Phoenix College Medical Laboratory Science Program (MLT) Application Associate in Applied Science in Medical Laboratory Science Program

Size: px
Start display at page:

Download "Phoenix College Medical Laboratory Science Program (MLT) Application Associate in Applied Science in Medical Laboratory Science Program"

Transcription

1 Phoenix College Medical Laboratory Science Program (MLT) Application Associate in Applied Science in Medical Laboratory Science Program Submission : September 6, 2013 Submit application to Phoenix College Advisement, 1202 W. Thomas Road, Phoenix, AZ by 4pm on September 6, 2013 We appreciate your interest in the Medical Laboratory Science Program (MLT Level program) at Phoenix College. Please follow this checklist carefully to insure that your application and documentation are in order for the selection committee. Completed Medical Laboratory Science Program (MLT) Application Completed Program Immunizations & Health Declaration Completed and signed Health Declaration signed after August 1, 2013 by health care provider Copy of MMR vaccination records or proof of positive titers for Measles, Mumps, and Rubella Copy of Varicella vaccination records or proof of positive titer for Varicella Copy of Tetanus/Diphtheria (Td) vaccination records completed after January 1, 2004 Copy of Hepatitis B vaccination records or proof of positive titer for Hepatitis B Copy of Negative TB skin test or chest x-ray completed after August 1, 2013 Copy of CPR card for the Health Care Provider must be valid through December 31, 2014 Unofficial high school/college transcript showing completion of prerequisite course work or signed waiver for prerequisites Copy of high school diploma or GED Completed reference form, to be mailed separately Completed experience or statement of understanding Medical Laboratory Science form Copy of valid Fingerprint Clearance Card (both sides of the card) Sign the MCCCD Background Check Requirements form I have completed this form and attached all of the required documentation listed above. Signature Print Name Student Number If you have any questions about this process please contact Advisement at (602) ALL DOCUMENTATION MUST BE SUBMITTED AT THE SAME TIME, excluding the reference letter. NO PARTIAL PROGRAM APPLICATION WILL BE ACCEPTED. THE COLLEGE DOES NOT GUARANTEE ALL APPLICANTS TO BE ACCEPTED INTO THE MEDICAL LABORATORY SCIENCE (MLT) PROGRAM DUE TO LIMITATIONS OF CLINICAL PLACMENTS AND ACCREDITATION RESTRICTIONS.

2 Medical Laboratory Science (MLT Level) Program Application Name Last First Middle Former Name(s) (Maiden) (names that may identify transcripts) Student Identification Number Telephone work home Mailing Address Street City State Zip Permanent Address Street City State Zip Address Medical Laboratory Science reapplication? yes, I applied in 2012 at Phoenix College no Are you a legal Arizona resident as defined in the Phoenix College catalog? yes no present stay in Arizona began Month Day Year ( of birth if Arizona resident since birth) Most recent state of legal residence prior to moving to Arizona What date did you leave that state? Month Day Year Part I Education List each college attended COLLEGE PRINT FULL NAME CITY AND STATE DATES ATTENDED Check each level of education you have completed: GED High School Diploma AA Degree Other (please specify) Submission due date is September 6, 2013

3 Part II Checklist Complete EACH of the following steps to insure that you receive proper credit: Submit the following to: Advisement, Coordinator Medical Laboratory Science (MLT) Admissions Office 1202 West Thomas Road Phoenix, AZ Completed Medical Laboratory Science Application postmarked OR hand-delivered ALL UNOFFICIAL TRANSCRIPTS FROM EACH UNDERGRADUATE COLLEGE AND UNIVERSITY ATTACHED TO APPLICATION Course work approved as substitute or equivalent must have written documentation. Verbal consent will not be accepted. Request one Reference Form be completed by an employer and mailed directly to Advisement (address above). Complete EACH of the following steps to insure that you receive proper credit: Submit the following to: Phoenix College Admissions & Records 1202 W. Thomas Road Phoenix, AZ Phoenix College Student Information Form (application), if not currently enrolled. Official transcripts from all colleges and universities must be sent directly from issuing institution(s) and officially evaluated by the Phoenix College Office of Admissions and Records (at the written request of the student) as follows: STEP 1: Contact those colleges or universities requesting that your official transcripts be sent to Phoenix College Admissions and Records Office. There may be a charge for official transcripts. STEP 2: After 3 to 4 weeks, check with Phoenix College Admissions and Records Office at to verify arrival of all transcripts. If transcripts have not been received, contact the former institutions. STEP 3: (This step does not apply to schools within the Maricopa Community College District) - Complete Transcript Evaluation Request Form and submit it to the Office of Admissions and Records. - Official evaluation of your credits will be made AFTER all transcripts have been received. - Following 3 to 5 weeks from the date that your last transcript has been received, you will receive a copy of the evaluation. Courses considered freshman level (numbered 100 or above) and grades of C or better may be transferred. Only credits from regionally accredited college(s) identified in the college catalog will be evaluated. If you have questions about this report, please contact your advisor. STEP 4: If you did not receive credit for a specific prerequisite or corequisite, you may have to provide a course description for review by Admissions and Records. International Transcripts Please contact the Admissions and Records Office for evaluation of transcripts from institutions outside the United States. Submission due date is September 6, 2013

4 Part III Course Work 1. At least five prerequisites and all general education requirements must be completed and grades posted prior to the Medical Laboratory Science Program start date, December 13, Only those grades completed and posted by the application deadline date will be considered for evaluation. 3. All courses must reflect a grade of C or better. Prerequisites Course Grade College BIO 156 Introductory Biology for Allied Health or higher Completed In Progress (Check) CHM 130 and CHM 130 LL MAT 102 HCC 130 HCC 145 AA HCC 109 or EMT 101 Fundamental Chemistry and Lab or higher Math Concepts or higher level math specify course: Fundamentals in Health Care Delivery Medical Terminology I or comparable course CPR for HC Provider or Current CPR Certificate E (HC or Rescuer Level) General Education Courses that must be completed prior to submitting a program application Completed Course Grade College ENG101 or 107 First Year Composition ENG102 or ENG 108 or ENG 111 COM100 or 110 or 225 or 230 CRE101 BIO160 or CHM151 First Year Composition Communication Critical & Evaluative Reading I or exempt by assessment Humanities & Fine Arts any approved course Social & Behavioral Sciences any approved course BIO160 Introduction to Human Anatomy & Physiology or CHM151 General Chemistry I In Progress (Check)

5 Part IV Experience in the Medical Laboratory Science Field OR Statement of Understanding Attach the completed documents, Experience in the Medical Laboratory Science Field (or letter from employer) OR Statement of Understanding the Field of Medical Laboratory Science to your application. Part V - Reference Form Request an employer to complete and mail the Reference Form directly to Advisement. Part VI I certify that: 1. All information provided in this application is true and complete. 2. I understand that I must have completed at least four prerequisites and be enrolled in the fifth prerequisite, prior to enrolling in the Medical Laboratory Science courses. 3. It is my responsibility to provide all requested information to complete my file. Failure to provide all requested information may adversely affect my evaluation. 4. Admission to the program is conditional until all requirements have been satisfactorily completed. 5. I understand and agree to actively participate in the learning process as required. Applicant Signature Submission due date is September 6, 2013

6 Part VII Additional Information Describe any special skills you may possess that would enhance your application to the Admissions Committee. Equal Opportunity Statement Phoenix College, one of the Maricopa Community Colleges, does not discriminate on the basis of race, color, gender, national origin, religion, handicap or age in application, admission, participation, access and treatment of persons in instructional or employment programs and activities. Submission due date is September 6, 2013

