NOTE: Immunization requirements are based on CDC recommendations for health care workers and Clinical site requirements.

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1 4500 Steilacoom Blvd SW Lakewood WA Practical Nurse Application WE DO NOT HAVE A DEADLINE FOR APPLICATIONS. WE ARE FIRST COME FIRST SERVED. THE WAITLIST IS CURRENTLY GREATER THAN THREE YEARS. Welcome. We appreciate your interest in our Practical Nurse Program. The application process consists of several requirements prior to admission please read the entire packet. Admission policies are subject to change. Applicants are accepted under the terms in place at the time the application is received. The student is advised to keep up to date on any changes that might affect his/her qualifications for acceptance. PROGRAM OVERVIEW The Practical Nursing Pathway prepares the student for employment as an entry-level practical nurse. Following successful completion of the pathway, the graduate is eligible to apply for licensure as a licensed practical nurse. The LPN provides basic client care under the supervision of a registered nurse, ARNP, physician, or other health care professional. LPN s are employed by long-term care facilities, in outpatient settings, and hospitals. The LPN performs basic client care, administers medications, performs skilled nursing procedures, and documents in the client record. During the program the student receives instruction in varied areas of nursing practice including basic nursing concepts and skills along with medical-surgical, geriatric, maternal-infant, and mental health nursing. During laboratory classes the student practices nursing skills, some of which are learned by practicing on classmates (i.e. bathing, injections, blood draws). The student also participates in a variety of clinical experiences that allow him/her to apply theoretical knowledge to client care. During this clinical experience, the student is expected to demonstrate competence in providing safe patient care. PROGRAM COMPONENTS The Practical Nursing Program begins each fall and spring quarter. The program is 4 quarters to in length. Classroom hours are 8 A.M. to 4 P.M. Monday through Friday for the first 2 quarters, with a 3- week clinical experience during the first and second quarter. The student is at a clinical site Tuesday through Friday and in the classroom on Monday during the 3rd and 4th quarters. Clinical experiences may be scheduled during day, evening, or weekend hours and may begin as early as 5:45 A.M. or end as late as 11:00 P.M. Students may be required to drive up to 50 miles to some clinical sites.

2 HEALTH DECLARATION It is essential that nursing students be able to perform a number of physical activities during the clinical portion of the program. This will include lifting/transferring patients, observation/assessment of clients using the physical senses, standing for long periods, performing bending activities, and executing movements required to provide care for patients in all health care settings. The clinical experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties that impact patients lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should carefully consider the mental and physical demands of the program prior to making application. INSTRUCTIONS FOR ADMISSION: *****Current Application Process**** Admission to the PN program involves 2 parts. Part 1 must be completed in order to receive notification of your projected assigned class and admission date. Part 2 must be completed prior to the deadlines to secure your seat in the assigned class. Part 1: Complete items 1 through 3. Applications must be turned into the Cashier s office in building 17 along with payment of fees. Ensure the cashier s receipt with the time/date stamp is attached to your application. Maintain a copy of the application and receipt for your records. Once the nursing program receives your completed application (ALL ITEMS 1-5 must be submitted), you will receive an letter acknowledging application receipt and your expected start date. 1. Complete & sign: Clover Park Technical College LPN Application Form 2. Provide a copy of High School Completion Transcript or GED: Either is required to be admitted into the pathway. A copy of high school transcript does not need to be official (diploma or college transcript will not suffice) or a copy of your GED is required for admission. 3. Non-refundable Admissions fee $ ALL FEES ARE SUBJECT TO CHANGE. Note: Under the current application process, you do not have to produce the required Part 2 documentation until 3 months prior to your acknowledged projected start date in the program. It is the student s responsibility to ensure all required documents are received by the nursing department prior to the posted deadlines. Applicants who do not submit required documentation by the deadline will be removed from their assigned class and will be given a starting date for a future class. IMPORTANT PLEASE NOTE: Current deadlines for Part 2 required documentation: Fall admit Documentation due no later than June 25. Spring admit - Documentation due no later than January 1.

