KILGORE COLLEGE ASSOCIATE DEGREE NURSING (RN) PROGRAM CHECKLIST & APPLICATION

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KILGORE COLLEGE ASSOCIATE DEGREE NURSING (RN) PROGRAM CHECKLIST & APPLICATION (rev.09.16) (Please proceed in order according to your current academic standing. We hope that this checklist will assist you in preparing for and applying to the ADN (RN) Program at Kilgore College. Please read & follow the instructions below.) 1. Apply for admission to Kilgore College (Meningitis vaccine required for all students younger than 22 years old.) 2. Apply for Financial Aid 3. Request official transcripts (College/University). For College/University other than Kilgore College; send two (2) sets of official transcripts to: 1. Attn: Registrar s office, Kilgore College 2. Attn: Associate Degree Nursing Department, Kilgore College (include with your Application Packet) 4. Applicants must be TSI Complete. 5. Complete KC New Student Orientation (Transfer students with 12 or more transferable credit hours are not required to attend KC New Student Orientation, if applicable.) 6. Register for and complete required support courses (pre-requisites) in order to apply to the nursing program: CHEM 1406 or 1411 w/lab BIOL 2420 w/lab (Microbiology) BIOL 2401 w/lab (A&P I) ENGL 1301 (English Comp I) BIOL 2402 w/lab (A&P II) PSYC 2314 (Life Span) Language Philosophy & Culture 3 hours - to be selected from one of the following: (ENGL 2322, 2323, 2326, 2332, 2333; HIST 2311, 2312, 2321, 2322; PHIL 1301, 2306) Additional points will be given to Students for each pre-requisite that has been successfully taken at Kilgore College. Successfully complete support courses (pre-requisites) with a C or higher and a minimum Science GPA of 2.75 and Overall GPA of 2.75 for these seven (7) support courses (pre-requisites). All Science courses must have been completed within 7 years, when applying to ADN RN Program. Any Science course that exceeds the 7 year mark of completion, will need to be re-taken prior to submitting your Nursing Application. This only applies to the four (4) Science Courses. All pre-requisite grades and all attempts at pre-requisite courses (within 7 years) will be used to calculate the Science GPA and Overall GPA, with a minimum 2.75 GPA requirement. (Points will be deducted after the 1 st Withdraw; this includes all pre-requisites.) If you are currently enrolled or will be enrolled, and will have completed the course(s) by the start of the semester for which you are applying, please indicate that on the Nursing Application; under Currently Enrolled and list the semester enrolled. Students currently registered for a Science course (during fall or spring semesters) should apply for Priority Registration at www.kilgore.edu/datasheet about a month into the semester for a chance to register for their next Science course earlier than the general student population. Follow the instructions exactly on the KC Priority Registration Request or your Registration Request will not be considered.

Although not a required pre-requisite to apply to the nursing program, it is strongly recommended by the ADN program that all pre-nursing students enroll in RNSG 1201, Intro to Pharmacology, before entering the nursing program. If you have questions concerning this course, please feel free to contact the nursing department at 903-983-8168 or email Mrs. Dayna Davidson, Director, Associate Degree Nursing (RN) Program at ddavidson@kilgore.edu or Mrs. Kathy Stone, Support Specialist at kstone@kilgore.edu. 7. Additional Courses (not required for an AAS in Nursing, but required to receive an AA or AS Degree from Kilgore College. (A ½ point will be given for each completed with a C or better): ENGL 1302 MATH 1342 Creative Art PSYC 2301 RNSG1201 HIST 1301 HIST 1302 GOVT 2305 GOVT 2306 MDCA 1313 HECO or BIOL 1322 SPCH 1315 or 1318 8. Register for the Nurse Entrance Exam Exam dates are limited, please register early. Email the nursing department for the schedule at kstone@kilgore.edu. Testing starts 8 weeks before Application deadline and ends 1 week prior to deadline date. Applicants may only take the Nurse Entrance Exam twice per calendar year. Please prepare for the exam. (Nurse Entrance Exams may not be older than 5 years.) You may take either the TEAS or the HESI-A2. (Please prepare for these exams.) a. TEAS Exam (scheduled through the Kilgore College Testing Center) Minimum Passing Scores: 65% for each; Math, Reading and English Cost: $65.00 make payment to Kilgore College Cashier b. HESI-A2 Exam (scheduled by contacting the Nursing Department @ kstone@kilgore.edu) Minimum Passing Scores: 79% Reading, 78% Math, 78% English Composite Cost: $65.00 make payment to Kilgore College Cashier (HESI-A2 Study Guide/Workbook can be purchased online to prepare for the exam.) 9. Apply for Admission to the A.D.N. Program. Please read the following: Application Packet to include the following: 1. Completed Associate Degree Nursing (RN) Application (rev. 09.16) 2. Official transcript(s) for all Colleges/Universities; including Kilgore College official transcript. 3. HESI-A2 or TEAS test results (print out). 4. A typed, 1-page, double-spaced, font Arial 10, essay that explains your interest in the nursing field. 5. Two (2) Reference Forms. Applicant completes the top portion of form, the person completing the Reference Form needs to mail the form to the Associate Degree Nursing Department (Kilgore College mailing address) and must be received before the deadline. At least one Reference must be from an employer or a teacher. (It may be beneficial to supply your references with a stamped self-addressed envelope.) 6. If you have attended a nursing school in the past; you must provide a letter of good standing from the Director of the Nursing Program. This letter can be emailed to kstone@kilgore.edu. 7. Submit your Application Packet in a sealed envelope to the ADN (RN) Department, located in the Health Sciences Center, Room G13 no later than close of business on the deadline date listed below: Application Deadline: Fall Semester (March 1st) Spring Semester (July 1 st )

