APPLICATION DEADLINE: Day Program MARCH 15 Evening/Weekend Program OCTOBER 15

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1 PRACTICAL NURSING PROGRAM Applicant Information PLEASE READ THIS MATERIAL CAREFULLY AND RETAIN FOR FUTURE REFERENCE APPLICATION DEADLINE: Day Program MARCH 15 Evening/Weekend Program OCTOBER 15 Classes are held at the Olathe Health Education Center Revised 12/2015

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3 TABLE OF CONTENTS General Information... 3 Notice of Non Discrimination... 3 Test of English as a Foreign Language... 4 Legal Qualifications for Licensure... 5 Disclosure of Criminal Background/Substance Abuse... 5 Health Policy... 6 Practice and Employment Expectations Prerequisite Courses and Additional Requirements... 9 Health Education Systems Inc. Exam (HESI) Final Selection into Program Acknowledging Acceptance Performance Expectations Estimated Expenses Points to Consider Application Procedure Disclosure and Consent for Background Check... 17

4 Directions to OHEC from JCCC main campus: I 35 South to Exit 214, Lone Elm Road/159 th Street. Go right at light onto Lone Elm Road. Turn right on 153 rd Street, also marked as Olathe Medical Park, 153 rd Street entrance. Take the first left onto S. Marion Street. (Note: S. Marion turns into W. 152 nd Street.) Olathe Health Education Center will be on the right. 2

5 GENERAL INFORMATION I. Johnson County Community College offers a 10 month Practical Nursing (PN) Day Program, and a 19 month Evening/Weekend Program. II. III. IV. The Practical Nursing Program is approved by the Kansas State Board of Nursing located at the Landon State Office Building, 900 SW Jackson, Suite 1051, Topeka, KS Telephone Johnson County Community College is accredited by the Higher Learning Commission. Upon successful completion of the program, the graduate is eligible to apply for licensure as a Practical Nurse. V. The PN Program is approved for 80 students maximum. JCCC usually admits 32 students annually to the Day Program and 24 students to the Evening/ Weekend Program. New students admitted to the Day Program will begin their studies in August (Fall Semester). New students admitted to the Evening/Weekend Program will begin their studies in January (Spring Semester). NOTICE OF NON DISCRIMINATION Johnson County Community College does not discriminate on the basis of sex, race, color, national origin, disability, age, religion, genetic information, marital status, veteran s status, sexual orientation, or other factors that cannot be lawfully considered in its programs and activities as required by all applicable laws and regulations. Inquiries concerning the college s compliance with its non discrimination policies may be referred to the Dean of Student Services and Success or Executive Director of Human Resources, Johnson County Community College, College Blvd., Overland Park, KS 66210, ; or to Office for Civil Rights, One Petticoat Lane, 1010 Walnut St., Suite 320, Kansas City, MO 64106, R12/15 3

6 TEST OF ENGLISH AS A FOREIGN LANGUAGE (TOEFL/TSE) SPECIAL INSTRUCTIONS FOR APPLICANTS EDUCATED IN COUNTRIES OTHER THAN THE U.S. As a selective admissions program, the Practical Nursing Program requires that students applying for admission to the Practical Nursing Program contact International and Immigrant Student Services in the Commons building, COM 306, as soon as they determine their interest in nursing. The minimum score for the exams submitted is required ON OR BEFORE THE APPLICATION DEADLINE. A synopsis of requirements from the International and Immigrant Student Services follows: Utilize English Proficiency Requirements (official) a. All applicants must show proficiency in oral and written English if their primary language was not English or if their education was not in English. b. Complete the TOEFL and TSE exams. Kansas requires a minimum score of 213 on the computerized TOEFL and 550 for the paper and pencil TOEFL and a minimum score of 50 on the TSE. c. The Board has approved the following minimum scores for the new TOEFL ibt: Writing 20 Reading 19 Speaking 20 Listening 20 *Each area must meet the minimum requirement. TOEFL/TSE Publications PO Box 6154 Princeton, NJ The test is given in several locations in Kansas and in many locations in the United States. d. Submit unofficial transcripts from a U.S. college or university documenting the completion of the equivalent of JCCC s English 106 course with a grade of D or better OR a minimum of twelve (12) credit hours with a grade of D or better OR completion of an English language study program. OR e. Submit unofficial high school transcripts documenting the completion of one academic year of study in the U.S. with an equivalent GPA of 3.0 or better. The official score must be addressed to the JCCC Director of Practical Nursing and received no later than the application deadline. Results will not be accepted if submitted by individuals/applicants. 4

