Rogue Community College 2018/19 Nursing Program Application For Fall 2019 Entry Applications will be accepted starting November 1, 2018. STEP ONE: Complete the online portion of the application available beginning November 1 at: (This link will be available and activated on November 1) DO NOT submit the online portion of the form more than once. You will receive an email when your online portion of the 2018/19 application is received by Enrollment Services. STEP TWO: Complete, print, and sign the Checklist and Agreement Form and the Prerequisite/Course Completion Chart. If applying for military veteran points, include a photocopy of your certified Form DD214 Service 2, verifying your honorable discharge. Applicants currently on active duty in one of the armed services must attach appropriate documents showing proof of active military duty and good standing. Attach completed forms and required reference letters as directed if applying for Volunteerism, and/or Work Experience, and/or Leadership points. Foreign Language points will only be awarded if official transcripts are attached (or are on file in Enrollment Services) as indicated on the Selection Points document. Please note: RCC Advisors cannot help you fill out your application. STEP THREE: Mail the printed forms (retain a personal copy) along with the $100 nonrefundable processing fee (check or money order made out to Rogue Community College) in a sealed envelope (make sure a complete return address including the applicant s name is on the outside of the envelope) to be received no later than the annual deadline of 5 p.m. on February 15, 2019. Rogue Community College Enrollment Services 2019 Nursing Program Application 114 S. Bartlett St. Medford, OR 97501
2018/19 Nursing Program Application Checklist and Agreement (for Fall 2019 Entry) Applicant Name RCC Student ID Secure Email Address (Official notifications will occur by email to address showing in your myrogue account. It is the applicant s responsibility to provide a secure email address and ensure the College and Nursing Program administrative assistant are notified of any changes in email address.) Applicant: You must complete and submit this checklist as part of your nursing application. Please initial each statement below indicating that you have read, understand, and agree to the application requirements for the RCC Nursing Program and make a copy for your records. Initial each item below: 1. I have been officially admitted to RCC and have obtained my 7 digit RCC ID#. 2. I have already completed STEP 1 by submitting the online portion of my Nursing Program Application. 3. I have previously submitted (and verified arrival of official transcripts at RCC) or have attached sealed official college transcripts from ALL previously attended, regionally accredited colleges or universities including all coursework completed through Fall Term 2018. I understand I will not be awarded 4 points for non-repeat of A&P if I do not submit such transcripts. (Rogue Community College transcripts do not need to be attached.) 4. I understand that a minimum of 30 credits of prerequisites must be completed with a C or better by the end of Fall Term 2018 (with a minimum cumulative GPA of 3.0), including BI231 Anatomy & Physiology I with lab and MTH95 or higher level math course (or equivalent transfer courses), in order to be eligible to apply. 5. For International students only: See Enrollment Services for admissions and registration information. 6. I understand that all applicants receive notice of status in the selection process by April 1 and if my points qualify me for Phase 2 as one of the top 85 applicants, I must respond to reserve a seat at the scheduled session (hold open dates: April 12 & 13, 2019) in the computer lab on the Redwood Campus. If I have not received notice of my status (i.e. whether I am among the top 85 applicants or among those who do not make it to Phase 2) by April 1, 2019, I will call the Nursing Program at 541-956-7308. I understand I can access information regarding the essay and critical thinking assessment in Phase 2 at HSRT ASSESSMENT.
