PATIENT CARE TECHNICAN PROGRAM Wallace Community College Selma APPLICATION PACKET

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PATIENT CARE TECHNICAN PROGRAM Wallace Community College Selma APPLICATION PACKET Please read the following information carefully before completing this application packet: Students seeking admission into the Patient Care Technician Program will be required to meet the following criteria: Application to the College Application packet to the Patient Care Technician Program 1.5 GPA on previous college or highschool work COMPASS Placement Test Score Deadline for applications The deadline to return this packet is April 15 th at 12:00 for summer admission; July1 st at 12:00 noon for fall admission, and December 1 st at 12 noon for spring admission. No application will be accepted after this date. Application Forms Read the information included in this packet carefully. All items must be completed. If any item does not apply to you, please mark it n/a Transcripts A copy of all transcripts must be attached to your application in order for it to be considered complete. A high school transcript or GED is acceptable if you have not had any prior college experience. Acceptance into this program requires a high school, diploma or GED. Testing A copy of your placement test results must be attached to your application in order for it to be considered complete. You may submit COMPASS scores. All applicants must take the Compass Test. If you have not taken a Compass placement exam, please contact Testing Services in student services at 334 876-9295 Financial Aid Please complete your financial aid packet if you have not done so. Once students have been accepted into the program they must be able to clear fees on the designated registration date. Copies You are encouraged to make copies of all material in your packet prior to submission. The Practical Nursing Division will not make copies of anything in your packet for use in re-applying to the Patient Care Technician Program or in applying to other programs. Questions If you have questions, please contact the BOOST Administrative Assistant at 334 876-9339 or BOOST Director at 334 876-9335. a: PCT application pack website.

PATIENT CARE TECHNICAN PROGRAM APPLICATION PACKET MUST BE COMPLETED AT THE TIME OF SUBMISSION REQUIREMENTS FOR COMPLETED PATIENT CARE TECHNICAN APPLICATION (Initial each requirement) Application for Admission to WCCS or Readmission form on file with Student Services Completed Patient Care Technician Application Unconditional admission to WCCS A minimum of 1.5 GPA for students with prior college work Signed Essential Functions form (Meeting the Essential Functions or Technical Standards required for nursing) Signed Student Drug Screen Policy Participating Form (Drug Screening fee is 35:00) Fees are subject to change. Signed Background Screening Policy Acknowledge Form (Background Screening fee is 35:00) Fees are subject to change. Take the COMPASS Test, Please attached your compass scores to this application. Submission of appropriate highschool and college transcript (s). Meeting minimal requirements does not guarantee acceptance to the Patient Care Technician Program. After meeting all minimum requirements, the first 48 completed/qualified applicants will be accepted. Deadline for: Spring Admission is December 1 st Summer Admission is April 15 th Fall Admission is July 1 st main jump checklist PCT

WALLACE COMMUNITY COLLEGE SELMA PATIENT CARE TECHNICAN ADMISSION APPLICATION Application Date Name: Complete address City State Zip Phone (home) (work) Student ID Number Are you presently enrolled in WCCS Yes No Initial intended semester of enrollment: Summer Fall Spring For office verification COMPASS SCORES: HS Graduate Math YES Reading NO Writing GED GPA YES Admission criteria met NO a: PCT application pack MAINJUMP Yes No

PRIOR LEARNING ASSESSMENT (PLA S) PLA for certifications will be based on credit hour courses completed and course compatibility. Documentation of current certification is required CERTIFICATES Documentation Provided CNA Date of completions EKG Date of completions Phlebotomy Date of completions Academies ENG 100 ENG 101 MTH 116 or higher CSI 130 BIO 201 BIO 202 PHL 206 Year of Completion Transcript Provided

