Application to Registered Nursing Program

ELIGIBILITY TO APPLY Application to Registered Nursing Program Associate of Science Nursing (ASN) Degree Department of Health Professions (rev. 02/15/18-12:30pm) Clarification added in yellow on page 7 on 02/27/18-11:42am. GPA: a minimum GPA of 2.75 in the most recent 60 college/university credits completed is required (all college/university coursework taken since high school is reviewed). PREREQUISITES: Successful completion of prerequisite courses per specifications listed on page 2. Note: you may submit an application in the semester you are completing the prerequisite courses. CO-REQUISITES: To be SUCCESSFUL in the nursing program, applicants are STRONGLY encouraged to complete the co-requisite courses before entering the program. LPN APPLICANTS: LPNs applying will need to meet individually with the Nursing Program Director to determine which of their practical nursing courses are equivalent to courses required for the ASN degree. Please contact Linda Barnes at 406-243-7875 or via email at linda.barnes@mso.umt.edu. (Additional details are available on page 2 of this application and on the nursing program website at http://mc.umt.edu/nursing/rn-prg-admission-curriculum.php.) APPLICATION EVALUATION & RANKING Applications will be evaluated for minimum eligibility and then ranked based on the three categories listed below with an opportunity for an additional 5% bonus as described. Each category is carefully considered and valuable in the application process. 1. Prerequisite / Competitive GPA (50% of application score): After grades for any in-progress courses are received, the GPA for prerequisite courses will be calculated. 2. TEAS Test (25% of application score): Completion of a proctored Test of Essential Academic Skills (TEAS) test. 3. Interview (25% of application score): The top 30 ranked applicants will be invited to an interview with a selection committee. Interviews will take place in early January after final fall semester grades are posted. Interview appointments will be scheduled by the Nursing Program Administrative Associate once a completed application packet (including transcripts) is received. 4. Bonus Points, if applicable: 5% will be added to the application score for any applicant meeting one of the healthcare experience criteria listed in detail on page 4. 1% will be added to the total application score for either completion of or in process of completing all co-requisite courses. The final application score is a cumulative score of the GPA, TEAS, and interview scores, plus bonus points, if applicable. In the event there are students in the top tier of 30 students with the same application score (a tie), the student with a higher score on the science portion of the TEAS test will be accepted. If that number is a tie, the higher score of the math portion of the TEAS will be used as the tiebreaker. Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.1

PREREQUISITE COURSES These courses fulfill both ASN and General Associate of Arts (AA) degree requirements. Course / Title BIOH 201 & BIOH 202N* Human Anatomy and Physiology I with Lab (minimum grade of B) CHMY 121* Introduction to General Chemistry CHMY 122* Introduction to General Chemistry Lab M 121, College Algebra OR one of the following: M 115, Linear & Probability M 162, Applied Calculus M 171, Calculus (The following 2 courses were last offered at UM in 2008-09.) M 152, Pre-Calculus with Algebra M 153, Pre-Calculus with Trig WRIT 101, College Writing I (or English Composition) Credits 4 3 1 Min. 3 3 CO-REQUISITE COURSES Although the following courses are considered part of the RN Program scope/sequence, IT IS HIGHLY RECOMMENDED THAT APPLICANTS COMPLETE THESE COURSES PRIOR to entering the nursing program. Course / Title BIOH 211 & BIOH 212N*, Human Anatomy & Physiology II with Lab (minimum grade of B) BIOM 250, Microbiology in Health Sciences (minimum grade of C) BIOM 251, Microbiology in Health Sciences Lab (minimum grade of C) PSYX 100S, Introduction to Psychology (minimum grade of C) SOCI 101, Introduction to Sociology (minimum grade of C) Credits 4 3 1 4 3 IMPORTANT NOTES: Course Age Limits, Number of Course Attempts, and Minimum Grades Required *Completion of prerequisite and co-requisite science courses within 5 years of application submission AND within a maximum of two attempts during a 5-year period. Grades of WP and WF (withdrawal pass and withdrawal fail) count as an attempt. The most recent grade earned is used to calculate the prerequisite GPA. All other prerequisite and co-requisite courses must be completed with a minimum grade of C AND within 10 years of application submission AND within a maximum of two attempts within a 10-year period. Grades of WP and WF (withdrawal pass and withdrawal fail) count as an attempt. The most recent grade earned is used to calculate the prerequisite GPA. College Level Entrance Program (CLEP) exam scores and Advanced Placement (AP) exam scores will be attributed a grade of C only. Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.2