3 Part 2: Complete and provide required documentation of items included in 1 through 4 below: DEADLINE FOR SUBMISSON OF DOCUMENTATION REQUIRED IN PART 2 OF THE APPLICATION IS AS FOLLOWS: FALL ADMISSION JUNE 25 SPRING ADMISSION JANUARY 1 Students must complete and submit documentation of the following prior to the above deadlines: 1. Prerequisite Academic Courses: College level courses in the following classes must be successfully completed with a B or higher prior to submitting the application. Please Note: If you have taken any prerequisites at another college, you must fill out the Request for Transfer of Credit Form. Mail your official transcript to Clover Park Technical College ATTN: Credential Evaluator (Bev Custard). Any questions or concerns regarding transferring credits can be made to the following ) After credit is granted, the request for transfer credit form will be returned to you. Approval of transferred credits must be received by the nursing program prior to June 25 th of the year you are projected to start. ENGL& 101 or ENGL& 102 or ENGL& 235 (5 cred). PSYC& 100 General Psychology (5 cred). MATH& 141 Pre-calculus or MATH& 146 Intro to Statistics or MAT 108 Math for Health Occupations (5 cred). BIOL 241 A&P I w/lab AND BIOL 242 A&P II w/lab or BIO 118 (please note starting Winter 2013 BIO 118 will be replaced by BIOL 160). 2. Complete a Nursing Assistant Certification (NA-C/ CNA) program and take the Washington State Nursing Certification Exam. Provide a copy of current Washington State Nursing Assistant Certification. 3. Proof of Medical/Health Insurance. Clinical facilities require this insurance. Call our Advising Office at for a low cost insurance offered to students. Please submit a copy of your insurance card. You may also sign a note stating that you will have insurance when school starts. 4. A copy of both sides of the American Heart Association Healthcare Provider CPR card. AHA cards ONLY are accepted. The card must be kept current during your attendance in the program. Online CPR courses are not accepted.

4 IMMUNIZATION INSTRUCTIONS: Please read carefully!!! You must have the immunizations listed below, but you are NOT required to submit any documentation to the nursing department prior to the first day of class. You are required to BRING a copy of proof of immunizations listed below on the first day of class. Please note: TB and Seasonal Flu vaccines are required annually and must be kept current throughout the program. You will be required to upload proof of immunizations into a program called certified background during your first weeks in class. This is a requirement that must be met in order to attend clinical rotations. Instructions for uploading these documents will be provided during your program orientation at the start of the quarter. You will not be allowed to attend clinical site rotations until proof of the required immunizations is met. NOTE: Immunization requirements are based on CDC recommendations for health care workers and Clinical site requirements. *****IMPORTANT*****ALL IMMUNIZATIONS MUST BE DOCUMENTED ON AN OFFICIAL FORM PRINTED FROM THE DOCTOR, CLINIC, OR PHARMACY WHICH INCLUDES THE NAME OF THE IMMUNIZATION, RESULTS, AND DATE. WE ALSO ACCEPT THE WASHINGTON STATE IMMUNIZATION BOOKLET ONLY IF THE IMMUNIZATIONS HAVE BEEN STAMPED BY HE CLNIC OR DOCTOR. ALL DOCUMENTATION OF TITERS MUST INCLUDE THE TYPE OF TITER, DATE, AND RESULTS. Hepatitis B Proof of immunity by series of three vaccinations and Titer. If you have a negative titer, you must repeat the series and receive a 2 nd titer. MMR (Measles, Mumps, Rubella) Proof of vaccination (two 92) doses) or Proof of immunity by titers for each Rubeola, Mumps, Rubella Tetanus, Diphtheria, Pertussis Tdap required one time prior to admission 9good for 10 years). Varicella (Chicken Pox) Proof of vaccination (2 doses) or Proof of immunity by Titer Tuberculosis (TB) Skin Test 2-step PPD required or 3 year concurrent history of annual tests or QuantiFeron serum test or If history of positive TB test results, a current chest x-ray report with the tests is required.

5 CLOVER PARK TECHNICAL COLLEGE LPN APPLICATION STUDENT ID# NAME LAST FIRST MI ADDRESS CITY STATE ZIP CODE HOME PHONE CELL OR MESSAGE ADDRESS OTHER NAMES YOU HAVE BEEN KNOWN BY LAST HIGH SCHOOL ATTENDED CITY STATE LAST YEAR ATTENDED YES NO. GRADUATED? LAST COLLEGE ATTENDED CITY STATE LAST YEAR ATTENDED YES NO. GRADUATED? U.S. CITIZEN? YES NO (IF NO, CHECK TYPE OF VISA) I have provided true, correct and complete information with this application. I have read and understand the information included in this application packet. I have read and understand the Health Declaration & WSP background information on page 1 and certify that I will be able to perform the essential functions as a nursing student at Clover Park Technical College... Applicant Signature Date Non-Discrimination Policy: Clover Park Technical College does not discriminate on the basis of race, color, national origin, sex, disability, sexual orientation, or age in its programs and activities. Any person at the college who feels he or she has reason to claim discrimination or unfair treatment may contact Human Resources to speak to an Equity Representative, (253) Limit of Liability: The College s total liability for claims arising from a contractual relationship with the student in any way related to classes of programs shall be limited to the tuition and expenses paid by the student to the College for those classes of programs. In no event shall the College be liable for any special, indirect, incidental, or consequential damages, including but not limited to loss of earnings or profits.

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