7 Experience in the Medical Laboratory Science Field ONLY complete this section if you have relevant work experience in laboratories. Name Student Identification Number 1. Briefly describe your duties while working in the Medical Laboratory Science field: 2. Experience Select one of the following indicating your total length of experience in the Medical Laboratory Science field: 6 months to less than 1 year full-time experience 1 year to less than 2 years full-time experience 2 years to less than 3 years full-time experience 3 years to less than 4 years paid full-time experience 4 years to less than 5 years full-time experience 5 years or more full-time experience 3. Work Experience Summary Employer From To Number of hours per week Example: Arizona Clinical Laboratory Jan./ 2009 Jan./ I verify that all of the above information is true and correct. I understand that any falsification could result in nonacceptance into the program or dismissal from the program. Failure to complete and sign this document will result in non-consideration of work/observation experience. Applicant Signature I verify that has worked for me as listed above and that all of the above information is true and correct. Supervisor Signature PRINT Supervisor Name Notary (or attach letter from supervisor on supervisor s letterhead) Submission due date is September 6, 2013

8 Statement of Understanding the Field of Medical Laboratory Science Applicants with no relevant work experience in medical laboratories must complete this Statement of Understanding (Attach to your application) Name Student Identification Number Briefly describe, in one page of less, your understanding of the Medical Laboratory Science field for Laboratory professionals in the Medical Laboratory Technician scope of practice. Please also document in your narrative response the resources used to acquire your understanding of the Medical Laboratory Science field (examples web site, observation, interview of a current Laboratory professional, etc.).

9 Reference Form - Phoenix College Medical Laboratory Science (MLT) Program Applicant Instructions: This reference is required to complete your application. It must come from an employer who knows you well and can comment on your academic ability, employment skills and your suitability and preparation for a career in Medical Laboratory Science. Please give the form to your designated reference, providing him or her with a stamped envelope, addressed to: Advisement, Phoenix College Hannelly Center, 1202 W. Thomas Road, Phoenix, AZ References written in confidence are often of greater value in assessing an applicant s qualifications. Please read the statement below and indicate your preference with regard to the confidentiality of this evaluation. In accordance with the Family Educational Rights and Privacy Acts of 1974 (Public Law ), I understand that I have the right of access to this reference but may choose to waive that right. My preference is noted below: I waive my right of access to this reference form I do NOT waive my right of access to this reference form Applicant s signature Applicant s name (please print) Student Identification # Evaluator Instructions: Please complete the following information and return directly to the Phoenix College Hannelly Center in the stamped envelope provided by the applicant. Sign the envelope on the back across the sealing flap. Name Title/Occupation Address Street City State Zip Phone ( ) How long have you known the applicant as an employee?: In what capacity? (check all that apply): Employer Supervisor Please indicate your evaluation of the applicant with a check mark: Intellectual Ability Communication Skills Emotional Maturity Adaptability Team Player Dependability Conflict Resolution Awareness of Limitations Reaction to Criticism Personal Integrity/Honesty Overall Evaluation Exceptional Excellent Good Average Below Average Not Observed Overall recommendation for admission to the Medical Laboratory Science Program: This applicant has my highest recommendation. I recommend the applicant with no reservation. I recommend the applicant with some reservations. I do not recommend this applicant. Additional comments optional. You may attach a separate sheet. Signature This form must be postmarked NO LATER THAN September 3, 2013

10 Allied Health and Nursing Programs Maricopa County Community College District Summary of Criminal Background Check Requirements effective September 1, 2011 Overview of the Requirements In order for students to be admitted to or maintain enrollment in good standing in Maricopa County Community College District s ( MCCCD ) Allied Health and Nursing programs ( Programs ) beginning on September 1, 2011, students must provide with their application to a Program all of the following: A copy of an Arizona Department of Public Safety Level One Fingerprint Clearance Card ( Card ). Students are required to pay the cost of applying for the Card. Cards that are NOT Level One status will not be accepted An original version of the Criminal Background Check Disclosure Acknowledgement form attached to this Summary signed by the student. Once a student has been offered placement in a nursing or allied health program they will be given information on how to complete the MCCCD supplemental background check with MCCCD s authorized vendor Certified Background. To enter the program the student must be able to provide documentation demonstrating that the student has achieved a Pass status on the MCCCD supplemental background check. Students are required to pay the cost of obtaining the background check. Students whose background checks on the date of actual admission to a Program that are more than 6 months old or students who have been in a Program for more than 12 months may be requested to obtain an updated background check. The addition of this criminal background check is due to the fact that some of MCCCD s largest clinical experience partners have established standards that are more stringent than those for obtaining a Card. At all times during enrollment in a Program, students must obtain and maintain BOTH a valid Level-One Fingerprint Clearance Card and passing disposition on supplemental background check performed by MCCCD authorized vendor. Admission requirements related to background checks are subject to change as mandated by clinical experience partners Implementation of the Requirements 1. Students that are denied issuance of a Card may be eligible for a good cause exception through the Arizona Department of Public Safety. It is the student s responsibility to seek that exception directly with the department. Until the student obtains a Card and meets the other requirements for admission, he or she will not be admitted to a Program. 2. Students admitted to a Program whose Card is revoked or suspended must notify the Program Director immediately and the student will be removed from the Program in which they have been admitted or are enrolled. Any refund of funds would be made per MCCCD policy. 3. The Criminal Background Check Disclosure Acknowledgement directs students to disclose on the data collection form of the MCCCD authorized background check vendor all of the requested information as well as any information that the background check may discover. Honesty is important as it demonstrates character. Lack of honesty will be the basis for denial of admission or removal from a Program if the information that should have been disclosed but was not would have resulted in denial of admission. Failure to disclose other types of information constitutes a violation of the Student Code of Conduct and may be subject to sanctions under that Code. Students have a duty to update the information requested on the [background check vendor] data collection form promptly during enrollment in a Program. The [background check vendor] data collection form may ask for the following information but the form may change from time to time: Legal Name Maiden Name Other names used Social Security Number of Birth Arrests, charges or convictions of any criminal offenses, even if dismissed or expunged, including dates and details. Pending criminal charges that have been filed against you including dates and details. Participation in a first offender, deferred adjudication or pretrial diversion or other probation program or arrangement where judgment or conviction has been withheld.

11 The authorized MCCCD background check vendor will be asked to pass or fail each student based on the standards of MCCCD s clinical experience partners that have established the most stringent requirements. The sole recourse of any student who fails the background check and believes that failure may have been in error is with the background check vendor and not MCCCD.

