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Admissions 450 North Avenue Battle Creek, MI 49017-3397 269 965 4153 Nursing Application Packet for the 2014 full-time/ 2015 part-time programs The deadline date for all Nursing programs is January 15, 2014. Applications are accepted beginning April 1, 2013.

Table of Contents Nursing Application 1 Selective Admission Application 2 Admission Requirements 3 Competitive Admission into the Nursing Program 4 Competitive Application into the Nursing Program 5

Admissions Nursing Application for the 2014 Full-time/ 2015 Part-time Programs (Return to Admissions) The deadline date to submit an application for all Nursing programs is January 15, 2014. Applications are accepted beginning April 1, 2013. The following items on this application must be completed and submitted prior to applying. IMPORTANT: Only complete applications will be accepted. Incomplete applications will not be considered, and will be returned to the student via postal mail. Items already on file at KCC do not need to be re-submitted; however, these items must be noted on this application, where indicated. Complete all sections on this page and submit this application to the Admissions office. This is a separate application used for Nursing applicants ONLY. Section 1 (Not required for applicants with LPN license) Submit documentation of ONE of the following: ACT composite score of 19 or higher (or equivalent SAT scores), OR COMPASS Reading score of 78 or higher, OR Associate degree or higher degree must be posted on an official college transcript from an accredited institution. I have submitted the following to KCC: ACT or SAT scores OR COMPASS Reading score OR Degree Earned: Degree Type College Attended SECTION 2 (Required for ALL nursing applicants) Submit official transcripts from ALL colleges attended. Official college transcripts must be submitted in a sealed envelope issued by the college attended. Grade point average (GPA) of 2.5** or higher at each institution. (2.0** or higher at each institution at each institution for applicants with a current LPN lincense.) **Students with a GPA falling below the requirement in any college may request an appeal from Selective Admissions. List each college attended on the Selective Admission Application. If the official and most current transcripts are already on file at KCC, please specify these items below: If any items listed here are not on file, this packet will not be considered complete. Institution Institution Institution submitted to KCC submitted to KCC submitted to KCC Section 3 Complete the admission requirements based on the program to which you are applying. Please refer to the Admission Requirements pages in this packet (pages 3 and 4). I certify that I have read this packet and completed each of the above requirements to the best of my knowledge. Student ID# Signature PAGE 1

450 North Avenue Battle Creek, MI 49017-3397 SELECTIVE ADMISSION APPLICATION (Return to Admissions) PLEASE NOTE: This application is for selective admission to Kellogg Community College. All students applying to an Allied Health or Nursing Program are required to use this application. If you are applying for general admission, or as a dual-enrolled, international, or guest student you should NOT fill out this application; instead fill out the application appropriate to your respective status. You may obtain any of these additional applications at the KCC Customer Service Center or the Admissions office. ANNUAL APPLICATION DEADLINES: Full-time Associate degree nursing (RN) January 15* Part-time Associate degree nursing (RN) January 15* Advanced Placement LPN to RN nursing January 15* Dental Hygiene April 1** Radiography February 1** Physical Therapist Assistant March 1** Magnetic Resonance Imaging February 15** Medical Lab Technician May 15** * Nursing applications will be accepted beginning April 1. ** Allied Health applications will be accepted beginning Aug. 1. NAME Last Name First Name Middle Initial *Social Security Number ADDRESS Street City State Zip Township School District PHONE Home Work or cell DATE OF BIRTH / / Maiden or Former Names Month Day Year CITIZENSHIP U.S. Citizen Non-U.S. Citizen *GENDER Male Female ARE YOU A MEMBER OF THE MILITARY? Active Duty Reserves Veteran *RACE/ETHNICITY Are you Hispanic or Latino? Yes No Select one or more as appropriate: American Indian/Alaska Native Asian Black/African American Native Hawaiian/Pacific Islander White *One of my parents has a bachelor s degree Yes No STATUS New (first time in any college) Returning (prior KCC student) Transfer (previous enrollment in any other college) * This information is optional but requested in order to provide information required by the Office of Civil Rights to assist in determining compliance with the Equal Opportunity Programs under the Civil Rights Act of 1964. It is not used in application decisions. INTENDED PROGRAM (check one to apply) 228 Dental Hygiene (fall) 273 Medical Lab Technician (fall)** 278 Full-time Associate degree RN (fall) 279 Part-time Associate degree RN (spring) Year of intended admission 283 Physical Therapist Assistant (fall) 288 Radiography (summer) 287 Magnetic Resonance Imaging (Summer) Have you previously applied to a nursing and/or allied health program Yes No If yes, which program? 281 Full-time Advanced Placement LPN to RN (fall)* 281 Part-time Advanced Placement LPN to RN (spring)* * Must be a current LPN ** fast track applicants see Program Coordinator. HIGH SCHOOL INFORMATION PREVIOUS COLLEGES AND UNIVERSITIES ATTENDED (Please list all, other than KCC) Name of High School City High school diploma Home-schooled Year Year GED State Year Highest educational level or degree attained thus far: Some college courses College certificate Associate degree Baccalaureate degree Master s degree Doctorate degree EDUCATIONAL INTENT What is your reason for enrolling at KCC? To earn a certificate or associate degree (24) To prepare to transfer to a four-year college or university (08) To gain the skills necessary to enter a new occupation, or retain or advance in my present position (06) To satisfy a personal interest or pleasure goal (07) I am uncertain about my educational plans at this time (23) I certify that all answers given to questions in this application are correct and complete to the best of my knowledge and hereby agree to abide by all the regulations of Kellogg Community College. Signature PAGE 2 Kellogg Community College is an equal opportunity institution and does not discriminate on the basis of race, religion, color, national origin, gender, marital status, sexual orientation, age, or disability in its programs, services or activities. Direct inquiries regarding the nondiscrimination policies can be made to either the Vice President for Instruction or the Director of Human Resources, 450 North Avenue, Battle Creek, MI 49017-3397.