7. I have provided a secure email address on my application and give my permission for RCC to contact me through this email address. I understand I will be emailed a notice verifying receipt of the application packet I am submitting to RCC once I have submitted both the online and the hard copy portion with application fee, and that I will also receive notification of my Degree Audit (transcript evaluation) results through email once it has been completed. I also understand that each of the top 85 applicants will be notified by email of his/her status regarding acceptance by June 1, 2019. I also understand that I am not to call the Nursing Program or Enrollment Services regarding acceptance status unless so directed. 8. I understand that if I have a financial hold on my RCC account, my application will be disqualified unless the financial hold is removed before 5 p.m., February 15, 2019, and my $100 application fee will be applied towards the outstanding financial hold. 9. I understand to earn selection points for being a military Veteran or for active military duty I must attach proof of my honorable discharge (Photocopy of my Certified Form DD214 Service 2) or proof of active military duty in good standing. 10. I have completed and attached the Prerequisite/Course Completion Chart. 11. I have attached the $100 non-refundable nursing application processing fee (check or money order made payable to Rogue Community College). 12. I understand that I must attach forms for points as indicated but any documents submitted, but not requested by this application form will be discarded/shredded. 13. I understand that reading and following directions is critical to success in any nursing program. Incomplete applications (e.g. submission of a previous year s application form, not completing admission to Rogue Community College, no student ID number in places where ID number is called for, no application fee, lack of submission of Official transcripts to Enrollment Services, no signature, etc.) will result in disqualification and that disqualified applicants will only receive notice of such after the application deadline has passed. 14. I understand applications will be accepted beginning November 1, even though fall courses have not yet been completed. I understand it is my responsibility to make sure that all required application materials are received in the RCC Enrollment Services Office (or postmarked) no later than 5 p.m. on February 15, 2019. 15. I have read and I understand the program information and admission criteria (including requirement for negative urine drug screen and criminal history background check in order to be admitted) for the nursing program at RCC. Program information, including selection points, may be found at: http://go.roguecc.edu/department/nursing/adn-program. 16. I understand that if accepted I will be required by a specified deadline prior to program start to order a criminal history background check with the RCC Nursing Department s contracted agency which performs criminal history background checks and must self-disclose all past arrests, charges, and/or convictions and/or disciplinary action taken by a Board of Nursing even if they are outside a 5 or 10 year window and must disclose any warrant, arrest, citation, charge or conviction if such occurs after acceptance. 17. I understand that a history of certain crimes might result in my being denied admission to the program and have reviewed the criminal background check information available on the Nursing website.
18. I understand that by making application to the Rogue Community College Nursing Program I am also applying for co-admission to the Oregon Health & Science University School of Nursing (OHSU) and I am authorizing the release of my application and academic information to OHSU as needed to facilitate my program of study or financial aid. 19. I understand that although co-admitted to OHSU, if I choose to transition to OHSU after completion of the RCC Nursing Program, I will have to request an additional Criminal Background Check specifically for OHSU and my ability to enroll in OHSU courses may be negatively impacted by any criminal history in my background. 20. I give my permission for release of pertinent application and academic information to the OCNE partner schools, Oregon Center for Nursing, and the Oregon State Board of Nursing for statistical, research, and evaluative purposes only. 21. I understand that it is my responsibility to meet all program and application criteria. RCC staff are available to answer application related questions, but will not check my application for completeness prior to submission. 22. I understand any student who left another Nursing program with an F or a W for any nursing course on their transcript or who was dismissed from a program before a grade was transcripted must attach a letter from the director of their previous program to the RCC Nursing Program application. To be considered eligible for the RCC Nursing Program, the letter must indicate the previous program would allow the student to re-enter. 23. I understand to receive any points for volunteerism or foreign language or work experience in a healthcare field or leadership, I must attach the documents called for on the following pages or in the Selection Points document. 