12 ACKNOWLEDGEMENT OF CRIMINAL BACKGROUND CHECK REQUIREMENTS APPLICABLE TO STUDENTS SEEKING ADMISSION TO ALLIED HEALTH OR NURSING PROGRAMS ON OR AFTER SEPTEMBER 1, 2011 Maricopa County Community College District In applying for admission to a Nursing or Allied Health program ( Program ) at the Maricopa County Community College District, you are required to disclose on the Arizona Department of Public Safety (DPS) form all required information and on the MCCCD authorized background check vendor data collection form any arrests, convictions, or charges (even if the arrest, conviction or charge has been dismissed or expunged), or participation in first offender, deferred adjudication, pretrial diversion or other probation program on this form. Additionally, you must disclose anything that is likely to be discovered in the MCCCD supplemental background check that will be conducted on you. Please complete the DPS form, the MCCCD authorized background check vendor form and any clinical agency background check form honestly and completely. This means that your answers must be truthful, accurate, and complete. If you know of certain information yet are unsure of whether to disclose it, you must disclose the information, including any arrest or criminal charge. Additionally, By signing this acknowledgement, you acknowledge the following: 1. I understand that I must submit to and pay any costs required to obtain a Level One Fingerprint Clearance Card and an MCCCD supplemental criminal background check. 2. I understand that failure to obtain a Level One Fingerprint Clearance Card will result in a denial of admission to a Program or removal from it if I have been conditionally admitted. 3. I understand that I must submit to and pay any costs required to obtain an MCCCD supplemental background check. 4. I understand that failure to obtain a pass as a result of the MCCCD supplemental criminal background check will result in a denial of admission to a Program or removal from it if I have been conditionally admitted. 5. I understand that, if my Level One Fingerprint Clearance Card is revoked or suspended at any time during the admission process or my enrollment in a Program, I am responsible to notify the Program Director immediately and that I will be removed from the Program. 6. I understand that a clinical agency may require an additional criminal background check to screen for barrier offenses other than those required by MCCCD, as well as a drug screening. I understand that I am required to pay for any and all criminal background checks and drug screens required by a clinical agency to which I am assigned. 7. I understand that the both the MCCCD supplemental or the clinical agency background check may include but are not limited to the following: Nationwide Federal Healthcare Fraud and Abuse Databases Social Security Verification Residency History Arizona Statewide Criminal Records Nationwide Criminal Database Nationwide Sexual Offender Registry Homeland Security Search 8. By virtue of the MCCCD supplemental background check, I understand that I will be disqualified for admission or continued enrollment in a Program based on my criminal offenses, the inability to verify my Social Security number, or my being listed in an exclusionary database of a Federal Agency. The criminal offenses for disqualification may include but are not limited to any or all of the following: Social Security Search-Social Security number does not belong to applicant Any inclusion on any registered sex offender database Any inclusion on any of the Federal exclusion lists or Homeland Security watch list Any conviction of Felony no matter what the age of the conviction Any warrant any state Any misdemeanor conviction for the following-no matter age of crime

13 o violent crimes o sex crime of any kind including non consensual sexual crimes and sexual assault o murder, attempted murder o abduction o assault o robbery o arson o extortion o burglary o pandering o any crime against minors, children, vulnerable adults including abuse, neglect, exploitation o any abuse or neglect o any fraud o illegal drugs o aggravated DUI Any misdemeanor controlled substance conviction last 7 years Any other misdemeanor convictions within last 3 years o Exceptions: Any misdemeanor traffic (DUI is not considered Traffic) 9. I understand that I must disclose on all background check data collection forms (DPS, MCCCD background check vendor and a clinical agency background check vendor) all required information including any arrests, convictions, or charges (even if the arrest, conviction or charge has been dismissed or expunged), or participation in first offender, deferred adjudication, pretrial diversion or other probation program. That includes any misdemeanors or felonies in Arizona, any other State, or other jurisdiction. I also understand that I must disclose any other relevant information on the forms. I further understand that non disclosure of relevant information on the forms that would have resulted in failing the background check will result in denial of admission to or removal from a Program. Finally, I understand that my failure to disclose other types of information of the forms will result in a violation of the Student Code of Conduct and may be subject to sanctions under that Code. 10. I understand that, if a clinical agency to which I have been assigned does not accept me based on my criminal background check it may result in my inability to complete the Program. I also understand that MCCCD may, within its discretion, disclose to a clinical agency that I have been rejected by another clinical agency. I further understand that MCCCD has no obligation to place me when the reason for lack of placement is my criminal background check. Since clinical agency assignments are critical requirements for completion of the Program, I acknowledge that my inability to complete required clinical experience due to my criminal background check will result in removal from the Program. 11. I understand the Programs reserve the authority to determine my eligibility to be admitted to the Program or to continue in the Program and admission requirements or background check requirements can change without notice. 12. I understand that I have a duty to immediately report to the Program Director any arrests, convictions, placement on exclusion databases, suspension, removal of my DPS Fingerprint Clearance Card or removal or discipline imposed on any professional license or certificate at any time during my enrollment in a Program. Signature Printed Name Desired Health Care Program

14 Medical Laboratory Sciences Essential Functions A student must be able to perform the following essential requirements to complete the activities necessary to participate in the Medical Laboratory Sciences program: 1. Characterize the color, consistency and clarity of biological specimens or reagents. 2. Employ a clinical grade binocular microscope to discriminate among fine differences in structure and color (hue, shading, and intensity) in microscopic specimens. 3. Read and comprehend (English) text, numbers and graphs displayed in print and on a video monitor. 4. Move freely and safely about a laboratory. 5. Perform moderately taxing continuous physical work uisng proper body mechanics and ergonomics, often requiring prolonged sitting over several hours. 6. Reach laboratory bench tops and shelves, patients lying in hospital beds or patients seated in specimen collection furniture. 7. Maneuver phlebotomy equipment to collect laboratory specimens. 8. Manual dexterity to manipulate laboratory equipment using proper ergonomics (i.e., pipettes, inoculating loops, test tubes) and adjust instruments to perform laboratory procedures. 9. Manipulate an electronic keyboard to operate laboratory instruments and to calculate, record, evaluate, and transmit laboratory information. 10. Read and comprehend technical and professional materials (i.e., textbooks, magazine and journal articles, handbooks and instruction manuals). 11. Follow oral and written instructions in order to correctly perform laboratory test procedures. 12. Effectively, confidentially, and sensitively converse with health care team members regarding laboratory tests. 13. Communicate with faculty members, student colleagues, staff and other health care professionals orally and in a recorded format (writing, typing, graphics or telecommunications). 14. Be able to manage the use of time and be able to systematize actions in order to complete professional and technical tasks within realistic constraints. 15. Possess the emotional health necessary to effectively use her or his intellect to exercise appropriate judgment. The candidate must be able to provide professional and technical services while experiencing the stresses of task-related uncertainty (i.e., ambiguous test ordering, ambivalent test interruption), emergent demands (i.e., "STAT" test orders), and a distracting environment (i.e., high noise levels, complex visual stimuli). 16. Be flexible, creative and adapt to professional and technical change. 17. Recognize potentially hazardous materials, equipment and situations and proceed safely in order to minimize risk of injury to self and nearby personnel. 18. Be honest, compassionate, ethical and responsible. The student must be forthright about errors or uncertainty. The student must be able to critically evaluate her or his own performance, accept constructive criticism and look for ways to improve (i.e., participate in continuing education activities). The student must be able to evaluate the performance of colleagues and professionals and tactfully offer constructive comments. If you are unable to meet the Essential Functions, please contact the Program Director or Disability Resource Center to discuss needed accommodations. ESSENTIAL FUNCTIONS REQUIREMENTS SIGNATURE I have read and have had the opportunity to have all of my questions answered regarding the Essential Functions for the Phoenix College Medical Laboratory Science Program. My signature represents that I understand these requirements. Signature/date

15 MARICOPA COMMUNITY COLLEGE DISTRICT ALLIED HEALTH PROGRAMS HEALTH AND SAFETY DOCUMENTATION Please attach documentation (test results, etc. for all immunization to this Health and Safety Documentation Home Phone: Cell Phone: Student ID Number: A. MMR (Measles/Rubeola, Mumps, and Rubella): Requires documented proof of two MMRs in lifetime or a positive titer for each of these diseases. 1 st MMR : 2 nd MMR : OR and results of titer: Measles/Rubeola Mumps Rubella B. Varicella (Chickenpox): Requires documented proof of two (2) vaccinations or positive IgG titer. 1 st Varicella : 2 nd Varicella : OR & results of IgG titer: C. Tetanus/Diphtheria (Td) immunization within the past 10 years. Td : D. Tdap once in past Tdap : E. Tuberculosis: Two-Step Testing** for initial skin testing of adults who will be retested periodically TWO-STEP TESTING Use Two-Step Testing for initial skin testing of adults who will be retested periodically. - If first test positive, consider the person infected. - If first test negative, give second test 1-3 weeks later. - If second test positive, consider person infected. - If second test negative, consider person uninfected. - If both parts of Two step test are negative then subsequent testing is done annually with one step procedure INITIAL TEST: Test Given Read Result SECOND TEST (1-3 weeks after initial test): Test Given: Read: Result OR Annual TB skin test (PPD): Test Given Read Result OR Previous Positive PPD test: Provide documentation of negative chest x-ray/evidence of TB disease free status of chest x-ray Result *If applicant has ever had a positive reaction, the test is not to be repeated. Other evidence that the applicant is free from Tuberculosis will be required. **Core Curriculum on Tuberculosis What the Clinician Should Know, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, Georgia, 4 th Edition, (continued)