7 LEGAL QUALIFICATIONS FOR LPN LICENSURE Before graduation, a candidate must submit a written application with the State Board of Nursing and the National Council of State Boards of Nursing to take the NCLEX LPN exam. Special Note: Graduation from this Practical Nursing Program does not guarantee licensure as a licensed practical nurse. State Boards of Nursing may deny licensure if the applicant has been found guilty of certain misdemeanors or felonies. Please contact the Legal Division of the State Board of Nursing if you have any questions related to criminal background checks. DISCLOSURE OF CRIMINAL BACKGROUND/SUBSTANCE ABUSE Clinical/field agencies, their accrediting agencies and/or state nursing licensure applications may require a criminal background check and a drug/alcohol screening. Additional requirements and/or disclosures may become necessary throughout the course of the program. Any non compliance with these mandates may result in termination from the program. Any fees associated with these mandates will be the responsibility of the student. If you have been convicted of a felony or a misdemeanor, you should contact the legal department of the State Board of Nursing or visit the State Board s website to which you are applying for clarification of the regulation for that particular state. Special Note: The Kansas State Board of Nursing has regulations that may deny licensure if an applicant has been found guilty of: 1. A felony or misdemeanor involving an illegal drug offense. 2. A felony conviction for a crime against persons R12/15 5

8 HEALTH POLICY Students entering the health programs should be aware that they will be in close contact with other individuals having a variety of health problems in which the cause may or may not be known. Health career programs have specific precautionary requirements based on the type of exposure and/or clinical agency policies. It is the student s responsibility to follow the program guidelines necessary for precautions against contracting and transmitting diseases including annual flu shots and additional vaccines as recommended by the CDC. The student is responsible for all healthcare costs (physical examinations and other healthcare costs, documentation of vaccinations and/or immunizations and may include lab work and chest X rays). Due to affiliate agreements, students must maintain medical insurance while attending the Practical Nursing Program. All healthcare costs are to be assumed by the individual student. Neither the college nor the clinical agency in which students are assigned is responsible for the provision of any healthcare nor for any payment of costs related to an injury or the exposure to or infection with a disease while completing clinical rotations. Students are responsible for meeting all course, clinic and program objectives. Students may be asked to provide a physician s statement to explain absences and/or justify re entry into the class or clinical setting. Progressions in the Practical Nursing Program will be contingent upon satisfactorily meeting the health requirements, having a negative drug/alcohol screen and having a background check that is clear of felonies or a pattern of misdemeanors. Health restrictions or evidence of criminal behaviors or acts may prohibit student participation in clinical rotations and the performance of total patient care and, therefore, would prevent progression in or completion of the Practical Nursing Program R12/15 6