Please contact us with any questions: Laura Mulanax Health Science Academic Advisor Email: lmulanax@kilgore.edu Kathy Stone Support Specialist, Associate Degree Nursing Email: kstone@kilgore.edu THE STUDENT SELECTION PROCESS IS BASED ON A POINTS SYSTEM & QUALIFIED APPLICANTS MAY BE INTERVIEWED.

KILGORE COLLEGE ASSOCIATE DEGREE NURSING (RN) PROGRAM APPLICATION (rev.09.16) Deadline: March 1 st for Fall Admission and July 1st st for Spring Admission. (Application to Kilgore College (www.kilgore.edu/admissions) is required before completion of the Nursing Application) STUDENT IS APPLYING FOR: Fall (year) Spring (year) RN Program LVN to RN Track (PRINT OR TYPE): SS# KC Student ID: KC Email NAME: Last First Middle/Maiden (Any other names records may appear) MAILING ADDRESS: (Street or P.O. Box) City State Zip Code HOME #: CELL #: BUSINESS #: (Attach Additional Paper if Needed): 1. Are you currently enrolled in college? yes no. If yes, where? 2. Please provide the name(s) and attendance dates of all previously attended colleges 3. Have you ever been accepted into a Nursing Program? yes no if yes, where/when 4. Do you hold any health related license or certificates? (Not CPR) yes no If yes, list licensure number and explain: 5. Have you had a Criminal Background Check done with TBON? yes no (If yes, please include copy of the Blue Card or your Declaratory Order with your Application Packet.) Students must have a grade of C or higher in the following courses and a minimum Overall GPA of 2.75 in these courses before entering the nursing program and a minimum Science GPA of 2.75. If you are currently enrolled or will be enrolled, and will have completed the course by the start of the semester for which you are applying, please indicate that below. Science courses must be completed within the prior 7 years of the semester you are applying for. List all grades and attempts at courses listed below (within 7 years). All grades will be averaged into the Science GPA, minimum requirement 2.75 GPA. (Points will be deducted for Withdraws; beginning after the 1 st Withdrawal.). This also applies to the other 3 pre-requisite courses. Support Courses (Pre-Requisites): Description: A B C D F W CHEM 1406 or 1411 Chemistry for HS or Gen. Chemistry I BIOL 2401 Anatomy & Physiology I BIOL 2402 Anatomy & Physiology II BIOL 2420 Microbiology ENGL 1301 English Composition I PSYC 2314 Life Span PHIL 1301, 2306; ENGL 2322, 2323, 2326, Language, Philosophy & Culture 2332, 2333; HIST 2311, 2312, 2321, 2322 (3 hrs. to be selected from one course) Currently Enrolled If you have COMPLETED any of the following courses and passed with a C or higher, please indicate below in order to receive points CREATIVE ARTS MATH 1342 HIST 1301 GOV 2305 SPCH 1315 or 1318 RNSG 1201 ENGL 1302 PSYC 2301 HIST 1302 GOV 2306 HECO or BIOL 1322 MDCA 1313 6. Required Entrance Exam: TEAS ( ) or HESI A2 ( ) Score: READ Comprehension MATH ENG. Composite 7. Include printed copies of your Entrance Test Scores; TEAS or HESI-A2 with your Nursing Application. 8. Include all Official Transcripts with your ADN (RN) Application Packet; including Kilgore College Official Transcript. 9. Include your Essay (1 page Arial 10 pitch, double-spaced, typed document explaining your interest in Nursing.) 10. Have 2 completed Reference Form s mailed to the Associate Degree Nursing Department prior to the Application deadline. 11. Submit your completed Application Packet in a sealed envelope to the Associate Degree Nursing Department before the deadline. PLEASE READ AND SIGN THE FOLLOWING: Kilgore College does not discriminate on the basis of race, color, religion, national origin, sex, handicap, marital status, or veteran status. I hereby certify that the information contained in this Application Packet is true and complete to the best of my knowledge. I understand that any misrepresentation or falsification of information is cause for denial of admission or expulsion from the college. Signature of Applicant: Date:

