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1 BRIDGING APPLICATION FOR CONSIDERATION FOR SUMMER 2016 Print out this entire document. All pre requisites must be completed prior to applying. Sciences must be less than 10 years old at the time you apply. Use the first page check off sheet to keep track of your application requirements and deadlines. If you applied for consideration for Summer 2015, we should still have your transcripts on file. You will only need to provide us with updated transcripts if additional courses have been taken. Be sure to check yes on the application area that asks if you applied last year. If you applied for consideration for Summer 2014, 2013, 2012 or prior, you will need to resubmit all official transcripts with your application. You will note that you are to submit a complete application packet: Application Curriculum work sheet if your VNPN transcript does not show the VNSG course numbers for the pre requisites listed, you may leave that area blank. Please note that we may have to contact you for course descriptions or syllabi. Sealed official transcripts. Official transcripts should be obtained from your college either in person or have the transcripts sent to you at your home address. If you are a graduate of an out of state PN program you must also include documentation of ACEN accreditation. Contact ACEN via their website and click on contact us and start an of your inquiry. Should you receive verification of accreditation from ACEN, print out the and include in your packet. Incomplete packets will not be processed. Other areas that will prevent the ADN department from processing your application: You have not applied to Temple College Temple College Admissions & Records has not received your transcript(s) Keep an eye on the account that you listed on your application. Always check your spamjunk mail box. Incomplete application packets will not be processed.

2 1. Temple College Application Official Transcripts to Admissions & Records 2. Application Curriculum Worksheet Official Transcripts from all colleges attended 3. Out of state VN school ACENNLNAC Accreditation TEMPLE COLLEGE APPLICATION PROCESS Summer 2016 InstructionsCheck Off Sheet Part 1 A If not already done, submit a completed application for admission or re-admission to TC Admissions & Records Office in One College Centre. This should be done immediately. You must meet all Temple College requirements for testing, transcripts, etc. You must be TSI complete. Arrange to have official transcripts (from each programcollegeuniversity) sent to TC Admissions & Records Office. Their address is on the bottom of this page. Transcripts must be received by February 8, If you transferred credits from one college to another, submit an official transcript from the original college. Failure to meet this requirement by the time your nursing application is received could jeopardize the processing of your nursing application. Print out this entire document. Complete all of the information requested on the application and curriculum worksheet. Return all of the forms to the Associate Degree Nursing (ADN) office by February 8, Include(with your application) official transcripts (keep them in their sealed envelopes) from all colleges attended, including Temple College. The address is at the bottom of this page. If you do not see the VNSG courses that are listed on the curriculum worksheet on your transcript, please leave it blank. We will find the appropriate courses. All pre-requisite courses must be complete before you apply. Be sure to read the Licensure page from the Texas Board of Nursing. Documentation of nursing practice experience may be required. Your Texas VN license must be in good standing, unrestricted, and not solely a compact license. If you graduated from a VNPN program outside of Texas, you must provide documentation that your nursing school was accredited by Accreditation Commission for Education in Nursing (formerly known as NLNAC) for your enrolled time period. We recommend contacting ACEN at Contact the webmaster; provide them with name, city and state of your nursing program and the year you entered the program. If they affirm accreditation by NLNACACEN, print the received from ACEN and include with the application. If your VNPN program was not accredited as required, please do not submit an application. MATERIALS NOT RECEIVED BY A SPECIFIED DEADLINE MAY JEOPARDIZE YOUR APPLICATION. You may drop off your application packet (including transcripts) to the ADN office or you may mail them to: Temple College ADN Office 2600 S. First Street Temple, TX (We will not accept scannedfaxed applications) Spring 2016, Part 1 KEEP THIS PAGE FOR FUTURE REFERENCE Official transcripts for all courses taken at another college must also be submitted to: Temple College Admissions & Records Office 2600 S. First Street Temple, TX 76504