THE ALABAMA COLLEGE SYSTEM NURSING PROGRAMS ESSENTIAL FUNCTIONS The Alabama College System endorses the Americans' with Disabilities Act. In accordance with College policy, when requested, reasonable accommodations may be provided for individuals with disabilities. Physical, cognitive, psychomotor, affective and social abilities are required in unique combinations to provide safe and effective nursing care. The applicant/student must be able to meet the essential functions with or without reasonable accommodations throughout the program of learning. Admission, progression and graduation are contingent upon one's ability to demonstrate the essential functions delineated for the nursing programs with or without reasonable accommodations. The nursing programs and/or its affiliated clinical agencies may identify additional essential functions. The nursing programs reserve the right to amend the essential functions as deemed necessary. In order to be admitted and to progress in the nursing program one must possess a functional level of ability to perform the duties required of a nurse. Admission or progression may be denied if a student is unable to demonstrate the essential functions with or without reasonable accommodations. The essential functions delineated are those deemed necessary for the Alabama College System nursing programs. No representation regarding industrial standards is implied. Similarly, any reasonable accommodations made will be determined and applied to the respective nursing program and may vary from reasonable accommodations made by healthcare employers. The essential functions delineated below are necessary for nursing program admission, progression and graduation and for the provision of safe and effective nursing care. The essential functions include but are not limited to the ability to: 1) Sensory Perception a) Visual i) Observe and discern subtle changes in physical conditions and the environment ii) Visualize different color spectrums and color changes iii) Read fine print in varying levels of light iv) Read for prolonged periods of time v) Read cursive writing vi) Read at varying distances vii) Read data/information displayed on monitors/equipment b) Auditory i) Interpret monitoring devices ii) Distinguish muffled sounds heard through a stethoscope iii) Hear and discriminate high and low frequency sounds produced by the body and the environment iv) Effectively hear to communicate with others c) Tactile i) Discern tremors, vibrations, pulses, textures, temperature, shapes, size, location and other physical characteristics d) Olfactory i) Detect body odors and odors in the environment 2) Communication/ Interpersonal Relationships a) Verbally and in writing, engage in a two-way communication and interact effectively with others, from a variety of social, emotional, cultural and intellectual backgrounds b) Work effectively in groups c) Work effectively independently d) Discern and interpret nonverbal communication e) Express one's ideas and feelings clearly f) Communicate with others accurately in a timely manner g) Obtain communications from a computer 3) Cognitive/Critical Thinking 5

a) Effectively read, write and comprehend the English language b) Consistently and dependably engage in the process of critical thinking in order to formulate and implement safe and ethical nursing care decisions in a variety of health care settings c) Demonstrate satisfactory performance on written examinations including mathematical computations without a calculator d) Satisfactorily achieve the program objectives 4) Motor Function a) Handle small delicate equipment/objects without extraneous movement, contamination or destruction b) Move, position, turn, transfer, assist with lifting or lift and carry clients without injury to clients, self or others c) Maintain balance from any position d) Stand on both legs e) Coordinate hand/eye movements f) Push/pull heavy objects without injury to client, self or others g) Stand, bend, walk and/or sit for 6-12 hours in a clinical setting performing physical activities requiring energy without jeopardizing the safety of the client, self or others h) Walk without a cane, walker or crutches i) Function with hands free for nursing care and transporting items j) Transport self and client without the use of electrical devices k) Flex, abduct and rotate all joints freely l) Respond rapidly to emergency situations m) Maneuver in small areas n) Perform daily care functions for the client o) Coordinate fine and gross motor hand movements to provide safe effective nursing care p) Calibrate/use equipment q) Execute movement required to provide nursing care in all health care settings r) Perform CPR and physical assessment s) Operate a computer 5) Professional Behavior a) Convey caring, respect, sensitivity, tact, compassion, empathy, tolerance and a healthy attitude toward others b) Demonstrate a mentally healthy attitude that is age appropriate in relationship to the client c) Handle multiple tasks concurrently d) Perform safe, effective nursing care for clients in a caring context e) Understand and follow the policies and procedures of the College and clinical agencies f) Understand the consequences of violating the student code of conduct g) Understand that posing a direct threat to others is unacceptable and subjects one to discipline h) Meet qualifications for licensure by examination as stipulated by the Alabama Board of Nursing i) Not to pose a threat to self or others j) Function effectively in situations of uncertainty and stress inherent in providing nursing care k) Adapt to changing environments and situations l) Remain free of chemical dependency m) Report promptly to clinicals and remain for 6-12 hours on the clinical unit n) Provide nursing care in an appropriate time frame o) Accepts responsibility, accountability, and ownership of one's actions p) Seek supervision/consultation in a timely manner q) Examine and modify one's own behavior when it interferes with nursing care or learning Upon admission, an individual who discloses a disability can request reasonable accommodations. Individuals will be asked to provide documentation of the disability in order to assist with the provision of appropriate reasonable accommodations. The respective College will provide reasonable accommodations but is not required to substantially alter the requirements or nature of the program or provide accommodations that inflict an undue burden on the respective College. In order to be admitted one must be able to perform all of the essential functions with or without reasonable accommodations. If an individual's health changes during the

program of learning, so that the essential functions cannot be met with or without reasonable accommodations, the student will be withdrawn from the nursing program. The nursing faculty reserves the right at any time to require an additional medical examination at the student's expense in order to assist with the evaluation of the student's ability to perform the essential functions. Requests for reasonable accommodations should be directed to: ADA Coordinator Sheila Thesis 334 876-9294

Wallace Community College Selma Essential Functions Verification Form My signature below indicates that I have read the Essential Functions for nursing programs set forth by the State Department of Post-secondary Education. My signature also verifies the following: (Initial) I can meet the Essential Functions of Nursing Programs set forth by the State Department of Postsecondary Education. (Initial) I understand that I must be able to continue to meet these same Essential Functions throughout my entire course of study in nursing. Signature Date