16 F. Hepatitis B: Documented evidence of completed series or positive antibody titer or declination. If beginning series, first injection must be according to your Program s required timeline and the series must be completed within 6 months. of 1 st injection: of 2 nd injection: of 3 rd injection: OR Hep B Titer : Titer Results: OR Signed Declination Form attached G. Influenza: Documented evidence of influenza vaccination within the past year or declination. of injection: OR Signed Declination Form attached H. For Dental programs-documented evidence of completed Ophthalmic Exam or Exam I. For Dental programs-documented evidence of completed Dental Exam of Exam J. Clearance for Participation in Clinical Practice It is essential that allied health students be able to perform a number of physical activities in the clinical portion of their programs. At a minimum, students will be required to lift patients and/or equipment, stand for several hours at a time and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement their assigned responsibilities. The clinical allied health experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties impacting patients lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. I believe the applicant WILL OR WILL NOT be able to function as an allied Health student as described above. If not, explain: Licensed Healthcare Provider (MD, DO, NP, or PA) Verification of Health and Safety Print Name: Title: Signature: : Address: City: State: Telephone:

17 VACCINATION DECLINATION (PRINT) Student Name (Complete the sections that are appropriate for this student.) Hepatitis B Vaccination Declination I understand that due to my exposure to blood or other potential infectious materials during the clinical portion of my allied program, I may be at risk of acquiring Hepatitis B virus (HBV) infection. The health requirements for the allied health program in which I am enrolled, as described in the Student Handbook, include the Hepatitis B vaccination series as part of the program s requirements. I have been encouraged by the faculty to be vaccinated with Hepatitis B vaccine; however, I decline the Hepatitis B Vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. By signing this form, I agree to assume the risk of a potential exposure to Hepatitis B virus and hold the Maricopa Community College Allied Health Program as well as all health care facilities I attend as part of my clinical experiences harmless from liability in the event I contract the Hepatitis B virus. Student Signature Faculty Signature Influenza Vaccination Declination I understand that due to the nature of health care and the volume of individuals that I may come in contact with, I may be at risk of acquiring an influenza virus. The health requirements for the allied health program in which I am enrolled, as described in the Student Handbook, include the current influenza vaccination as identified by the Centers for Disease Control for the current influenza season as part of the program s requirements. I have been encouraged by the faculty to be vaccinated; however, I decline the influenza vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring influenza. By signing this form, I agree to assume the risk of potential exposure to influenza and hold the Maricopa Community College Allied Health Program as well as all health care facilities I attend as part of my clinical experiences harmless from liability in the event I contract the virus. I also understand that, due to the contagious nature of the virus, that a health care setting may not accept my placement if I refuse vaccination. Student Signature Faculty Signature

Phoenix College 2015-2017 Medical Laboratory Science Program Application Associate in Applied Science in Medical Laboratory Science Program

Phoenix College 2015-2017 Medical Laboratory Science Program Application Associate in Applied Science in Medical Laboratory Science Program Phoenix College 2015-2017 Medical Laboratory Science Program Application Associate in Applied Science in Medical Laboratory Science Program Submission Due Date: 4 pm September 4, 2015 Submit application

More information

Medical Assisting Program Application

Medical Assisting Program Application Medical Assisting Program Application PHOENIX COL E.,E Phoenix College The Center for Excellence in Healthcare Education 3144 N 7th Ave. Phoenix, AZ 85013 Submit completed application and paperwork to:

More information

RADIOLOGIC TECHNOLOGY PROGRAM ASSOCIATE IN APPLIED SCIENCE DEGREE INFORMATION AND ADMISSIONS PACKET

RADIOLOGIC TECHNOLOGY PROGRAM ASSOCIATE IN APPLIED SCIENCE DEGREE INFORMATION AND ADMISSIONS PACKET CENTRAL ARIZONA COLLEGE RADIOLOGIC TECHNOLOGY PROGRAM ASSOCIATE IN APPLIED SCIENCE DEGREE INFORMATION AND ADMISSIONS PACKET Superstition Mountain Campus Radiologic Technology Radiologic Technology is a

More information

PRE-CLINICAL HEALTH AND SAFETY PACKET

PRE-CLINICAL HEALTH AND SAFETY PACKET PRE-CLINICAL HEALTH AND SAFETY PACKET Effective Spring 2014 ALLIED HEALTH PROGRAMS Information on Pre-Clinical Health and Safety Requirements 108 N. 40th Street Phoenix, AZ 85034 www.gatewaycc.edu (602)

More information

NURSING ASSISTANT PROGRAM

NURSING ASSISTANT PROGRAM NURSING ASSISTANT PROGRAM Information Packet Revised February 2014 6000 West Olive Avenue Glendale, AZ 85302 Rev. 7.3.2014 NURSING ASSISTANT PROGRAM (NUR158) INFORMATION COURSE INFORMATION: Upon satisfactory

More information

NURSING ASSISTANT PROGRAM INFORMATION AND

NURSING ASSISTANT PROGRAM INFORMATION AND CENTRAL ARIZONA COLLEGE SKILLS CENTER HEALTHCARE PROGRAMS NURSING ASSISTANT PROGRAM INFORMATION AND ENROLLMENT PACKET One-Stop / Skills Center Job Skills Training Program SkillsCenter6/2008 Central Arizona

More information

RN-BSN IN NURSING APPLICATION PROCEDURE

RN-BSN IN NURSING APPLICATION PROCEDURE RN-BSN IN NURSING APPLICATION PROCEDURE Admission to The University of South Dakota Nursing Program is a two-step process. The following checklist will assist you in this process. All items must be completed

More information

FAST TRACK PRACTICAL NURSING PROGRAM

FAST TRACK PRACTICAL NURSING PROGRAM FAST TRACK PRACTICAL NURSING PROGRAM INFORMATION and APPLICATION PACKET For The Fall 2015/Spring 2016 (7/1/15 6/30/16) Wait List Data Base The Maricopa Community Colleges reserve the right to change, without

More information

SKILL CENTER PROGRAMMING NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION

SKILL CENTER PROGRAMMING NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION SKILL CENTER PROGRAMMING NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION Classes are offered at the following location: Casa Grande Center 1015 E. Florence Blvd, A100 Casa Grande, AZ 85122

More information

Eastern Shore Community College Practical Nursing Program Application Packet 2015

Eastern Shore Community College Practical Nursing Program Application Packet 2015 Eastern Shore Community College Practical Nursing Program Application Packet 2015 The Eastern Shore Community College School of Practical Nursing was originally Northampton- Accomack Memorial Hospital

More information

FAST TRACK PRACTICAL NURSING PROGRAM

FAST TRACK PRACTICAL NURSING PROGRAM FAST TRACK PRACTICAL NURSING PROGRAM INFORMATION and APPLICATION PACKET For The Fall 2015 Wait List Data Base The Maricopa Community Colleges reserve the right to change, without notice, any materials,

More information

LPN to RN ADMISSION REQUIREMENTS

LPN to RN ADMISSION REQUIREMENTS LPN to RN ADMISSION REQUIREMENTS Students must turn in a complete application packet in a plain manila envelope to a Nursing Program Advisor, Room 191-D, prior to the listed application deadlines. Incomplete

More information

MIAMI DADE COLLEGE MEDICAL CAMPUS SCHOOL OF HEALTH SCIENCES EMERGENCY MEDICAL SERVICES Emergency Medical Technician (EMT) Application Packet