3 TEMPLE COLLEGE APPLICATION PROCESS Summer 2016 Additional Information Part 1 B 4. Acceptance Status: 5. Financial Aid: After satisfactory completion of the application process, applicants will be notified by letter or during the latter part of March regarding your application status. Please do not call regarding this notification process before the end of March. During the application process, keep an eye on your account and also check your junk . Please print all of your contact information on your application legibly. It often takes 6-8 weeks or longer to complete the financial aid process, so get started now. The Financial Aid Office is in One College Centre. 6. Meningitis: According to state law, some students will be required to show proof of the bacterial meningitis immunization to Temple College A & R prior to registration. If you are under the age of 30, check with A & R regarding this requirement. If conditionally accepted into the program, you will receive instructions on completing the following requirements, do not submit any of these items with your application. 7. Physical: You will be required to submit a physical examination by April 11, Anticipate this expense. A form will be mailed with acceptance letters. 8. Hepatitis B TB & Immunizatio ns: The series of 3 Hepatitis B vaccines must be completed by July 13, Required TB screeningsimmunizations (including flu vaccine) are detailed on the physical examination form. 9. CPR: You must show proof of successful completion of the CPR course: American Heart Association Basic Cardiac Life Support for Health Care Providers, by the first day of classes. This requirement remains in effect throughout your entire Bridging program. 10. Orientation: You need to attend an orientation day. It is typically in April. The date will be provided in the letter of acceptance. This is mandatory. 11. Background Check: YOU MUST HAVE TEXAS BOARD OF NURSING CLEARANCE BY MAY 16, Specific instructions will be given. 12. Drug You must pass a drug screen. Specific instructions will be given. Screen: 13. Classes: Classes start for the summer semester Tuesday, May 31, Classes will be scheduled Monday through Thursday for the Summer I session.

4 TEMPLE COLLEGE STUDENT APPLICATION FOR ADMISSION SUMMER 2016 PLEASE TYPE OR PRINT CLEARLY IN INK Date: _ TC Student ID # _ Social Security # : Date of Birth: Name: (Last) (First) (Middle) (Maiden) Home Ph #: ( ) _ Cell Ph #: ( ) Work Ph #: ( ) Personal Address: TC Physical Address: (Number, Street, Apt. #) (City) (County) ( State) ( Zip) (School District) Mailing Address: (Number, Street, Apt. #) (City) (County) ( State) (Zip) Did you apply to the TC Bridging program for Summer 2015? No Yes VN Nursing License #: State: SchoolsColleges Attended What VN program did you graduate from? When: (Name of school, city, and state*) *Graduates of out of state VNPN programs must provide documentation of NLNACACEN accreditation Name, city, & state of other nursing schools attended: Only list LVN work experiences starting with the most recent. Letters of verification may be requested. Year Started Year Ended Agency Name CityState Full TimePart Time (Circle One) Type of Service* FTPT FTPT FTPT *Type of service = med surg, long term care, ob, etc. I have reviewed the Texas Board of Nursing (BON) Licensure questions. I am aware that I must report to the BON and be cleared of any issues or conditions addressed in these licensure questions. If I am not cleared in all of the areas addressed, I understand that I will not be allowed to register for nursing courses. _ (Signature of applicant) (Date) I certify that all given information is correct & complete. I understand that failure to provide correct & complete information could result in being removed from the application process or immediate dismissal, should I be accepted into the program. I understand that I must have background check clearance by the Texas Board of Nursing by May 16, 2016, should I be accepted into the program. I understand that by signing below, I give permission for the TC ADN Department to contact me at the address(es) provided. _ (Signature of applicant) (Date) It is the policy of Temple College that all persons shall receive equal opportunities in admission or access to its programs and activities without regard to race, religion, color, handicap, sex, age, national origin or veteran status Revised Spring 2016