9 PRACTICE AND EMPLOYMENT EXPECTATIONS To successfully progress through the nursing curriculum and function as a practicing nurse upon graduation, an individual must be able to perform certain physical and mental activities. The following was based largely upon the Functional Ability Categories and Representatives Activities/Attributes as provided in the National Council of State Boards of Nursing Inc. Critical thinking ability sufficient for clinical judgment, including sufficient intellectual functioning and emotional stability to plan and implement care for clients; to identify causeeffect relationships and plan/control activities for others; to synthesize knowledge and skills; and to sequence information. Analytical thinking ability sufficient to transfer knowledge from one situation to another, process information, evaluate outcomes, problem solve, prioritize tasks, and use long and short term memory. Interpersonal skills sufficient to interact with individuals, families and groups from a variety of social, emotional, cultural and intellectual backgrounds; negotiate interpersonal conflict; respect differences in clients; and establish rapport and demonstrate respect for clients, coworkers and faculty. Emotional stability to establish therapeutic boundaries, provide clients with emotional support, adapt to changing environment/stress, deal with the unexpected (e.g., client going bad, crisis), focus attention on task, monitor own emotions, perform multiple responsibilities concurrently and handle strong emotions (e.g., grief). Gross motor skills to move within confined spaces, sit and/or stand and maintain balance, reach above shoulders (e.g., IV poles), and reach below waist (e.g., plug electrical appliances into wall outlets). Manual dexterity of fine motor skills with the ability to handle small objects, pick up objects with hands, grasp small objects with hands (e.g., IV tubing, pencil), write with pen or pencil, keyboard/type (e.g., using a computer), pinch/pick or otherwise work with fingers (e.g., manipulating a syringe), twist (e.g., turning objects/knobs using hands), squeeze with finger (e.g., eye dropper) and to perceive texture. Physical endurance with ability to stand (e.g., at client side during surgical or therapeutic procedure), to sustain repetitive movements (e.g., CPR) and maintain physical tolerance (e.g., work entire shift). Physical strength with ability to push and pull 50 pounds (e.g., position clients); support 50 pounds of weight (e.g., ambulate client); lift 50 pounds (e.g., pick up a child, transfer client); move light objects weighing up to 10 pounds (e.g., IV poles), move heavy objects weighing from 11 to 50 pounds and carry up to 25 pounds frequently, but occasionally may exceed these limits; stoop, kneel, crouch and/or crawl at appropriate times as needed; push or pull with hands and arms as needed; stand and/or walk as the job requires in the performance of duties; defend self against combative client; carry equipment/supplies; use upper body strength (e.g., perform CPR, physically restrain a client); squeeze with hands (e.g., operate fire extinguisher). 7

10 Mobility needed to twist, bend, stoop, move quickly (e.g., response to an emergency) and climb (e.g., ladders/stools/stairs). Hear normal speaking levels sounds (e.g., person to person report), faint voices and faint body sounds (e.g., blood pressure sounds, assess placement of tubes) accurately to perform skills and techniques needed to gather information relevant to the client s care. Hear in situations when not able to see lips (e.g., masks are used) and hear auditory alarms (e.g., monitors, fire alarms, call bells). Visual acuity required to assess client s condition, evaluate test results, discriminate between colors and maintain safe environment; see objects up to 20 in. away (e.g., information on a computer screen, skin conditions); see objects up to 20 ft. away (e.g., client in room); see objects more than 20 ft. away (e.g., client at end of hall); use depth perception, use peripheral vision; distinguish color (e.g., color codes on supplies, charts, bed); and distinguish color intensity (e.g. flushed skin, skin paleness). Tactile to feel vibrations (e.g. palpate pulses); detect temperature (e.g., skin, solutions); feel differences in surface characteristics (e.g., skin turgor, rashes); feel differences in sizes and shapes (e.g., palpate vein, identify body landmarks); and detect environment temperature (e.g. check for drafts). Smell to detect odors from client (e.g., foul smelling drainage, alcohol breath, etc.), detect smoke and detect gases/noxious smells. Reading ability to read and understand written documents (e.g. policies, protocols). Mathematical competence to read and understand columns of writing (flow sheet, charts), digital displays, graphic printouts (e.g., EKG); graphs (e.g., vital sign sheets) and measurement marks (e.g., measurement tapes, scales, etc.); calibrate equipment; convert numbers to and/or from the metric system; tell time; measure time (e.g., count duration of contractions, etc.); count rates (e.g., drips/minute, pulse); use measuring tools (e.g., thermometer); add, subtract, multiply and/or divide whole numbers, compute fractions (e.g., medication dosages); use a calculator; write numbers in records; perform algebraic equations to calculate medication dosages. Communicate, both verbally and in writing, in order to respond to clients, families and the members of the healthcare team; teach (e.g., client/family about healthcare), explain procedures, give oral reports, (e.g., report on client s condition to others); interact with others (e.g., healthcare workers), speak on the telephone, influence people, direct activities of others and convey information through writing (e.g., progress notes); read, interpret and record clinical data appropriately; complete theory assignments such as, but not limited to, writing nursing care plans, test taking and giving oral reports. Proficient in Windows based computer programs and Microsoft Office, with ability to send and receive . 8