MIAMI DADE COLLEGE MEDICAL CAMPUS SCHOOL OF HEALTH SCIENCES EMERGENCY MEDICAL SERVICES Emergency Medical Technician (EMT) Application Packet MEDICAL CAMPUS SCHOOL OF HEALTH SCIENCES EMERGENCY MEDICAL SERVICES Emergency Medical Technician (EMT) Application Packet Student Name (Print) Student Number The information in this 8 - page packet must

More information

Medical Assisting Program 2015 Application Packet

Medical Assisting Program 2015 Application Packet Medical Assisting Program 2015 Application Packet The goal of the medical assisting program is to prepare competent, entry-level medical assistants in the cognitive (knowledge), psychomotor (skills), and

More information

Vocational Nursing Admission Procedures January 2015- May 2016

Vocational Nursing Admission Procedures January 2015- May 2016 Career & Technical Education Vocational Nursing Program (530) 841-5929 Fax (530) 841-5214 Vocational Nursing Admission Procedures January 2015- May 2016 The application period will begin August 11, 2014

More information

NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION

NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION Classes are offered at the following locations: Superstition Mountain Campus Signal Peak Campus Maricopa Campus Aravaipa Campus Spring Semesters

More information

STUDENTS ARE RESPONSIBLE FOR THEIR OWN HEALTH INSURANCE

STUDENTS ARE RESPONSIBLE FOR THEIR OWN HEALTH INSURANCE Page 1 of 4 Date: Part A RN Student Reapplication to Program NORTH ARKANSAS COLLEGE Department of Nursing & Allied Health Programs Application for Admission LPN-RN-Associate Degree (AAS) Program Demographic

More information

2014-2016 TVCC/OCNE NURSING PROGRAM APPLICATION PACKET DIRECTIONS

2014-2016 TVCC/OCNE NURSING PROGRAM APPLICATION PACKET DIRECTIONS 2014-2016 TVCC/OCNE NURSING PROGRAM APPLICATION PACKET DIRECTIONS Thank you for your interest in Treasure Valley Community College (TVCC) Nursing Program. TVCC s nursing program is a member of the Oregon

More information

The University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria

The University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria 1 The University of Texas of the Permian Basin Bachelor of Science in Nursing (BSN) Admission Criteria 1. All students interested in applying for the Nursing Program must be admitted to the University

More information

** Clinical Training Requirements Checklist for Conditionally Accepted 2015-16 Allied Health Students**

** Clinical Training Requirements Checklist for Conditionally Accepted 2015-16 Allied Health Students** 1 ** Clinical Training Requirements Checklist for Conditionally Accepted 2015-16 Allied Health Students** The following checklist outlines required documentation for conditionally accepted 2015-16 Allied

More information

** Clinical Training Requirements Checklist for Conditionally Accepted Fall 2015 Nursing Students**

** Clinical Training Requirements Checklist for Conditionally Accepted Fall 2015 Nursing Students** 1 ** Clinical Training Requirements Checklist for Conditionally Accepted Fall 2015 Nursing Students** The following checklist outlines required documentation for conditionally accepted Fall 2015 nursing

More information

Student Health Form Howard Community College Health Science Division

Student Health Form Howard Community College Health Science Division Name: HCC ID#: Student Health Form Howard Community College Health Science Division Please complete all sections of this form and return to Health Sciences Division Office HS 236 HEALTH FORM DEADLINES

More information

Admission Requirements: AACC-MLT or CCBC-MLT Transfer Students

Admission Requirements: AACC-MLT or CCBC-MLT Transfer Students Admission Requirements: AACC-MLT or CCBC-MLT Transfer Students This application is for students who have graduated with an associate s degree from the Medical Laboratory Technology (MLT) Program at Anne

More information

NURSE ASSISTANT PROGRAM

NURSE ASSISTANT PROGRAM Information & Application Packet July 2013 through July 2014 http://www.paradisevalley.edu/nurse-assistant MANDATORY TO ATTEND NA INFORMATION SESSION Monday s June 2 nd, 9 th, 16 th, 23 rd, and 30th July

More information

ALLIED HEALTH NON-CLINICAL PRACTICUM APPLICATION

ALLIED HEALTH NON-CLINICAL PRACTICUM APPLICATION DAVENPORT UNIVERSITY COLLEGE OF HEALTH PROFESSIONS Student Name: Student ID Number: ALLIED HEALTH NON-CLINICAL PRACTICUM APPLICATION Health Information Technology (HINT297c) Health Insurance Claims Management

More information

LICENSED PRACTICAL NURSE TO REGISTERED NURSE PROGRAM APPLICATION PACKET DEADLINE: OCTOBER 15, 2015

LICENSED PRACTICAL NURSE TO REGISTERED NURSE PROGRAM APPLICATION PACKET DEADLINE: OCTOBER 15, 2015 Name: LICENSED PRACTICAL NURSE TO REGISTERED NURSE PROGRAM APPLICATION PACKET DEADLINE: OCTOBER 15, 2015 Date: Thank you for your interest in the Northland Pioneer College, Associate of Applied Science

More information

RESPIRATORY THERAPY ASSOCIATE OF APPLIED SCIENCE APPLICATION FOR ADMISSION. Application Deadline MAY 1 ST

RESPIRATORY THERAPY ASSOCIATE OF APPLIED SCIENCE APPLICATION FOR ADMISSION. Application Deadline MAY 1 ST RESPIRATORY THERAPY ASSOCIATE OF APPLIED SCIENCE APPLICATION FOR ADMISSION Application Deadline MAY 1 ST EACH APPLICATION MUST INCLUDE THE FOLLOWING: o Application o Receipt of non-refundable $25 application

More information

Medical Assisting. Program Application. For More information please call 535-5446 January 11, 2016

Medical Assisting. Program Application. For More information please call 535-5446 January 11, 2016 Program Application For More information please call 535-5446 January 11, 2016 ADMISSION INFORMATION AND CRITERIA FOR MA PROGRAM Thank you for your interest in the EITC MA Program. Medical Assisting is

More information

SURGICAL TECHNOLOGY PROGRAM APPLICATION

SURGICAL TECHNOLOGY PROGRAM APPLICATION SURGICAL TECHNOLOGY PROGRAM APPLICATION Dear Applicant: Thank you for your interest in Wharton County Junior College s Surgical Technology Program. Information on the program and the requirements necessary

More information

MEDICAL LABORATORY TECHNICIAN AAS

MEDICAL LABORATORY TECHNICIAN AAS MEDICAL LABORATORY TECHNICIAN AAS Medical Laboratory Technicians perform tests on blood and body fluids providing critical information to assist physicians in patient diagnosis and treatment, as well as

More information

STUDENT ADMISSION PACKET Allied Health Programs Updated 10/21/2015

STUDENT ADMISSION PACKET Allied Health Programs Updated 10/21/2015 Allied Health Programs Updated 10/21/2015 ADMISSION REQUIREMENTS STUDENT NAME CONTACT # SELECT ONE: MAP105 MIP105 PHB105 For assistance, email your questions to: swsc.advisor@estrellamountain.edu or contact

More information

Master s Nursing Program Spring 2017 Application Packet For:

Master s Nursing Program Spring 2017 Application Packet For: Master s Nursing Program Spring 2017 Application Packet For: Nurse Education Nurse Administrator Nurse Educator + FNP Certificate Nurse Administrator + FNP Certificate Family Nurse Practitioner Updated

More information

Nursing Program Application Packet. Fall 2015

Nursing Program Application Packet. Fall 2015 Nursing Program Application Packet Fall 2015 Submit all application materials to: Southwestern Oregon Community College Jade Stalcup 1988 Newmark Ave. Coos Bay, OR 97420 jstalcup@socc.edu 541-888-7443

More information

Admission packets must include the following:

Admission packets must include the following: Hillsborough Community College Health Sciences Admissions APPLICATION FOR ADMISSION NURSING PROGRAM Thank you for your interest in Hillsborough Community College Health Sciences Programs. Because acceptance

More information

Pharmacy Technician Program Application Packet Fall 2016

Pharmacy Technician Program Application Packet Fall 2016 Enrollment Services 4000 Lancaster DR NE PO Box 14007 Salem, OR 97309 Chemeketa Community College is an equal opportunity, affirmative action, institution Pharmacy Technician Program Application Packet

More information

Medical Assisting. Program Application. For More information please call 524-3000 ext. 3200 or 3437 December 13, 2013

Medical Assisting. Program Application. For More information please call 524-3000 ext. 3200 or 3437 December 13, 2013 Program Application For More information please call 524-3000 ext. 3200 or 3437 December 13, 2013 ADMISSION INFORMATION AND CRITERIA FOR MA PROGRAM Thank you for your interest in the EITC MA Program. Medical

More information

MEDICAL ASSISTANT PROGRAM Application and Information Packet HEALTH PROFESSIONS

MEDICAL ASSISTANT PROGRAM Application and Information Packet HEALTH PROFESSIONS Updated 01/07/2015 MEDICAL ASSISTANT PROGRAM Application and Information Packet HEALTH PROFESSIONS DEADLINE: August 7, 2015 (For fall semester) November 20, 2015 (For spring semester) 1 Allied Health Program

More information

College of the Redwoods Health Occupations (707) 476-4214

College of the Redwoods Health Occupations (707) 476-4214 College of the Redwoods Health Occupations (707) 476-4214 Revised November 2003 7351 Tompkins Hill Road (707) 476-4419 (Fax) Eureka, CA 95501-9300 www.redwoods.edu.main/dept/ho/index.htm Licensed Vocational

More information

Medical Assistant Training Program Checklist and Application. Student Name: Campus Requested:

Medical Assistant Training Program Checklist and Application. Student Name: Campus Requested: Medical Assistant Training Program Checklist and Application Student Name: Campus Requested: Thank you for your interest in our Medical Assistant Training Program! Please check the last page of this application

More information

COAHOMA COMMUNITY COLLEGE SHORT-TERM CERTIFICATE PROGRAMS Application & Admission Procedure

COAHOMA COMMUNITY COLLEGE SHORT-TERM CERTIFICATE PROGRAMS Application & Admission Procedure COAHOMA COMMUNITY COLLEGE SHORT-TERM CERTIFICATE PROGRAMS Application & Admission Procedure Please choose the program you are applying for: o Phlebotomy Spring 2016 Page 1 General Information (There is

More information

Admission packets must include the following:

Admission packets must include the following: Hillsborough Community College Health Sciences Admissions APPLICATION FOR ADMISSION NURSING PROGRAM Thank you for your interest in Hillsborough Community College Health Sciences Programs. Acceptance to

More information

Application for Admission: Categorical Certificate Training Program

Application for Admission: Categorical Certificate Training Program Medical Technology Program Stevenson University 1525 Greenspring Valley Road Stevenson, MD 21153 (410) 601-1113 vgriffey@lifebridgehealth.org http://www.stevenson.edu/academics Application for Admission:

More information

Pierpont Community & Technical College School of Health Careers Practical Nursing Program

Pierpont Community & Technical College School of Health Careers Practical Nursing Program Pierpont Community & Technical College School of Health Careers Practical Nursing Program ADMISSION PROCESS 1. Complete and submit Pierpont Community & Technical College application including: a. Submit

More information

Dear PN Applicant. Sincerely, The PN Program Faculty North Arkansas College

Dear PN Applicant. Sincerely, The PN Program Faculty North Arkansas College Dear PN Applicant We are happy you are considering the Practical Nursing Program at North Arkansas College. The PN Program has been granted full approval by the Arkansas State Board of Nursing and traditionally

More information

2015 2016 PTA INFORMATION PACKET

2015 2016 PTA INFORMATION PACKET 2015 2016 PTA INFORMATION PACKET ASSOCIATE OF APPLIED SCIENCE DEGREE PROGRAM PHYSICAL THERAPIST ASSISTANT The Physical Therapist Assistant (PTA) program is a two-year program of study that prepares students

More information

Concordia COLLEGE Department of Nursing

Concordia COLLEGE Department of Nursing Concordia COLLEGE Department of Nursing Dear Accelerated Nursing Program Applicant, Thank you for your interest in the accelerated nursing major at. As Chair of the Department of Nursing, I want to congratulate

More information

Admission Standards and Requirements

Admission Standards and Requirements College of Health and Pharmaceutical Sciences School of Health Professions Medical Laboratory Science MLT to MLS Bridge Program Admission Standards and Requirements Admission to the University does not

More information

Robeson Community College

Robeson Community College Robeson Community College Traditional Health Science Admissions Timeline for 2016 Fall Enrollment Programs: Associate Degree Nursing (AAS) April 29 May 13 May 31 June 15 Admissions Application Submission

More information

NURSING PROGRAM APPLICATION PACKET APPLICATION DEADLINE: FEBRUARY 16, 2015 4:00 PM

NURSING PROGRAM APPLICATION PACKET APPLICATION DEADLINE: FEBRUARY 16, 2015 4:00 PM Name: Nursing Program P.O. Box 610 Holbrook, AZ 86025 (928) 532-6136 NURSING PROGRAM APPLICATION PACKET APPLICATION DEADLINE: FEBRUARY 16, 2015 4:00 PM Date: Thank you for your interest in the Northland

More information

Oregon Coast Community College Medical Assistant Program Application 2015-2016 Academic Year Deadline: December 4, 2015

Oregon Coast Community College Medical Assistant Program Application 2015-2016 Academic Year Deadline: December 4, 2015 Oregon Coast Community College Medical Assistant Program Application 2015-2016 Academic Year Deadline: December 4, 2015 Program Description The Oregon Coast Community College Medical Assistant Program

More information

Westchester Community College Ossining Extension Center 22 Rockledge Avenue Ossining, New York 10562 Attn: Surgical Technology Program

Westchester Community College Ossining Extension Center 22 Rockledge Avenue Ossining, New York 10562 Attn: Surgical Technology Program Central Sterile Processing Program Directions for Completing the Application Fall 2012 Ossining Extension Center, 22 Rockledge Avenue Ossining, New York 10562 Thank you for your interest in the Central

More information

OAKLAND UNIVERSITY SCHOOL OF NURSING Instructions for completing the Clinical Health Requirements

OAKLAND UNIVERSITY SCHOOL OF NURSING Instructions for completing the Clinical Health Requirements OAKLAND UNIVERSITY SCHOOL OF NURSING Instructions for completing the Clinical Health Requirements Submission Deadline Dates for NEW Accelerated Second Degree and NEW Basic-BSN students Semester Admitted

More information

APPLICATION CHECKLIST

APPLICATION CHECKLIST HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE - NURSING APPLICATION CHECKLIST A. Submit an application to the Texas Southmost College, MEET REQUIREMENTS FOR ADMISSION,

More information

Division of Continuing Education and Community Services Application for Nurse Assistant Course CNA APPLICATION CHECK LIST

Division of Continuing Education and Community Services Application for Nurse Assistant Course CNA APPLICATION CHECK LIST CNA APPLICATION CHECK LIST Applicant Name: Phone No: Alternative No: Application Date: Please submit this information to WCCC as soon as possible. You will not be eligible to start classes if we do not

More information

What you need to know. ADN / BSN Concurrent Enrollment Program (CEP) Working together to provide Associate and Baccalaureate Degrees in Nursing