5 For Office Use Only: FINAL: GPA: LTR TYPE: DATE SENT: DOB: TEMPLE COLLEGE SUMMER 2016 CURRICULUM WORKSHEET Please print clearly and provide all information. Incomplete applications will not be processed. For Office Use Only: AR APP: AR TRANS: NF SA: TCVN: TX VN PROGRAM: YES NO ACEN? Last Name First Name MI Maiden Name SSN TC stu.templejc.edu City that you live in School District that you live in Personal Address TC Address Fill in the following information. All prerequisites must be completed prior to applying. If you are currently enrolled in any listed corequisite courses, indicate IP (In Progress) in the grade area. In Progress courses will not be counted in your calculation of admission points. *BIOL prerequisite courses cannot be more than 10 years old at the time you apply and must be 4 credits. Prerequisite Course College Course No. & Name Sem. Hrs. Composition I Semyear Taken (i.e. Fall 2009) Grade T For Office Use Only EQSUB Human Anatomy & Physiology I* Human Anatomy & Physiology II* General Psychology VNSG 1160 Clinical I (1 credit) VNSG 1423 Basic Nursing Skills (4 credits) VNSG 1231 Pharmacology (2 credits) VNSG 1509 Nursing in Health & Illness II (5 credits) Corequisite Course College Course No. & Name Sem. Hrs. Lifespan Growth & Development Elective See list of options below Semyear Taken (i.e. Fall 2009) Grade T EQSUB Elective options: ENGL 2322, 2323, 2327, 2328, HIST 2311, 2312, HUMA 1301, SPAN 1411, 1412, ARTS 1301, 1303, 1304, 2356, DRAM 1310, MUSI 1301, 1306, 1308, 1309, 1310 Spring 2016 FOR OFFICE USE ONLY:

6 Texas Board of Nursing Licensure Questions: All students seeking licensure as a registered nurse must pass the NCLEX-RN administered by the Texas Board of Nursing. The Board may delay or refuse to admit persons to their examination or refuse to issue a license or certificate of registration for any of the following reasons: 1) For any criminal offense, including those pending appeal, have you: a. Been convicted of a misdemeanor? b. Been convicted of a felony? c. Pled nolo contendere, no contest, or guilty? d. Received deferred adjudication? e. Been placed on community supervision or court-ordered probation, whether or not adjudicated guilty? f. Been sentenced to serve jail or prison time? Court-ordered confinement? g. Been granted pre-trial diversion? h. Been arrested or any pending criminal charges? i. Been cited or charged with any violation of the law? j. Been subject of a court-martial; Article 15 violation; or received any form of military judgementpunishmentaction? (You may only exclude Class C misdemeanor traffic violations.) NOTE: Expunged and Sealed Offenses: While expunged or sealed offenses, arrests, tickets, or citations need not be disclosed, it is your responsibility to ensure the offense, arrest, ticket or citation has, in fact, been expunged or sealed. It is recommended that you submit a copy of the Court Order expunging or sealing the record in question to the BON office with your application. Failure to reveal an offense, arrest, ticket, or citation that is not in fact expunged or sealed, will at a minimum, subject your license to a disciplinary fine. Non-disclosure of relevant offenses raises questions related to truthfulness and character. NOTE: Orders of Non-Disclosure: Pursuant to Tex.Gov t Code (b), if you have criminal matters that are the subject of an order of non-disclosure you are not required to reveal those criminal matters on this form. However, a criminal matter that is the subject of an order of non-disclosure may become a character and fitness issue. Pursuant to other sections of the Gov t Code chapter 411, the Texas Nursing Board is entitled to access criminal history record information that is the subject of an order of non-disclosure. If the Board discovers a criminal matter that is the subject of an order of non-disclosure, even if you properly did not reveal that matter, the Board may require you to provide information about that criminal matter. 2) Are you currently the target or subject of a grand jury or governmental agency investigation? 3) Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of, suspended, placed on probation, refused to renew a professional license, certificate, or multi-state privilege held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you? 4) Within the past five (5) years have you been addicted to andor treated for the use of alcohol or any other drug? 5) Within the past five (5) years have you been diagnosed with, treated, or hospitalized for schizophrenia andor psychotic disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder? If you answered yes or if you are not certain of the answer, then you MUST start the declaratory order process immediately! Instructions and forms can be obtained at You will not be allowed to register for nursing courses without BON clearance.

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