24. I verify that all statements on this application are complete and true and I understand that falsification of any information may lead to disqualification or dismissal from the program. Applicant Signature RCC Student ID Date If the applicant is less than 18 years old, a parent must also sign: Rogue Community College does not discriminate in any programs, activities, or employment practices on the basis of race, color, religion, ethnicity, use of native language, national origin, sex, sexual orientation, gender identity, marital status, veteran status, disability, age, pregnancy, or any other status protected under applicable federal, state, or local laws. For further policy information and for a full list of regulatory specific contact persons visit the following webpage: www.roguecc.edu/nondiscrimination. Rogue Community College Nursing Program Prerequisite/Course Completion Chart
Student Name/ID #: Complete this form to the best of your ability. It serves as a double check for the transcript specialists. To be eligible to apply, you must have completed a minimum of 30 credits of the required prerequisite/preparatory coursework including MTH95 or higher and BI231 (or equivalent within the past 7 years) with a cumulative application GPA of at least 3.0 prior to the application deadline. For calculation of your application GPA, your most recent grade in a course will be used. Exception: If you have completed more than one math, or computer science course that would equally apply to a requirement, the course with a higher grade will be used. If you are accepted to the program, all prerequisite/preparatory courses (minimum of 45 credits) must be completed with a C or better by the end of summer term in order to retain acceptance. (NOTE: BI 234 is available fall, winter and spring terms at RCC but not summer term.) Required Prerequisite/Preparatory Courses RCC Course Number/Title CS120 Concepts in Computing (or documented proficiency within 10 years) Your Completed or Planned Course # College & Year Course Completed (or planned course) Grade (if complete) RCC Credits BI211 General Biology I w/lab (including genetics) 4 BI231 Anatomy & Physiology I (within 7 years) 4 BI232 Anatomy & Physiology II (within 7 years) 4 BI233 Anatomy & Physiology III (within 7 years) 4 BI234 Microbiology 4 MTH95 (or 93 & 94) Intermediate Algebra or higher 4 NFM225 Nutrition 4 *PSY201 or 202 General Psychology I/II (or other 3-4 credit Social Science if PSY215 requirement has been met. PSY215 Lifespan Human Development 4 *WR121 English Composition I 4 *WR122 English Composition II 4 **Humanities, Social Science, or Science Electives (Will only be applied as needed to meet minimum of 45 prerequisite/preparatory credits once all are completed) 0-4 4 0-6 *In some instances, 3 credits may be equivalent see Official degree Audit. **See Page 54 of the RCC College Catalog for a list of acceptable Social Science, Humanities, and Science courses. Possible Additional Selection Point Items I have previously earned an Associate s Degree or higher at a regionally accredited College/University. Please Circle Your Response Additional Information YES NO Highest Degree Completed:and month/year of graduation: Completed at (School Name) **I have completed 12 or more credits of electives as listed on the Nursing Graduation Guide. YES NO Number of elective credits completed: I have repeated BI231 or BI232 or BI233 at least once in YES NO the past 7 years. (W & AU attempts count as repeats) I am a military veteran and have submitted my DD214 as YES NO proof of my honorable discharge from the service, or am active duty and have attached proof of status. I am a current resident of Josephine or Jackson County YES NO Number of credits completed at RCC I have provided transcripts required if seeking points for foreign language. I am enrolled in fall term 2018 courses. YES NO Yes No COMMUNITY SERVICE VOLUNTEER VERIFICATION FORM 2019 Rogue Community College Nursing Program
Applicants to the Rogue Community College Nursing Program may receive up to 5 points for volunteering in any organization/circumstance where the individual was supervised (directly or indirectly) and provided a service to the community. Applicants should not submit volunteer verification documentation with their application if they have not performed at least 50 hours of volunteer service in the last 5 years. Note to applicant: Be sure to fill in necessary information in the top section before giving this form to the supervisor/organization where the volunteer hours were performed. Volunteer hours must be verified using this form and include a letter of reference from your supervisor or their designee which describes the activity and how it serves the community. You may duplicate this form as needed. You must include a reference letter from each organization filling out a verification form. Be sure the form is complete. Incomplete forms or missing reference letters cannot be given consideration in the point assignment process. Dear Human Resources/Supervisor, I am in the process of applying to the Rogue Community College Nursing Program. The selection points process requires verification of volunteer hours and a reference letter. Volunteer hours must be unpaid and completed between January 2013 and February 2019. I, (print program applicant s name) authorize the college to contact the individuals listed on this form to verify the information provided. Applicant s Signature: Date: The portion below is to be completed by Supervisor or Human Resources Verification of unpaid volunteer hours: A. Dates of Service: Total Hours: mm/dd/yy mm/dd/yy B. Supervised by: Print Name, Title C. Organization: D. Supervisor contact number: E. Supervisor email address (must be organizational email if not, additional letter verifying supervisor s involvement with the organization must be attached to application): F. Supervisor signature: Date: G. PLEASE ATTACH A LETTER OF REFERENCE FOR THE APPLICANT DESCRIBING THE VOLUNTEER ACTIVITY AND HOW IT SERVES THE COMMUNITY. HEALTHCARE WORK EXPERIENCE FORM 2019 Rogue Community College Nursing Program