What you need to know. ADN / BSN Concurrent Enrollment Program (CEP) Working together to provide Associate and Baccalaureate Degrees in Nursing Working together to provide Associate and Baccalaureate Degrees in Nursing What you need to know ADN / BSN Concurrent Enrollment Program (CEP) Revised 6/10/15 INTRODUCTION The Pima Community College (PCC)/Northern

More information

Nursing Assistant I Admission Requirements

Nursing Assistant I Admission Requirements Nursing Assistant I Admission Requirements 1. High School Diploma, GED or College Transcripts 2. Driver s License or State ID 3. Social Security Card 4. Physical Examination 5. Criminal Background Check

More information

PLEASE READ ALL OF THE ABOVE INFORMATION

PLEASE READ ALL OF THE ABOVE INFORMATION INFORMATION FOR THE CLASS OF 2016 Huntsville Memorial Hospital's Joe G. Davis School of Vocational Nursing is approved by the Texas Board of Nursing and the Texas Education Agency The program is a twelve

More information

Medical Assisting Program 2013 Application Packet

Medical Assisting Program 2013 Application Packet Medical Assisting Program 2013 Application Packet The goal of the medical assisting program is to prepare competent entry-level medical assistants in the cognitive (knowledge), psychomotor (skills), and

More information

PROGRAM TUITION DOWN PAYMENT. Patient Care Technician $3500 $2500. Pharmacy Technician $2500 $1500. Phlebotomy Technician $2300 $1300

PROGRAM TUITION DOWN PAYMENT. Patient Care Technician $3500 $2500. Pharmacy Technician $2500 $1500. Phlebotomy Technician $2300 $1300 APPLICATION INSTRUCTIONS AND CHECKLIST Please fill out the application completely. Then you can print and mail or bring it to Fast Track with your down payment. : PROGRAM TUITION DOWN PAYMENT Patient Care

More information

Surgical Technology. Program Application. For More information please call 524-3000 ext. 3200 or 3437 August 8, 2013

Surgical Technology. Program Application. For More information please call 524-3000 ext. 3200 or 3437 August 8, 2013 Program Application For More information please call 524-3000 ext. 3200 or 3437 August 8, 2013 Thank you for your interest in the EITC Surgical Technology Program. We urge you to recognize the commitment

More information

APPLICATION FOR ADMISSION FALL 2015 GENERAL INFORMATION

APPLICATION FOR ADMISSION FALL 2015 GENERAL INFORMATION BACHELOR OF SCIENCE IN NURSING (RN-BSN Program) APPLICATION FOR ADMISSION FALL 2015 GENERAL INFORMATION 1. Transcripts: In order to be considered for admission to the RN-BSN program, all students must

More information

Pearl River Community College Practical Nursing Full-Time Program Applications Accepted October 1 till March 1

Pearl River Community College Practical Nursing Full-Time Program Applications Accepted October 1 till March 1 Pearl River Community College Practical Nursing Full-Time Program Applications Accepted October 1 till March 1 We are pleased that you have shown an interest in the Practical Nursing Program at Pearl River

More information

TMCC NURSING PROGRAM APPLICATION FOR 2015-2016 FALL ADMISSION

TMCC NURSING PROGRAM APPLICATION FOR 2015-2016 FALL ADMISSION Nursing students are candidates selected for admission into the nursing program of study. The application process for admission into the Associate of Applied Science Practical Nursing Program must be completed

More information

CNA Certified Nurse Assistant Program

CNA Certified Nurse Assistant Program Health Center Signature/Stamp *1 st floor of Student Services Building HEALTH SCIENCES PROGRAM HEALTH REQUIREMENTS To be filled out by Health Care Provider (HCP) CNA Certified Nurse Assistant Program Student

More information

Phlebotomy Technician Training Program Checklist and Application. Student Name: Campus Requested:

Phlebotomy Technician Training Program Checklist and Application. Student Name: Campus Requested: Phlebotomy Technician Training Program Checklist and Application Student Name: Campus Requested: Thank you for your interest in our Phlebotomy Technician Training Program! All applicants must follow these

More information

HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE NURSING Associate Degree Nursing Program

HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE NURSING Associate Degree Nursing Program HEALTH CARE, CAREER AND TECHNICAL EDUCATION DIVISION ASSOCIATE IN APPLIED SCIENCE NURSING APPLICATION CHECKLIST A. Submit an application to the Texas Southmost College, MEET REQUIREMENTS FOR ADMISSION,

More information

Certified Nurse Aide Training Program Checklist and Application. Student Name: Campus Requested:

Certified Nurse Aide Training Program Checklist and Application. Student Name: Campus Requested: Certified Nurse Aide Training Program Checklist and Application Student Name: Campus Requested: Thank you for your interest in our Certified Nurse Aide Training Program! All applicants must follow these

More information

Medical Assisting Program Fall 2015 Admissions Packet

Medical Assisting Program Fall 2015 Admissions Packet Fall 2015 Admissions Packet It is important that you read all information in this Admissions Packet for the fall 2015 Medical Assisting Program. Included in this packet: Admissions Guidelines Application

More information

UNIVERSITY OF SOUTH ALABAMA COLLEGE OF NURSING ADMISSIONS POLICY

UNIVERSITY OF SOUTH ALABAMA COLLEGE OF NURSING ADMISSIONS POLICY UNIVERSITY OF SOUTH ALABAMA COLLEGE OF NURSING ADMISSIONS POLICY Enrollment into the University (pre-professional component) as a nursing major does not assure the student admission to the Professional

More information

SAN DIEGO MESA COLLEGE PHLEBOTOMY TRAINING PROGRAM Information/Application Guide for Fall 2016

SAN DIEGO MESA COLLEGE PHLEBOTOMY TRAINING PROGRAM Information/Application Guide for Fall 2016 SAN DIEGO MESA COLLEGE PHLEBOTOMY TRAINING PROGRAM Information/Application Guide for Fall 2016 STUDENTS MAY SUBMIT APPLICATIONS STARTING: NOVEMBER 2, 2015 APPLICATION SUBMISSION DEADLINE: MARCH 4, 2016

More information

Trinity Washington University School of Nursing and Health Professions Nursing Program Application Packet Checklist Spring Semester, 2013

Trinity Washington University School of Nursing and Health Professions Nursing Program Application Packet Checklist Spring Semester, 2013 Trinity Washington University School of Nursing and Health Professions Nursing Program Application Packet Checklist Spring Semester, 2013 Please make an appointment to meet with your academic advisor to

More information

NURSING ADVANCED PLACEMENT BRIDGE LPN TO RN TRANSITION PROGRAM PACKET

NURSING ADVANCED PLACEMENT BRIDGE LPN TO RN TRANSITION PROGRAM PACKET NURSING ADVANCED PLACEMENT BRIDGE LPN TO RN TRANSITION PROGRAM PACKET After you have read and studied these procedures, return the application page to: Wytheville Community College Admissions & Records

More information

ADVANCED PLACEMENT INFORMATION & APPLICATION PACKET for PARAMEDIC APPLICANTS

ADVANCED PLACEMENT INFORMATION & APPLICATION PACKET for PARAMEDIC APPLICANTS ADVANCED PLACEMENT INFORMATION & APPLICATION PACKET for PARAMEDIC APPLICANTS Effective for Admissions Spring and Fall 2016 MaricopaNursing Locations offering Paramedic-to-RN Transition Courses: Spring

More information

Upon completion of the Medical Assisting program, students will be eligible to take the national certification exam.