RN APPLICATION INSTRUCTIONS Please read carefully & follow instructions precisely. Application packets with incomplete information or missing documents will be rejected. 1. Application Deadline noon, Tuesday, May 1. 2. Submission Packet: All application materials must be submitted in a sealed 9x12-inch envelope 3. Transcript Requirements: An UNOPENED OFFICIAL PAPER transcript is required from every college or university attended regardless if the school s transfer courses show on another of your transcripts. One Exception: an official transcript for courses taken at Missoula College, Bitterroot College or University of Montana-Missoula is not required because these are already accessible to our program. Ordering Transcripts via National Student Clearinghouse: You can check to see if your college/university allows ordering of transcripts through the National Student Clearinghouse (http://www.studentclearinghouse.org/). o Click on the orange Order-Track-Verify button, then select Order or Track a Transcript. o From there, you can click on the Select school drop-down menu to see if your school(s) show on the list. If not listed, you will have to go to that school s own website for transcript ordering instructions. Paper transcripts ONLY accepted. Must be unopened and included in your submission packet. Have transcripts mailed to you ONLY, NOT to Missoula College, the nursing program, or University of Montana. Deviation from this may result in you missing the application submission deadline. A print-out of courses in-progress from an unofficial transcript. Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.3

4. Required Documents / Actions: Transcripts (as detailed on previous page): Nursing Program Application: Complete the 2-page application form included in this document (pages 8 and 9). Verification of Experience: You may also need to complete page 10 read the applicable instructions at the bottom of this page. Missoula College Application / Academic File Transfer: ONLY if you are accepted by the Nursing Program, AND you are not already enrolled at Missoula College (or Bitterroot College), then you must also do one of the following as applicable to your situation: If you are currently enrolled at the University of Montana-Missoula campus or were enrolled there less than 24 months ago, you must: o Complete the Intra-Campus File Transfer Form (https://www.umt.edu/registrar/pdf/intra%20campus%20transfer%20form.pdf) o Submit the form to Admissions/New Student Services in Lommasson Center 101 or email it to Violet Hopkins (Violet.Hopkins@umontana.edu). If you attended University of Montana-Missoula campus, but over 24 months ago, you must: o Submit a Readmission Application, selecting Missoula College as your campus. (https://www.umt.edu/registrar/students/readmission%20information.php) If neither of the above situations apply to you, you must: o Complete an application for admission to Missoula College (http://mc.umt.edu/new%20students/default.php). Verification of Experience (CNA, HCA, LPN, LVN) 5% bonus Healthcare Experience: If you have worked a minimum of 120 paid hours as one of the following: CNA (Certified Nursing Assistant), HCA (Health Care Assistant), LPN (Licensed Practical Nurse), or (Licensed Vocational Nurse), in order to take advantage of the 5% bonus to your application score, you must: Complete the Verification of Healthcare Experience form (page 9) in order to take advantage of the 5% bonus added to your application score. If your 120 hours were completed with more than one organization, use a separate page 7 form for each organization. Enclose a copy of your most recent professional certification or license (current or expired) in your application submission packet. TEAS Test Results Required (details in #5 on the next two pages): Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.4

5. TEAS Test: Completion of a proctored Test of Essential Academic Skills (TEAS) is required. Description: The TEAS is a 3.5-hour timed test; a short break is allowed. The test is usually offered in a web-based format. It is a comprehensive, standardized, multiple-choice exam that measures entry-level skills and abilities in math, science, English, and the social sciences. Applicants who have completed or are in the process of completing Human Anatomy & Physiology II tend to do better in the science module. Test Preparation: an Internet search will provide many sources of study/preparation materials and practice tests, including the company that delivers the test, ATI (Assessment Technologies Institute) Nursing Education (https://www.atitesting.com/ati_store/teas-products.aspx). Please Note: feedback from previous test-takers has indicated that practice tests provided by ATI and other various sources are not quite as difficult as the actual test so please study accordingly. Nursing Program Restrictions and Taking the TEAS: Minimum Score: The minimum score required is 66.7%; to be competitive, a higher score is advised. Test Age Restriction: A proctored test must be taken within 12 months of the application deadline. Attempt Restrictions: We allow 2 attempts within each of the following 6-month timeframes in case you score below 66.7% or are dissatisfied with your score from your 1 st attempt. The applicant must pay for each attempt. The most recent score counts. November 16 through May 15: only 2 attempts allowed a minimum of 4 weeks apart May 16 through November 15: only 2 attempts allowed a minimum of 4 weeks apart Testing Sites: Tests must be taken at an approved TEAS testing site under a proctor. If you are outside of the greater Missoula area, please connect with Cyndi Stary at Cyndi.Stary@mso.umt.edu. Setting Yourself Up to Take the TEAS: Create or Activate an ATI Student Account at least 24 hours before your scheduled test time. DO NOT register for the test online that comes later. Go to the ATI homepage (https://atitesting.com). To create an account: click on the dark red Create an Account button under the posted photo. To activate an existing account: If you do not remember your log-in and/or password, click on the bright red Student Login button. TEAS Cost and Results: Cost: Signing up for one of the dates listed below keeps the cost at $58, which is payable by credit card or debit card at test time. Our nursing faculty/staff volunteer as proctors so no proctor fee is charged. Proctor fees at other testing sites can range from $5 to $50. Test Results: For the web-based format, your score shows immediately at the end of the test. For your application packet, you must include page 1 only of your results (i.e. Individual Performance Profile ), which shows your total score and a score for each of the 4 modules. The remaining pages of the profile list the topics you need to review. To access and print your Profile, log into your ATI account. Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.5