KILGORE COLLEGE ASSOCIATE DEGREE NURSING (RN) PROGRAM REFERENCE FORM (rev.09.16) APPLICANT COMPLETE THE UPPER PORTION OF THIS FORM ONLY APPLICANT NAME (Please Print): Under the Federal law entitled the Family Educational Right and Privacy Act of 1974, students are given the right to inspect their records, including letters of recommendation. While we shall consider all letters of recommendation carefully, we believe that in many instances letters written in confidence in the long run are of greater use in assessment of a student s qualifications, abilities, and promise. I do do not waive my right to review the content of this form. Applicant Signature: Date: ----------------------Only the Person Completing Reference Form is to Respond Below---------------- ---------- The Applicant whose name appears above is requesting that you complete this reference form in regard to his/her Application to the Associate Degree Nursing (RN) Program. Please take the time to respond to the questionnaire as honestly as possible. Circle only one choice in each Category. This Applicant will not be considered for the Associate Degree Nursing (RN) Program unless this reference form is returned. Please advise the Applicant if you will not be returning it. Please mail the completed form prior to the deadline: March 1 st or July 1st Kilgore College Associate Degree Nursing Program 1100 Broadway Kilgore, TX, 75662 1. How long have you known this person? (circle below) <6 months 6-12 months 1-3 years >3 years 2. In what capacity have you known the Applicant? (circle below and indicate your profession) Teacher / Counselor / Pastor / Employer / Co-worker Profession: Health Care or Non-Health Care 3. Rate this Applicant s behavior in the following Categories by circling the appropriate phrase: DEPENDABILITY / ATTENDANCE Frequently absent or late - rarely calls if either INITIATIVE / MOTIVATION / ENTHUSIASM Seldom needs direction and prompting; frequently initiates own activity MATURITY Occasionally acts immature Never absent or late Self-motivated; asks appropriate questions and requests learning opportunities Acts mature most of the time Occasionally absent or late - sometimes calls Relies on direction for all actions Frequently acts immature Rarely absent or late - usually calls Occasionally initiates own activity, needing occasional direction Very mature in all actions

NEATNESS / GROOMING Consistently displays poor hygiene and grooming Always neat and well groomed Occasionally displays poor hygiene and grooming Usually neat and well groomed ATTITUDE / PERSONALITY / INTERPERSONAL SKILLS Displays evidence of difficulty getting along with people Gets along well most of the time with most people Makes an attempt to get along but easily swayed or angered Always gets along with coworkers, supervisors, and subordinates REACTION TO STRESS Displays good coping skills under stress Easily upset by stressful situations Needs frequent direction and assistance during stressful situations Handles stress but shows some signs of distress during or immediately after stress CAPACITY FOR PROBLEM-SOLVING Needs frequent guidance and direction for problem solving Independent thinker Needs occasional guidance and direction for problem solving Usually able to problemsolve independently needing minimal guidance COMMUNICATION SKILLS Frequently uses poor grammar and terminology in verbal and written Occasionally uses poor grammar and terminology in verbal and written Always uses proper grammar and terminology in verbal and written Usually uses proper grammar and terminology in verbal and written ORGANIZATION / WORK HABITS Occasionally disorganized; requires excessive time to complete tasks Completes tasks in timely manner even though disorganized Disorganized; does not complete tasks Well organized in work habits; productive 4. In your opinion, is this Applicant suited for a career in the healthcare field? Yes or No Comments (May use back if needed): Signature Printed Name Date Phone Position/Title Business/Company Page 2 of 2