Upon completion of the Medical Assisting program, students will be eligible to take the national certification exam. Medical Assisting Metropolitan Community College s Medical Assisting program is a one-year certification program designed to give students the knowledge and skills to provide administrative and clinical

More information

Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program

Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program Type of complete in ink. (Immunizations must be submitted with application.) Desired DATE OF ENTRY into program: Semester

More information

Admission packets must include the following:

Admission packets must include the following: Hillsborough Community College Health Sciences Admissions APPLICATION FOR ADMISSION HEALTH SCIENCES PROGRAMS Thank you for your interest in Hillsborough Community College Health Sciences Programs. Acceptance

More information

Explanation of requirements for clinical experiences HFU

Explanation of requirements for clinical experiences HFU Page 1 Explanation of requirements for clinical experiences HFU Two Step TB screening Explanation of Required Immunizations and Health Requirements All nursing students are required to have an initial

More information

MIAMI DADE COLLEGE MEDICAL CAMPUS SCHOOL OF HEALTH SCIENCES EMERGENCY MEDICAL SERVICES Emergency Medical Technician (EMT) Application Packet

MIAMI DADE COLLEGE MEDICAL CAMPUS SCHOOL OF HEALTH SCIENCES EMERGENCY MEDICAL SERVICES Emergency Medical Technician (EMT) Application Packet SCHOOL O HEALTH SCIENCES EMERGENCY MEDICAL SERVICES Emergency Medical Technician (EMT) Application Packet Student Name (Print) Student Number The information in this 8 - page packet must be completed to

More information

Program Counselor: Patsy Saenz Phone #: 915-831-4608 Office Location: RG Counseling Dept., 103 Montana Ave., 3 rd. floor

Program Counselor: Patsy Saenz Phone #: 915-831-4608 Office Location: RG Counseling Dept., 103 Montana Ave., 3 rd. floor PROGRAM CONTACT INFORMATION 2015-2016 Catalog SPECIALIZED ADMISSIONS PROGRAM INFORMATION GUIDE FOR PHARMACY TECHNOLOGY ASSOCIATE OF APPLIED SCIENCE (AAS-PHRA) CERTIFICATE OF COMPLETION (C2-PHRC) Program

More information

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

NOTE: Immunization requirements are based on CDC recommendations for health care workers and Clinical site requirements. 4500 Steilacoom Blvd SW Lakewood WA 98499 www.cptc.edu Practical Nurse Application WE DO NOT HAVE A DEADLINE FOR APPLICATIONS. WE ARE FIRST COME FIRST SERVED. THE WAITLIST IS CURRENTLY GREATER THAN THREE

More information

Submission Deadline: 1 August, 1 November, or 1 January (or first working Monday) Incomplete applications will not receive action.

Submission Deadline: 1 August, 1 November, or 1 January (or first working Monday) Incomplete applications will not receive action. MA-HS-EP Application, June 2015 1 APPLICATION FOR ADMISSION HUMAN SERVICES MASTER OF ARTS ENHANCED PROFESSIONAL (MA-HS-EP) SINTE GLESKA UNIVERSITY PO Box 105 Rosebud Sioux Reservation Mission, South Dakota

More information

Last day to apply for a Spring 2016 Allied Health Internship is Monday, October 26, 2015

Last day to apply for a Spring 2016 Allied Health Internship is Monday, October 26, 2015 Step 1 Obtain required immunizations and/or titers (students must prove immunity by either proof of immunization or titer), AZ DPS Level One Fingerprint Clearance Card, and CPR card for Health Care Providers.

More information

Associate Degree Nursing/Tech Prep Plan (Generic Student Curriculum)

Associate Degree Nursing/Tech Prep Plan (Generic Student Curriculum) Associate Degree Nursing/Tech Prep Plan (Generic Student Curriculum) Dear Associate Degree Nursing Applicant, Victoria College offers a two-year Associate of Applied Science degree in nursing. Upon successful

More information

SURGICAL TECHNOLOGY PROGRAM APPLICATION

SURGICAL TECHNOLOGY PROGRAM APPLICATION SURGICAL TECHNOLOGY PROGRAM APPLICATION Dear Applicant: Thank you for your interest in Wharton County Junior College s Surgical Technology Program. Information on the program and the requirements necessary

More information

2016-2017 Admissions Packet

2016-2017 Admissions Packet 2016-2017 Admissions Packet Dear Prospective Surgical Technology Student, Congratulations on your decision to pursue the Surgical Technology Program at Washburn Tech. This packet will help guide you through

More information

Delgado PHYSICAL THERAPIST ASSISTANT PROGRAM

Delgado PHYSICAL THERAPIST ASSISTANT PROGRAM Delgado COMMUNITY COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM APPLICATION PACKET Spring, 2016 The Delgado Community College Physical Therapist Assistant (PTA) Program is accredited by the Commission on

More information

FOOTHILL COLLEGE PROCEDURES AND INFORMATION FOR RADIOLOGY TECHNOLOGY PROGRAM APPLICANTS

FOOTHILL COLLEGE PROCEDURES AND INFORMATION FOR RADIOLOGY TECHNOLOGY PROGRAM APPLICANTS FOOTHILL COLLEGE PROCEDURES AND INFORMATION FOR RADIOLOGY TECHNOLOGY PROGRAM APPLICANTS 2015 Thank you for your interest in the Foothill College Radiologic Technology Program. Admission to the program

More information

School of Nursing Application Packet for Admission to the RN to BSN Option

School of Nursing Application Packet for Admission to the RN to BSN Option School of Nursing Application Packet for Admission to the RN to BSN Option Please follow the steps outlined below to complete your application. A. To the Bellin Health Chief Nursing Officer, Laura Hieb,

More information

Name: Last First Middle. Mailing Address: Street City/State Zip Street Address: Street City/State Zip Telephone: ( ) Social Security Number:

Name: Last First Middle. Mailing Address: Street City/State Zip Street Address: Street City/State Zip Telephone: ( ) Social Security Number: School Nurse Application for Employment TANQUE VERDE UNIFIED SCHOOL DISTRICT, NO. 13 11150 E. Tanque Verde Road Tucson, AZ 85749 520-749-5751 / fax 520-749-5400 All positions require an Arizona Registered

More information

Dental Hygiene Program Application 2016

Dental Hygiene Program Application 2016 Dear Applicant: You have indicated an interest in pursuing a career in Dental Hygiene. Enclosed are all the necessary instructions and forms for your application to the Dental Hygiene Program at Lamar

More information

Columbia College Nursing Application Packet (revised 8-28-15)

Columbia College Nursing Application Packet (revised 8-28-15) 1 2 Location: Licensure: Accreditation: The Columbia College Nursing Program is offered in two locations the main campus in Columbia, Missouri and the Lake of the Ozarks campus in Osage Beach, Missouri.

More information

RED ROCKS COMMUNITY COLLEGE EMT PROGRAM INFORMATION SUMMER AND FALL 2015

RED ROCKS COMMUNITY COLLEGE EMT PROGRAM INFORMATION SUMMER AND FALL 2015 RED ROCKS COMMUNITY COLLEGE EMT PROGRAM INFORMATION SUMMER AND FALL 2015 The EMT program is an entry-level program, with no experience required. It consists of 210 hours of classroom and skills instruction

More information

Hillsborough Community College Health Sciences Admissions APPLICATION FOR ADMISSION NURSING PROGRAM

Hillsborough Community College Health Sciences Admissions APPLICATION FOR ADMISSION NURSING PROGRAM Hillsborough Community College Health Sciences Admissions APPLICATION FOR ADMISSION NURSING PROGRAM Rev. 06-03/08/2016 Thank you for your interest in Hillsborough Community College Health Sciences Programs.

More information

HUTCHINSON COMMUNITY COLLEGE PRACTICAL NURSING PROGRAM APPLICATION PROCESS. Prerequisites

HUTCHINSON COMMUNITY COLLEGE PRACTICAL NURSING PROGRAM APPLICATION PROCESS. Prerequisites HUTCHINSON COMMUNITY COLLEGE PRACTICAL NURSING PROGRAM APPLICATION PROCESS Application and Testing Deadlines: (Steps 1 & 2 below) Full-time Program: August 1 to January 15 Part-time Program: April 1 to

More information