(continued from page 5) Nursing Program TEAS Testing Dates & Scheduling: Contact Person: Cyndi Stary, Cyndi.Stary@mso.umt.edu Scheduling Your Test: Beginning April 2, email Cyndi Stary with your preferred test date. April 9 Monday 1:00 5:00 (must be seated by 12:45pm) MC 228 computer lab April 10 Tuesday 2:30 6:30 (must be seated by 2:15pm) MC 227 computer lab April 12 Thursday 8:00 Noon (must be seated by 7:45am) MC 228 computer lab April 13 Friday 9:00 1:00 (must be seated by 8:45am) MC 228 computer lab Testing Time Needed: 30 minutes is needed for payment and test setup; 3.5 hours is allowed for taking all 4 test modules; 15 minutes is allowed for a break as approved by the test proctor. Testing Accommodations: If necessary, a paper format can be made available rather than the web-based format. Two (2) weeks advance notice and an alternate test date-time is needed. You must provide payment to Cyndi Stary before she will order the test money order only. Documented additional testing time will be accommodated: Two (2) weeks advance notice is required and must be accompanied by official disability documentation. An alternate testing date-time must be arranged. We prefer to use the web-based test format due to the longer time needed for a proctor, but the paper format is an option. TEAS Test 2 nd Attempts: If your 1 st attempt (taken during April 9-13 testing) was unsatisfactory, you must connect withl Cyndi Stary via email to arrange a date-timeplace for your 2 nd attempt. ONLY if it is absolutely unfeasible for you to attend one of our four April testing dates and you need to take either a 1 st or 2 nd TEAS attempt, you must email Cyndi Stary before March 21 to explain the situation and make other arrangements. SELECTION PROCESS Step 1. Applications will be read and evaluated by the Nursing Program Student Application Review Committee. All applicants will be notified regarding their selection status as soon as possible after final grades for the spring semester have been posted. This process takes approximately 1-2 weeks after final exams conclude. Please do not call or email us to check on your application status you will be apprised by email as soon as information is available. Step 2. The top 30 ranked candidates will receive an invitation to interview. Selected candidates are required to participate in an interview for consideration. Interview appointments will be scheduled by the Nursing Program Administrative Associate. Step 3. The Student Application Review Committee will then make final selections for admission offers. All applicants will be notified of acceptance or non-acceptance by letter or email. The Committee s decision is final. The Committee reserves the right to decline any nursing program applicant based on the application packet and interview process. Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.6

DEGREE COMPLETION & RN LICENSING IMPORTANT NOTES: Successful completion of the Missoula College Registered Nursing Program and earning of an ASN degree does not guarantee you a Registered Nursing license. You cannot practice in the profession of nursing until you have successfully passed a National Certification Exam. Acceptance for taking National Certification Exams is approved or denied by the Montana State Board of Nursing on an individual basis. If you have a criminal conviction, you may be denied. Montana State Board of Nursing (www.nurse.mt.gov) 301 South Park / PO Box 200513 Helena, MT 59620 APPLICATION SUBMISSION & DEADLINE Your application packet must be received no later than 12:00 noon on Tuesday, May 1, 2018. Incomplete or late applications will be rejected. Please review the complete detailed application instructions on pages 3, 4, 5, and 6 before submitting your application to insure you have complied with all requirements as stated. Keep pages 1-7 for your records submit only pages 8 and 9, plus page 10 (if it applies to you) along with the other required documents. Required Documents to Include in Check-off List for Your Records: 2-page RN application Verification form(s) for Healthcare Experience (if applicable) completed & signed Copy of healthcare license or certification (if applicable) Official transcripts as directed on page 3 (must be unopened) Print of unofficial transcript, showing in-progress courses (if applicable) TEAS test report (most recent counts). IF you arranged with Cyndi to take a 2nd attempt in May, include a note saying that in your submission Submission Envelope: packet instead of a test report. Must be 9x12 inches in size Include name, full return address, and RN Program in upper left corner If submitting by mail: Nursing Program Missoula College - UM 1205 East Broadway Missoula, MT 59802 If submitting in person: Missoula College Health Professions Office, Room 441 1205 East Broadway Missoula, MT 59802 Thank you for your interest in the Missoula College UM Registered Nursing Program. We look forward to receiving your application. Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.7