Admission REQUIREMENTS Laddered Nursing Program (RN) Admission Requirements Each of the following must be complete with a grade of B- or higher at the time the Nursing Application is submitted. Please verify that these courses are complete prior to submitting the Nursing Application. Incomplete applications will not be considered and will be returned to the student. All college-level admission requirements must be completed within six years prior to admittance to the program. Admission requirements for the full- and part-time Laddered Nursing Program are as follows: Admission requirements completed with a grade of B- (2.67) or higher: Chemistry 100 (Fundamentals of Chemistry I) or equivalent, or higher level chemistry course Mathematics 101 (Beginning Algebra) or equivalent, or higher (excluding MATH 115), or COMPASS algebra score of 40 or higher Biology 201 (Human Anatomy) or equivalent Biology 202 (Human Physiology) or equivalent Please note High school transcripts are only required for students who are using high school Algebra or Chemistry to meet Admission Requirements. High school-level admission requirements are only applicable two years post-high school graduation. Advanced Placement Option (for applicants who already hold LPN status and want RN status) Each of the following admission requirements must be complete with the required grade at the time the Nursing Application is submitted. Please verify that these courses are complete prior to submitting the Nursing Application Packet. Incomplete applications will not be considered and will be returned to the student. Admission requirements for the full- and part-time Advanced Placement (A/P) Programs are as follows: Admission requirements completed with a grade of C or higher: COMM 101 Interpersonal Communication OR COMM 111 Business and Technical Communications, OR equivalent ENGL 151 Freshman Composition, or equivalent PSYC 201 Introduction to Psychology, or equivalent PSYC 220 Developmental Psychology, or equivalent Admission requirements completed with a grade of B- or higher:* CHEM 100 Fundamentals of Chemistry I, or equivalent, or higher level chemistry course MATH 101 Beginning Algebra or higher, or equivalent, or COMPASS algebra score of 40 or higher BIOL 201 Human Anatomy, or equivalent BIOL 202 Human Physiology, or equivalent *Any student not meeting the B- or higher requirement may contact Selective Admissions regarding the appeal process. Submission of current Michigan LPN licensure Applicants who have completed the above criteria and the documentation listed on page 1 will be admitted to the program according to the date of application completion. Keep for your records PAGE 3

