criteria: a) GPA in prerequisites b) HESI A 2 score on the first attempt c) Fewest withdrawals, repeats or low grades in required program courses 3) If an applicant is not offered a seat and wants to be considered in the next application cycle, the student must submit a new application, however the $50.00 program application fee is good for 1 year. 4) Applicants will be notified of acceptance or denial the first week of December, before the winter semester starts. This gives students time to drop or add courses as necessary. If a student does not achieve the required grades in prerequisite courses in the semester prior to admission, the student will automatically lose their admission seat and will need to re-apply. If a student chooses not to accept a seat in the program for that year, he/she will need to re-apply for next year and compete with the candidates for that year. 5) Upon acceptance into the PNC Program, an applicant must: a) Register with CastleBranch Corporation and pay for fingerprinting, drug screen, background check, and immunization compliance tracking services. b) Submit all required health data documentation to CastleBranch Corporation. c) Submit to CastleBranch Corporation their Professional Level CPR Certification. The course that meets this criterion is offered by the American Heart Association (CPR for the Health Care Provider). The JC Emergency Medical Services (EMS) Department offers CPR courses throughout the year. You may contact the Allied Health Office at 517-768-7007 to register or register online at https://bookwhen.com/jcemsaha Students may not attend clinical if their health data and CPR certification are not continuously up to date. Students may not progress in the program without satisfactorily completing the clinical portion of the nursing courses. 6) If a student has a change in any demographic information (name, address, telephone number) from the information submitted on their application, he/she must inform the Nursing Coordinator Office and Student Services in writing. 7) The Nursing Department will be sending all electronic correspondence to students via their Jackson College e- mail accounts. No personal e-mail addresses will be used. Page 6 POINT SYSTEM WORKSHEET

The selection process will be based on the following point system. Only courses that have been completed and a grade awarded on the official transcript at the time of the application deadline will be considered in the point calculation. Points are awarded for grades 2.5 and higher. The points awarded are outlined below. Area I - Pre-Requisite Course Grades 1) Completion of LPN 141 or PNC 100 With a grade of 4.0 4 points 3) Completion of ENG 131 With a grade of 3.5 3 points With a grade of 4.0 4 points With a grade of 3.0 2 points With a grade of 3.5 3 points With a grade of 2.5 1 point With a grade of 3.0 2 points With a grade of 2.0 0 points With a grade of 2.5 1 point OR With a grade of 2.0 0 points 2A) Completion of BIO 253 4) Completion of NUR 121/NRS 116 With a grade of 4.0 4 points With a grade of 4.0 4 points With a grade of 3.5 3 points With a grade of 3.5 3 points With a grade of 3.0 2 points With a grade of 3.0 2 points With a grade of 2.5 1 point With a grade of 2.5 1 point With a grade of 2.0 0 points With a grade of 2.0 0 points AND 2B) Completion of BIO 254 With a grade of 4.0 4 points With a grade of 3.5 3 points With a grade of 3.0 2 points With a grade of 2.5 1 point With a grade of 2.0 0 points Section points NOTE: Points will be awarded for only 1 option of A&P (either LPN 141/PNC 100 or BIO 253 & 254 NOT ALL THREE) Grade Point Average of the SPECIFIC General Education Courses required for the PN program: (BIO 253/254, LPN 141/PNC 100, ENG 131, MAT 133, NUR 121/NRS 116) Points Credits Grade Credits Earned Earned BIO 253 x 4 = BIO 254 x 4 = LPN 141/PNC 100 x 4 = ENG 131 x 3 = MAT 133 x 4 = NUR 121/NRS 116 x 3 = = Less than 2.5 0 points 3.25 3.49 4 points 2.50 2.74 1 points 3.50 3.74 5 points 2.75 2.99 2 points 3.75 4.00 6 points 3.00 3.24 3 points Page 7 Section points Area I total points

Area II Additional Educational Preparation or Certification (NOTE: Maximum Points allowed from Area II = 7) 1) Additional SPECIFIC course work preparing for future ADN/BSN (BIO 220, NUR 207/NRS 145, PSY 140, GEO #6, ENG 132, ENG 231, COM 240, COM 241) Credits Credits BIO 220 4 = ENG 132 4 = NUR 207/NRS 145 4 = ENG 231 3 = PSY 140 4 = COM 240 3 = GEO #6 3 = COM 241 3 = 3 6 credits 7 9 credits > 9 credits 1 point 2 points 3 points points 2) Completion of SEM 140 Seminar in Life Pathways > 3.0 2 points 3) Current Certification or Licensure in a Health Occupation 2 points (i.e.: CMA, CNA, EMT, etc.) (Current certification or license Must Be Attached) Area III Academic History in Required Program Courses Area II total points Withdrawals, Repeats or Low Grades in Required Program Courses: Exemption is one semester of repeated Math. Multiple Math repeats will be counted 0 to 2 Courses - W/D, R, or Low Grades (<2.0) 3 points 3 or More Courses - W/D, R, or Low Grades < 2.0 0 points Area III total points Area I points + Area II points + Area III points = Total points Tiebreakers Maximum Total Points Range = 28-32 1) Highest GPA from prerequisite courses 2) HESI A 2 scores first attempt 3) Fewest number of W/D, R, low scores in required pre-requisites Note: There Is No Guarantee Of Admission Regardless Of Point Total. Admission Is Competitive. Page 8