Application Form for Fall 2018 Admission Missoula College Registered Nursing Program Associate of Science Nursing (ASN) Degree This application is for students applying to begin the registered nursing program in August 2018. You must have completed, or will complete all nursing prerequisite courses by the end of fall 2018 semester. If accepted by the Nursing Program and you are not already enrolled at Missoula College or Bitterroot College, please see the detailed Application Instructions (#4) on page 3 of this document. Please print clearly; this application must be legible. Personal Information Full Legal Name Last First Middle Previous Name(s) Last First Middle Last four (4) digits of Social Security Number UM Student ID 790- Veteran Status**: Non-veteran Veteran ** The requirement to provide priority of service to veterans applies to all programs that receive funding from the United States Department of Labor. Veteran is defined as a person who served at least one day in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable. Proof of service may be requested. Current mailing address: (If not permanent, enter date this address is valid through) Street / Apt# / PO Box City State Zip Phone ( ) - Permanent mailing address: (if same as above, check this box and skip to next item) Street / Apt# / PO Box City State Zip Phone ( ) - UM Student E-mail address @umontana.edu (format: FirstName.LastName@umontana.edu there may be a number after first name if others attending UM have same name.) Personal E-mail address Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.8

(continued from page 7) Application Form for Fall 2018 Admission Missoula College Registered Nursing Program IMPORTANT: ALL Colleges / Universities Attended For any applicant who is attending or attended Missoula College, University of Montana- Missoula or Bitterroot College, the nursing program has access to the transcript via university archives so an official transcript is not required from any of these schools. HOWEVER, an official paper transcript is still required from every other college or university attended regardless if the school s transfer courses show on another transcript. IF CURRENTLY TAKING COURSES, Name(s) of Institution(s) you are attending: School #1 Official Paper Transcript Enclosed School #2 Official Paper Transcript Enclosed Courses currently in progress: List ALL courses in progress by subject & number below (Example: SUBJ: CHMY CRSE# 121) SUBJ: CRSE# SUBJ: CRSE# SUBJ: CRSE# SUBJ: CRSE# SUBJ: CRSE# SUBJ: CRSE# SUBJ: CRSE# SUBJ: CRSE# SUBJ: CRSE# All OTHER Colleges / Universities You Have Attended (official paper transcripts required): (If applicable to you, include the Verification form on next page WITH a copy of certification or license.) Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.9

Nursing Program Application Addendum VERIFICATION OF HEALTHCARE EXPERIENCE FOR ADMISSION TO THE ASSOCIATE OF SCIENCE (ASN) DEGREE PROGRAM 5% BONUS: To take advantage of the 5% bonus to your application score, you must thoroughly and legibly complete this form, take care of signatures. Submit this form as part of their application packet. IMPORTANT NOTE: Your Supervisor* needs to be a person who holds healthcare credentials and is who evaluates your clinical performance. Their verification is necessary to confirm that YOU comply with: is currently licensed as an LPN/LVN or has a current or expired CNA/HCA certification; is or has been employed in a setting that requires direct patient care; and has completed at least 120 hours of paid employment in the applicable practice setting per checked applicant credential below within the past 5 years prior to signing this form. 1. APPLICANT INFORMATION (PRINT CLEARLY) Name Address Street or PO Box Email Phone City State Zip code 2. APPLICANT EXPERIENCE minimum 120 hours must be documented below (PRINT CLEARLY) Use additional forms if required 120 hours of paid experience was performed for more than one supervisor or organization. Your Position Title Name of Organization Organization Address Mailing Address Organization Phone & Physical Address if different than Mailing Address City State Zip code Your Supervisor s Name & Position Title: Supervisor s Email Address: Your Credential: CNA / HCA LPN / LVN (attach applicable license/ certification) Time Period (start & end dates) # of Hours Worked Additional Time Period if needed # of Hours Worked Description of Role Responsibilities, including Patient Care: APPLICANT AGREEMENT: By my signature below, I acknowledge that at the date of this form the above information is correct regarding hours worked, time periods work was performed during, and the duties performed. Applicant Signature Date SUPERVISOR AGREEMENT: By my signature below, I confirm the above-named applicant has completed at least 120 hours of paid employment within 5 years prior to the date of this form. The information above accurately describes the experience of the applicant within this organization. Supervisor Signature + Title + Credentials Date Missoula College RN Program Application / ASN Degree: rev. 02/15/2018 p.10