Competitive Admission into the 2014/2015 Nursing Program (Not available for Advanced Placement Program) Applicants who sign and date the Competitive Application (page 5) AND complete the criteria required for competitive admission to the Nursing program, will be considered for a competitive seat. Please note Being considered for a competitive seat does not change your status on the traditional list, which is ranked by date of application completion. The following items will be used to rank your application for competitive seating, if you choose to be considered. The required competitive courses (ITEM 1) are required IN ADDITION TO the other Nursing admission requirements outlined on pages 1 and 3 of this packet. The TEAS assessment results (ITEM 3) are also required to obtain a competitive seat. (Please see page 5 for TEAS registration information.) The general education co-requisite courses (ITEM 2) are optional, with the exception of CHEM 100, which is required to be considered an applicant to the nursing program. ITEM 1: Required Competitive Coursework COURSEWORK COURSE TITLE POINTS ENGL 151 Freshman Composition MATH 121 or higher* Intermediate Algebra BIOL 201 Human Anatomy BIOL 202 Human Physiology *excluding Math for Liberal Arts (MATH 115) A to A- (1st attempt) = 40 points B+ to B- (1st attempt) = 30 points A to A- (2nd attempt) = 20 points B+ to B- (2nd attempt) = 10 points (160 points maximum for this section) ITEM 2: General Education Coursework COURSEWORK COURSE TITLE POINTS CHEM 100 (Required) Fundamentals of Chemistry I COMM 101 (Optional) Interpersonal Communication Each course that has been completed with a B- or better will be awarded 5 points. (20 points maximum for this section) PSYC 201 (Optional) PSYC 220 (Optional) Introduction to Psychology Developmental Psychology ITEM 3: TEAS Assessment Results (REQUIRED) The minimum scores required for points to be awarded: Reading 70%; Total 65% READING SCORE TOTAL SCORE POINTS TOTAL SCORE: 96-100 = 84 points % % 91-95 = 72 points (84 points maximum for this section) 86-90 = 60 points 81-85 = 48 points 76-80 = 36 points 71-75 = 24 points 65-70 = 12 points Below 65 = 0 points TOTAL POINTS (264 maximum total points) Total Item 1 + Total Item 2 + Total Item 3 = Keep for your records PAGE 4

Admissions Competitive application 2014/2015 Nursing Program (Not available for Advanced Placement Program) Competitive seats will be offered for the Associate Degree Nursing program during the 2014/2015 academic year. These seats are filled based on competitive admission requirements. (Please see page 4 for the competitive admission requirements). Seats are available in both the full-time and part-time category. To be considered for a competitive seat, IN ADDITION TO being placed on the traditional list, you must: 1. Submit the Nursing Application by the January 15, 2014 deadline, after completing the Nursing admission requirements as outlined on pages 1 and 3 of this packet; AND 2. Complete all sections of the Test of Essential Academic Skills* (TEAS ) and submit the assessment results by 5:00 p.m. January 15, 2014. If you choose to take the TEAS at a location other than KCC, you must take Version V (5), and a copy of the assessment scores must be submitted no later than 5:00 p.m., January 15, 2014. We are not able to accept electronic submissions. Please be sure to print and submit a copy of your TEAS results. *The TEAS was developed to measure basic essential skills in the academic content area domains of Reading, Mathematics, Science, and English and Language Usage. These entry level skills were deemed important for nursing program applicants by a panel of nursing program curriculum experts. The TEAS is a 170-item, four-option, multiple-choice assessment. To prepare in an organized and efficient manner, you should know what to expect from the real assessment. You may go to www.atitesting.com to obtain information and purchase study manuals and practice tests. 3. Sign, date and submit this page to the Admissions office indicating that you want to be considered for a competitive seat. Please note that there is a $35** cost associated with the TEAS assessment and payment must be made at the time of testing, by credit or debit card. **Cost of TEAS assessment is subject to change. If you are interested in being considered for a competitive seat in the 2014/2015 Nursing program, please sign and date below, and return to the Admissions office along with the rest of the Nursing Application. Signature Print Name Student ID# The TEAS test will be offered at KCC on specific dates for students who are registered for, or have completed their final semester of all admission requirements (traditional and competitive). Please indicate your first, second, and third choice, and you will be registered for the test date that is available. A confirmation will be sent to your KCC e-mail account regarding the test that you have been registered for. Registration for TEAS is a first-come first-served basis. Twelve (12) TEAS sessions will be offered at KCC on the following dates: Students may submit this form if they are registered for the final semester of Admission Requirements. TEAS TESTING DATES Please indicate your first, second, and third choice. Tues, 7/16/2013, 6 pm - 9:30 pm Thur, 10/17/2013, 3 pm - 6:30 pm Name First Last Fri, 7/19/2013, 8:30 am - 12 pm Fri, 10/18/2013, 6 pm - 9:30 pm Tues, 8/13/2013, 6 pm - 9:30 pm Thur, 11/14/2013, 3 pm - 6:30 pm Student ID# Fri, 8/16/2013, 8:30 am - 12 pm Fri, 11/15/2013, 6 pm - 9:30 pm Thur, 9/19/2013, 3 pm - 6:30 pm Thur, 12/12/2013, 3 pm - 6:30 pm Phone Fri, 9/20/2013, 6 pm - 9:30 pm Fri, 12/13/2013, 6 pm - 9:30 pm All sessions are limited to 24 students and will be administered in Roll Building 211. PAGE 5