11 PREREQUISITE COURSES AND ADDITIONAL REQUIREMENTS MUST BE COMPLETED PRIOR TO THE APPLICATION DEADLINE: HESI A2 Admission Assessment Exam MAY BE CURRENTLY ENROLLED IN AT THE APPLICATION DEADLINE: All prerequisite courses including BIOL 144 Anatomy & Physiology (5 credit hours), or BIOL 140 Human Anatomy (4 credit hours) and BIOL 225 Human Physiology (4 credit hours); and PSYC 130 Introduction to Psychology (3 credit hours), PSYC 218 Human Development (3 credit hours). Applicants must complete all prerequisite college courses with a grade of C or higher by the end of the semester in which they apply. If these courses are taken at another college, official transcripts must be received by January 1 for Evening/Weekend and June 1 for Day Program. AVHO 102 Certified Nurse Aide (5 cr hrs) or equivalent Kansas CNA Certification must be current (through the first day of class). Proof of current CNA (see page 17 for how to print information) OR proof of current course enrollment must be provided to department at the time of interview. If enrolled at time of interview, student must pass Kansas CNA testing, then submit proof of CNA certification directly to department no later than January 1 for Evening/Weekend PN Program or June 1 for Day PN Program. XNC 3140 CPR for Health Care Provider or equivalent American Heart Association Certificate for BLS CPR for Health Care Providers is required prior to the first day of class of the first semester of the PN Program and must remain active throughout the entire program. Documentation of a negative 2 step TB skin test* is required prior to the first day of class of the first semester of the PN Program and must remain active throughout the entire program. *Documentation of a TB titer less than 12 months old (Interferon Gamma Release Assays [IRAs] blood tests for TB infection). Students who have previously applied to the Practical Nursing Program must submit a new nursing application, including all required documentation, and are considered first time applicants. Attend a nursing information session. To register: Go to type Nursing Information Sessions in the search box and follow the link. These sessions fill quickly; do not wait to register. Interviews will be scheduled for students who have complete admission files and are enrolled in/or have taken the prerequisite courses, meet the minimum GPA and HESI A2 requirements. Students must carry valid medical insurance during the course of the program. 9

12 The online application is the pivotal document in creating your nursing file. HESI A2 results and/or transcripts are not required prior to the submission of the application, but must be received by JCCC Selective Admissions office on or before the application deadline. Applications are completed online. Applications will be reviewed in the order in which they are received. Transcript information and/or course equivalencies will NOT be discussed over the telephone or prior to the submission of the PN Program application. JCCC does not accept transfer credits from a non accredited college. Applicants can check their degree audit by logging in to their My JCCC account, selecting the EASI tab and clicking on the Student and Financial Aid link. If at any time during the application process you have a change of address or phone number, OR if you decide to withdraw your application, please submit that information in writing to the Admissions Office, ATTN: Selective Admissions, Box 41, or call the Health Occupations Office at If you are having trouble with the application, call our Student Success Advocates at NOTE: This program does not meet eligibility requirements for students with an F1 Visa. Applicants can view notifications verifying receipt of materials in the Selective Admissions Office by checking their Personal Admission Plan within their MyJCCC account. It is the responsibility of the applicant to make sure ALL materials are received in the Admissions Office prior to the application deadlines. Address ALL application materials to: Selective Admissions Johnson County Community College College Blvd. Box 41 Overland Park, KS