Student Name: / Date: Print applicant name Signature of applicant Dear Employer/Supervisor/Human Resources Manager/Commanding Officer: The above individual is planning to apply to the RCC Nursing program by February 15, 2019. To earn up to four (4) points in the selection process, the applicant must prove accumulation of a minimum of 500 hours work experience since January 1, 2015 caring for human patients in a position requiring them to have unencumbered certification as an Oregon Certified Nursing Assistant (CNA-1 or 2), or licensure or national certification as a Licensed Practical Nurse (LPN), Respiratory Therapist, Emergency Medical Technician (EMT), Paramedic, Certified Medical Assistant, or service as a Medic or Corpsman in one of the Armed Services. By providing this form to you to complete, this applicant is giving you permission to provide the requested information. To assist this applicant with the process, please fill in the requested information responding to all questions, seal it in an envelope (preferably a company letterhead envelope), sign your name across the seal, and return it to the applicant. Points will not be awarded if the form is incomplete. Even if their employment with you is for less than 500 hours, the applicant may submit documents from more than one employer in order to provide proof of required hours of work experience. Applicants with work experience in any area of healthcare not listed above may be awarded up to two points if you complete this form and they attach it to the application with their explanation of why their experience should be considered. The applicant must attach the sealed envelope to the application and submit it no later than 5:00 p.m. on February 15, 2019 to be eligible for the points. If you have any questions, you may call me at (541) 956-7308. Thank you for your help. Sincerely, Linda Wagner, RN, MN Nursing Department Chair Please identify the healthcare role/position held by this applicant in your organization: Did this position require Oregon certification or licensure or national certification as indicated above? Yes No If not one of the roles listed above, what degree or licensure or certification or training was required for the role? Total Number of Hours Worked here as = Insert role above Insert total hours above Signature of Supervisor/HR Manager/ Commanding Officer Print Name of Facility/Organization Email address Printed Name and Title Phone Number LEADERSHIP VERIFICATION FORM 2019 Rogue Community College Nursing Program
Applicants to the Rogue Community College Nursing Program may receive up to 3 points for evidence of leadership, supervisory, or managerial role in paid or unpaid activity or positions in school, community, work, or other organizations between January 2013 and February 2019. Applicants will receive no points if leadership activity involved less than 50 hours in the leadership role or if role did not involve guiding or directing a group of people. Applicants may not apply for both volunteerism points and leadership points for the same activities or role. In the space below the applicant must provide a description of the leadership role including specific responsibilities and total number of hours in that role between January 2013 and February 2019. The applicant must attach a letter of reference from someone who worked with them and can attest to their leadership role and length of time in that role. The applicant may duplicate this form as needed. If multiple forms are submitted because leadership hours occurred in different organizations, the applicant must include one reference letter per organization. Be sure the form is complete. Incomplete forms or missing reference letters cannot be given consideration in the point assignment process. Applicant s description of leadership role, including name of organization or school, position, whether it was paid or unpaid activity, and specific responsibilities regarding guiding or directing a group of people: I verify that I have completed the following hours in the above leadership role: A. Dates of Leadership Role: Total Hours: mm/dd/yy mm/dd/yy B. Applicant: Print Name C. Applicant signature: Date: D. PLEASE ATTACH A LETTER OF REFERENCE FROM A PERSON WHO WORKED WITH YOU. ASK YOUR REFERENCE TO VERIFY YOUR APPROXIMATE TOTAL HOURS IN THE LEADERSHIP ROLE AND THEIR EVALUATION OF YOUR LEADERSHIP QUALITIES. The letter of reference should be in a sealed envelope and the person writing the reference should sign across the envelope seal before returning it to the applicant.