At the time you apply the following pre-requisite courses must be complete or you must be enrolled in for Spring 2016:

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1 ADN APPLICATION FOR CONSIDERATION FOR FALL 2016 Print out this entire document. At the time you apply the following pre-requisite courses must be complete or you must be enrolled in for Spring 2016: BIOL 2401 Human Anatomy & Physiology I (must be less than 10 years old at the time you apply) ENGL 1301 Composition I PSYC 2301 General Psychology Use the first page check off sheet to keep track of your application requirements and deadlines. If you applied for consideration for Fall 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 Fall 2014, or prior, you will need to re-submit all official transcripts with your application. You will note that you are to submit a complete application packet: Application Curriculum work sheet Sealed official transcripts. Official transcripts should be obtained from your college(s) either in person or have the transcripts sent to you at your home address. Do not have them sent to the ADN office. HESI A2 score - If you are using a Fall 2015 TC VN Hesi A2 score and do not have a copy, please obtain one from the VN secretary to include in your packet. If you are using a Spring 2015 TC ADN test score, please obtain one from the ADN secretary to include in your packet. HESI A2 scores older than Spring 2015 will not be accepted. The most recent HESI A2 score received from the TC Testing Center will be used. NEW: Your HESI A2 score must have an 80 or higher in EACH category tested in order to apply. Example: Subject Area HESI Score (1) Reading Comprehension 92.00% (2) Meaning-Word Use % (3) Conclusions 71.43% (4) Implications 88.24% (5) Understand % (6) Vocabulary & General Knowledge 90.00% English Language Composite Score 91.00% (7) Math 82.00% Cumulative Score: 88.00% 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 TEMPLE COLLEGE APPLICATION PROCESS Fall 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 April 4, If you transferred credits from one college to another, submit an official transcript from the original college. Failu to meet this requirement by the time your nursing application is received could jeopardize the processing of your nursing application. 2. HESI A2 Take the HESI Admissions Assessment Exam. Temple College Testing Center will be offering it February 22 through March 31, 2016, no appointment is necessary. The Hutto TC campus will also offer it February 22 through March 31, 2016 by appointment only. You will be tested on math (no calculator), reading, vocabularygeneral knowledge. The fee is $45. You will be given the results as soon as you finish your test. A score of 80 or higher in EACH category tested is needed to apply. For more information, please contact the Testing Center (254) We do not accept HESI A2 scores from CTC, MCC, ACC, or Baylor. It is best to test at Temple College. 3. Application Curriculum Worksheet Official Transcripts from all colleges attended HESI Score Print out this entire document. Complete all of the information requested on the application and curriculum worksheet. Return your ADN packet (application, curriculum work sheet, official transcripts from all colleges attended, including Temple College if you took courses here and HESI A2 score) to the Associate Degree Nursing office by April 4, Incomplete application packets will not be processed. The address is at the bottom of this page. Be sure to read the Licensure page (which you will keep) from the Texas Board of Nursing. Do not submit any immunizations, certificates, CPR cards, etc. Only the listed items are to be submitted. 4. In Progress course transcripts Arrange to have official transcripts for any in progress pre-requisite and co-requisite courses sent to the ADN office by May 17, If these courses were taken at another college, also make arrangements to have official transcripts sent to TC Admissions & Records. Your application packet must include: HESI A2 scores (less than 1 year old (minimum score of 80 in each category tested), application, curriculum work sheet, official transcripts in original sealed envelopes. MATERIALS NOT RECEIVED BY A SPECIFIED DEADLINE MAY JEOPARDIZE YOUR APPLICATION. You may drop off your completed application packet to the ADN office or you may mail it to: Temple College ADN Office 2600 S. First Street Temple, TX (We will not accept scannedfaxed applications) Spring 2016, Part 1A 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 Fall, 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 May regarding your application status. Please do not call regarding this notification process before the end of May. 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 ACCEPTED 7. Physical: You will be required to submit a physical examination. 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 started no later than June 10, 2016 to ensure completion by mid October for patient contact. We recommend starting the series now. Required TB screeningsimmunizations (including flu vaccine) are detailed on the physical examination form. This documentation will only be required if accepted into the program. Please do not submit with your application. 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 the entire ADN program. This documentation will only be required if accepted into the program. Please do not submit with your application. 10. Background Check: YOU MUST HAVE TEXAS BOARD OF NURSING CLEARANCE to register for nursing courses. Specific instructions will be given in the acceptance letter. 11. Orientation: You need to attend an orientation day. It is typically in August. The date will be provided in the letter of acceptance. This is mandatory. 12. Drug Screen: You must pass a drug screen. Specific instructions will be given.

4 TEMPLE COLLEGE STUDENT APPLICATION FOR ADMISSION FALL 2016 PLEASE TYPE OR PRINT CLEARLY IN INK (illegible applications will not be processed) Date: _ TC Student ID # _ Social Security # : Date of Birth: Name: (Last) (First) (Middle) (Maiden) Home Ph #: ( ) _ Cell Ph #: ( ) Work Ph #: ( ) Personal Address*: TC *in the absence of a TC account, by providing a personal address, I acknowledge that I am giving permission for the TC ADN Department to contact me using this account about this application process. 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 ADN program for Fall 2015? No Yes Have you been accepted for admission to the TC Summer 2016 VN program? No Yes List all schoolscolleges attended: Have you attended any nursing program? No Yes Year(s) When: (Name of school, city, and state*) 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 August 1, 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 FALL 2016 CURRICULUM WORKSHEET For Office Use Only: HESI NF SA: AR APP: AR TRANS: VN ACCEPT: Please print clearly and provide all information. Incomplete applications will not be processed. 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. Remember to include any courses you are currently enrolled in and indicate SP 16 in the Semyear Taken column. *BIOL courses cannot be more than 10 years old at the time you apply and must be 4 credits. Prerequisite Course ENGL 1301 Composition I BIOL 2401 Human Anatomy & Physiology I* PSYC 2301 General Psychology Corequisite Course BIOL 2402 Human Anatomy & Physiology II* PSYC 2314 Lifespan Growth & Development Elective (3 credits) See list of options below College Course No. & Name Sem. Hrs. College Course No. & Name Sem. Hrs. Semyear Taken (i.e. Fall 2009) Semyear Taken (i.e. Fall 2009) Grade Grade For Office Use Only T EQSUB 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 FOR OFFICE USE ONLY: Spring 2016

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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