13 HEALTH EDUCATION SYSTEMS INC. ASSESSMENT EXAM Aptitude Test for Practical Nursing The Health Education Systems Inc. Assessment Exam is designed to evaluate and predict the academic potential of nursing candidates prior to admission into the Practical Nursing Program. Test results are considered in the selection process and may be discussed at the time of applicant interviews. For additional information and practice tests, view test.com. A HESI A2 study guide is also available at the JCCC library. In addition, JCCC Adult Basic Education Department can assist you in preparing for this exam. The HESI A2 can be taken only once during each testing period and must be completed before the application deadline. The fee is $50.00 (non transferrable and/or non refundable upon cancellation or non attendance). Retake exams are not available. Students can access their test results online. Results of the HESI A2 Exam are valid for 3 years. If you have taken the HESI A2 at another location within the acceptable time frame, please have an official score report forwarded to the JCCC Testing Services Office by the program deadline. To be considered for admission to the program, students must have a math score of at least 70%, a reading score of at least 70% and a vocabulary score of at least 70%. To view test dates and to register for the HESI A2 exam, go to: 1. Choose Shop JCCC from the menu on the right side of the screen. 2. Select Testing Services under the Services heading. 3. Select the HESI link on the left of the screen. 4. Choose your date and complete the required information. 5. Pay as directed. 6. Print your receipt. NOTE: Registration is online only after the dates are posted. An will be sent to you confirming your registration. If you have a JCCC account, please list it on the registration screen. If a JCCC account has yet to be assigned, you may list your personal ; however, be aware that communication with your personal account will be limited to this confirmation only. PLEASE NOTE: SPACE IS LIMITED REGISTER EARLY On the day of the test, plan to be on campus by 7:45 a.m. Your receipt and current photo ID will be required. You will not be allowed to test if you are late no exceptions. For questions or concerns regarding the HESI A2 test, or if you need help understanding the results of the exam, contact Jane Zaccardi, Director of Practical Nursing, at

14 FINAL SELECTION INTO THE PRACTICAL NURSING PROGRAM I. Final selection will be based upon the following total ranking criteria of each applicant: A. A 2.0 grade point average at JCCC and a cumulative GPA in all completed course work to date is required for consideration for admission to the program. B. HESI A2 exam scores in math, reading and vocabulary will contribute 60% to the final ranking. C. The interview will contribute 40% to the final ranking. D. Successful completion of all prerequisite college courses with a grade of C or higher by the end of JCCC s semester during which you apply (Spring or Fall). Upon completion of all interviews and ranking, applicants will be notified by certified mail if they have been accepted into the program. Those candidates not initially chosen for positions will be notified by . ACKNOWLEDGING ACCEPTANCE I. Accepted applicants will be given five (5) business days after receipt of letter to accept their position. II. The applicant is required to return the Intent to Accept notice and post a $ non refundable tuition deposit. III. IV. If any of the selected students do not accept, or if they accept and then withdraw prior to the beginning of nursing classes, the vacancy created will be offered to the next highest ranked applicant. Students offered admission after the initial mailing will be required to submit a nonrefundable $ tuition deposit within five (5) business days. V. Final acceptance in the program will be contingent upon satisfactorily completing any outstanding prerequisite courses, passing the Kansas CNA exam, meeting the health requirements and having a background check that is clear of felonies. Health restrictions or evidence of a criminal background may prohibit student participation in clinical rotations and the performance of total patient care, and therefore prevent acceptance into the Nursing Program. VI. Questions concerning the selection process should be directed to the Director of PN & Health Occupations, Questions concerning the admission process should be directed to the Admissions Office, , or Questions concerning the program should be directed to the Health Occupations Department,