TECHNICAL STANDARDS FOR ADMISSION NURSING DEPARTMENT JACKSON COLLEGE The Nursing Department faculty have specified the following non-academic criteria which applicants generally are expected to meet in order to participate in the Nursing Programs and professional practice. These technical standards are essential and have been developed to provide for the health and safety of the patients receiving care from the Nursing Department students. 1. OBSERVATION The applicant must be able to participate in all demonstrations, laboratory exercises and clinical experience and to assess and comprehend the condition of all assigned patients. 2. COMMUNICATION The applicant must be able to communicate with patients, health care staff, and faculty effectively. 3. MOTOR The applicant must have motor functions sufficient to elicit information from patients by appropriate diagnostic or therapeutic maneuvers; be able to perform basic tasks; possess all necessary skills to carry out diagnostic or therapeutic procedures; be able to interpret movements reasonably required to provide general care and emergent treatment/actions as necessary for patient safety and comfort. 4. INTELLECTUAL/CONCEPTUAL INTEGRATIVE AND QUANTITATIVE ABILITIES The applicant must be able to measure, calculate, reason, analyze, evaluate, and synthesize information and observations. Problem solving, the critical skill demanded of nurses requires all of these cognitive abilities. 5. BEHAVIOR AND SOCIAL ATTRIBUTES The applicant must possess the emotional health required for full utilization of intellectual abilities; execute appropriate medical judgement; the prompt completion of assigned or non-assigned responsibilities for care of the service to the patient; and the development of supportive and effective relationships with patients. Applicants must be able to tolerate taxing physical and mental workloads, function effectively under stress, adapt to changing environments and conditions, display flexibility and function in the face of uncertainties inherent in the clinical setting and with patients. Compassion, honesty, dependability, concern for others, interest and motivation are personal qualities which each applicant should possess. 6. FREE OF CHEMICAL IMPAIRMENT The applicant must be free of chemical impairment. This is defined as a person who is under the influence of or is abusing alcohol, over-the-counter medication, illegal drugs, prescribed medications, inhalants, or synthetic designer drugs. Abuse of the substances includes episodic misuse or chronic use that has produced psychological symptomology. 7. SAFETY The applicant must be groomed in a safe manner in the clinical area. Any significant tattoos must be covered by the nursing uniform. Body piercing jewelry, other than ear piercing must be removed. Very young children and the patient with an altered mental status may be adversely affected by tattooing or body piercing. Page 9

TECHNICAL STANDARDS AND FUNCTIONS THAT ARE REQUIRED TO SUCCESSFULLY COMPLETE AN ASSOCIATE IN APPLIED SCIENCE NURSING DEGREE OR CERTIFICATE IN PRACTICAL NURSING STANDARDS Vision sufficient to see fine detail, and sufficient to be able to read and accurately complete reports in charts. Speech sufficient to be understood by others; ability to understand the communication of others. Hearing sufficient to understand the spoken word, hear variations in physical assessment findings. Physical coordination including fine motor functions sufficient to perform nursing procedures accurately, efficiently and safely. Sufficient muscle strength and lower back and knee stability to lift patients in a safe manner. Able to stoop when necessary. Sufficient psychological stability and knowledge of techniques/resources to be able to respond appropriately and efficiently in patient care situations. Free of Chemical Impairment during participation in the nursing program including classroom, laboratory and clinical settings. Sufficient endurance to walk for extended periods of time, up to twelve hours per day. Ability to learn technical, medical, and pathophysiological information. Physical appearances free of visible tattoos and body piercing jewelry in the clinical area. FUNCTIONS Observing patient s skin color, measuring exact amounts of parenteral medications. Reading and completing of charts and reports. Communicating with patient and health care team. Listening to patients and other health care staff including phone conversation. Auscultate lung sounds, hearts sounds, and bowel sounds. Ability to perform nursing procedures such as insertion of catheters, suctioning, and applying dressings. Lifting and transferring of patients, physically assisting patients, moving beds and equipment. Bending at the knees to empty Foley bags, lift objects off of the floor. Recognizing and responding appropriately inpatient care situations including emergencies. Displaying behavior that is free from signs of chemical impairment such as frequent mood swings, disappearing with as insufficient excuse, unexplained absences, and inappropriate behavior. Nursing requires almost constant walking. Completion of clinical and didactic components of program requires ability to learn. Care for confused clients, children without causing harm to patient and to self. Page 10