15 PERFORMANCE EXPECTATIONS In order to progress from one semester to the next in the Practical Nursing Program, the student will be required to: 1. Complete the appropriate sequence of courses as defined by the Program of Study for the Practical Nursing curriculum. 2. Achieve a grade of C (76%) or higher in all theory courses of the required curriculum for the Practical Nursing Program and pass all clinical courses. NOTE: Illness or other extenuating circumstances may result in the receipt of an incomplete grade in the Practical Nursing course. A written contract for removal of the incomplete may be awarded at the discretion of the Nursing faculty. In such instances, specific deadlines for completion of required assignments will be established. A copy of the contract with specific deadlines will be given to the student. 3. Actively participate in class, the skills laboratory and the clinical laboratory to satisfactorily attain written objectives. Participation should reflect adequate preparation for assigned learning activities. 4. Complete skills proficiency check offs. Competency for each skill must be achieved. 5. Administer nursing care which, in the professional judgment of the Johnson County Community College Practical Nursing faculty: a. Is consistent with the accepted Code of Ethics of the American Nurses Association and the Johnson County Community College Practical Nursing Program philosophy and objectives. b. Reflects the ability to meet the clinical objectives defined in the Clinical Performance Evaluation of each clinical experience. c. Demonstrates in her/his performance an understanding of the role of the Licensed Practical Nurse. 6. Arrive on time. Attend all classes and clinical experiences. Transportation to and from clinical agencies is the responsibility of the student. Clinical experience may require students to arrive as early as 6:00 a.m. or be dismissed as late as 11:00 p.m. Our clinical sites require that our students carry health insurance. Therefore, students must carry health insurance for the duration of the program. Student employment must not interfere with timeliness and/or attendance. 13

16 ESTIMATED EXPENSES Tuition & Fees:* 1st Semester: Johnson County Resident $1,674 Other Kansas County $1,980 Out of State $3,960 Metro Rate $2,430 Liability Insurance $16.00 Standard Testing Fee (over 2 semesters) $ nd Semester: Johnson County Resident $1,488 Other Kansas County $1,760 Out of State Metro Rate $3,520 $2,160 Nursing Pin w/engraving (optional) $75.00 Other estimated costs not included in Tuition & Fees: Uniforms: Hunter Green Scrub Top $11.99 Hunter Green Cargo Pants $16.99 Drug Screen $35.00 Criminal Background Check $61.00 Physical Exam/Immunizations/Flu Shot $ Textbooks (less if used textbooks available) $850 $1,000 State Board Application and NCLEX $ Supplies $ Graduation Photos Sitting Fee $25.00 Laptop Computer (recommended) $1, * Proposed curriculum, tuition and fees pending approval and are subject to change without notice. Students anticipating difficulty in financing their education should contact the Financial Aid Office, 2nd floor of the Student Center, for assistance, , as soon as possible to request application information. To check your student account, go to then log in to MyJCCC by entering your JCCC username and password. Click on the EASI tab, scroll down and click on Student Services and Financial Aid, and then scroll down and click on Financial Aid. Scholarship application information is available at search for Scholarships. Students must complete the JCCC online scholarship application and have a FAFSA on file to be considered for a departmental scholarship. 14

17 CONSIDER THE FOLLOWING POINTS BEFORE YOU APPLY HAVE YOU READ AND UNDERSTOOD THE PRECEDING PAGES? If you have questions, please contact the appropriate party listed on page 12. DO YOU MEET THE ADMISSION REQUIREMENTS? If you have questions as to your academic status, please call to make an appointment to meet with an academic counselor. HAVE YOU MADE ARRANGEMENTS TO ATTEND A NURSING INFORMATION SESSION? For dates and times: Go to and type nursing information sessions in the search box. These sessions fill quickly, so do not wait to register. If you can answer yes to each of the above questions, complete the application process listed on the following pages. Please retain pp for future reference. 15

18 APPLICATION PROCEDURE The following must be submitted to JCCC on or before application deadline: 1. Practical Nursing Application The application is valid only for the program and semester selected. It is recommended you submit the PN application first and then follow up by the deadline date with the remainder of the required documentation. The application is online at (click apply for admission). Please contact our Student Success Advocates if you need assistance at If you are not a current student at JCCC, you will also be entered as a Liberal Arts student, creating two personal admission plans. 2. Health Education Systems Inc. Exam HESI A2 scores must be submitted by the application deadline. For additional information, see page 11. NOTE: Contact Testing Services if you have taken the HESI A2 anywhere else within the last three years to determine if these scores can be used. TEAS test results will NOT substitute for HESI A2 results. 3. Disclosure/Consent Form signed and dated (downloaded from the online application). 4. Official College Transcripts from each college and/or university attended. Applicant is responsible for notifying each institution to request that an official transcript be sent directly to the JCCC Selective Admissions Office. Hand carried, faxed or copies issued to students will not be accepted. An official JCCC transcript is not required. Your JCCC transcript will be placed in your file. 5. Official High School Transcripts or GED Scores are required only if you are applying for federal financial aid and have completed less than 12 college credits. Applicants currently enrolled in high school must submit transcripts through the fall semester of their senior year. Kansas CNA Certification is NOT due by application deadline; however, it must be current and/or completed by January 1 for the Evening/Weekend Program and June 1 for the Day Program and must remain current through the first day of class. To print proof of certification, follow these directions: (1) Go to Click on Certification Verification. Enter required information and click on Search, then click Details. Print this page and bring to interview. OR (2) Submit proof of enrollment in a CNA course at time of interview, then proof of completion/certification no later than January 1 for the Evening/Weekend Program and June 1 for the Day Program, directly to the LPN Department. (Course is completed upon passing the Kansas Certified Nurse Aide test.) Verify passage of the test by following the steps listed above and forwarding the certification directly to the LPN Department, OHEC Campus. NOTE: If you have CNA certification in another state, please contact the Kansas Dept. for Aging and Disability Services office in Topeka at as soon as possible for information on challenging the State Certified Nurse Aide Test. There are NO exceptions to this requirement. Prior healthcare background/ experience does not amend this requirement. 16

19 JOHNSON COUNTY COMMUNITY COLLEGE ALLIED HEALTH PROGRAMS DISCLOSURE AND CONSENT FOR BACKGROUND CHECKS The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has instituted new regulations that must be followed which require that all persons who are involved in patient care activities submit to criminal and other healthcare related background checks. Accordingly, all students desiring admission to the college s Respiratory Care, Polysomnography, Registered Nursing (RN), Licensed Practical Nursing (LPN) and Emergency Medical Training (EMS) programs programs which require clinical placement and training with healthcare providers pursuant to contracts with the college must complete such background checks. Because of the requirements of the JCAHO and the college s affiliated healthcare providers, admission to and enrollment in any of the above described programs require successful completion and passage of the background checks. Those students who are already enrolled in any of the above programs, and who fail the background checks, will not be permitted to participate in clinical training and thus will be unable to complete the program. However, the results of the background checks will not necessarily preclude admission to or enrollment in other college courses. The company of Validity Screening Solutions or similar agencies will conduct background checks, including but not limited to the following: Criminal History; Sex Offender Registry; Office of Inspector General and General Services Administration Excluded Parties Lists; Social Security Number Trace; Employment Verification; and Caregiver Background Screening. The Fair Credit Reporting Act (FCRA) may give applicants specific rights in dealing with consumer reporting agencies such as Validity Screening Solutions, and Validity Screening Solutions may provide applicants with additional notices or seek additional consents before conducting any background checks. Validity Screening Solutions does charge a fee for its services, approximately $55.00 (subject to change), for which the applicant is responsible. (We need your signature for release, but no money is needed now. Further instructions will be provided.) In the event that information from a background check or consumer report is utilized in whole or in part in making an adverse decision with regard to admission, enrollment or clinical placement, then before taking such action, the college or Validity Screening Solutions will provide the applicant with a copy of the background check and a written description of the applicant s rights under the FCRA. An applicant may dispute the accuracy or completeness of a background check directly with Validity Screening Solutions. By signing below, the applicant acknowledges and agrees that the college itself is not responsible for the accuracy or completeness of any background check and agrees to release, defend, indemnify and hold the college harmless from and against any and all loss, damage, injury or expenses arising out of such background checks. By signing below, the applicant hereby agrees that he/she has read and understands the above disclosures and hereby authorizes the college and Validity Screening Solutions or similar agencies to obtain a background check, consumer report and/or investigative report about the applicant for the purposes of determining admission to or enrollment in any of the above programs or participation in clinical training. Signature Printed Name Date 17