Associate of Applied Science Degree

Transcription

1 Transforming Lives Building Communities Associate of Applied Science Degree LPN to RN Application Please Note: Accepted students will be admitted on space availability. Open date: Tuesday, August 2, Applicants can begin submitting program applications. Close date: Friday, October 14, All required documentation listed on the application checklist must be received by the Admissions, Registration and Records office no later than 5 p.m. No postmark date allowed, no exceptions. Submit all application materials to: Mt. Hood Community College Admissions, Registration and Records LPN to RN Application SE Stark St. Gresham, OR 97030

2 APPLICATION PACKET CHECKLIST Applicant Name: Date: MHCC ID# Every item on this checklist needs to be submitted by the application deadline October 14, by 5 p.m. Only completed applications containing all the required documents will be considered for review. You will not be given notification if items are missing. It is the responsibility of the applicant to make sure everything was received by the deadline. Item 1. Online General Admissions Form ( 2. Application Checklist Page 2 3. Allied Health Division Application Page 3 4. Prerequisite Course Planning Sheet Page Letters of Reference in Sealed Envelope Pages 5 & 6 6. Skill Assessment Checklist Pages 7 & 8 7. $75 Application Fee (non-refundable) Make check payable to MHCC. Bank card/cash is only payable in person in Student Services (Room AC2253). 8. Official (in a sealed envelope) College Transcript(s) from EVERY COLLEGE EVER ATTENDED (Do not include MHCC transcripts). 9. Current LPN License Print off from the OSBN ( 10. Completion of the ATI Step Test (offered 9/19/16 & 10/7/16 at the Bruning Center for Allied Health). 11. Work Experience - Letter from previous supervisor documenting at least 500 hours of LPN work experience. 1. MHCC s Admissions, Registration and Records office will send all application notification by . It is my responsibility to set my spam filter system to accept mail addresses even if I am currently receiving s from MHCC. MHCC cannot be responsible for notices which are not received due to spam or junk mail handling. I will make sure to add MHCC to my safe senders list. MHCC recommends applicants to check their on a computer and NOT on a smart phone. 2. I have read, completed, and fully understand the admission criteria as listed in the Program Application Guide for the Nursing program at Mt. Hood Community College and OCNE. I understand that it is my responsibility to meet all program and application criteria. I verify that all statements on this application are complete and true; and I understand that falsification of any information may lead to disqualification or dismissal from the program. I give my permission for release of pertinent application information to the OCNE partner schools, including Oregon Health and Science University, and the State Board of Nursing, as necessary to facilitate my program of study and to enhance the application process for future applicants. 3. I understand it is my responsibility to ensure all items are received by the application deadline and only complete applications will be evaluated for admission. Furthermore, I have read and understand the admission requirements and procedures for applying. I understand that withholding information or giving untruthful answers to questions on this application could be cause for nonacceptance or dismissal from the program. By signing below, I am confirming each item above is included with my application or I have confirmed they are already on file at MHCC. I understand it is my sole responsibility to submit the required documents, and I will not be given notice if my application is incomplete until after the deadline, at which time it will be too late to submit missing documents. 4. I understand that selection for enrollment in the MHCC pathophysiology and pharmacology courses does not guarantee admission to the Nursing program. Applicants must successfully complete each nursing course with a C grade or better before they are officially admitted into the MHCC Nursing Program. 5. I understand students are only admitted on a space availability. Signature Date LPN to RN Application (071416) Page 2 of 8

3 OCNE/MHCC LPN TO RN- ALLIED HEALTH DIVISION APPLICATION Please print and complete fully, do not leave blank. Attach extra paper if needed. Name: SSN or MHCC ID: Previous Last Name(s): ALL notifications will go out via to this address Current Mailing Address: Street City State Zip Phone Number and Alternate Phone: ( ) ( ) Home Cell Name of Nearest Relative and Their Relationship to You: Address of Named Relative: Name Relationship (i.e. mother) Education Record: List ALL colleges EVER attended. Omission of any college transcript will result in non-admittance or dismissal from the program. We will need an official copy of each transcript regardless of program length, course of study, or program applicability. Failure to submit these transcripts will result in an immediate incomplete application. College: Date of completion (if applicable): Previous Applications: List all Allied Health programs you have previously applied to (including MHCC). If you have previously been admitted into an Allied Health program but did not finish the program, you must get a letter from the department at your prior institution stating you left in good standing and are eligible to reapply. College: Program Title: Application year(s): Were you accepted? For Office Use Only: Received Date: Received By: LPN to RN Application (071416) Page 3 of 8

4 PREREQUISITE COURSE PLANNING SHEET Applicant Name: Date: MHCC ID# Please complete the following chart indicating where you have completed the required nursing prerequisites and first year general education courses equivalent to the MHCC courses list below. The required mathematics, Anatomy and Physiology I, II, III; nutrition; and microbiology must be completed within the last seven years (not prior to Winter term 2010) with a C grade or better. SECTION I (REQUIRED): Completion of all program first year general education courses prior to the October 14, deadline. Course Name Courses Completed Term / Year Grade Credits ANATOMY & PHYSIOLOGY I, II, III (completed not prior to 2010) BI231 Anatomy & Physiology I BI232 Anatomy & Physiology II BI233 Anatomy & Physiology III MATHEMATICS (completed not prior to 2010) MTH095 Intermediate Algebra or higher math SCIENCE COURSES BI102/112/212 or other biology with genetics BI234 Microbiology (completed not prior to 2010) FN225 Nutrition (completed not prior to 2010) ENGLISH COMPOSITION (8 credits total) WR121 English Composition I WR122 English Composition II OR WR227 Technical Report Writing HEALTH / PHYSICAL EDUCATION HPE295 Health and Fitness for Life (or any 3 hours of HE, HPE, or PE) Human Development (4 credits) PSY237 Human Development SOCIAL SCIENCE COURSES (6-8 credits) PSY201 General Psychology (or a social science elective) Social Science Elective HUMANITIES COURSES (3-4 credits) Humanities Elective SECTION II (OPTIONAL): Completion of in-program second year general education electives with a grade of C or better prior to the October 14, application deadline. This is for discretional points only. SOCIAL SCIENCE COURSES (3-4 credits) Social Science Elective HUMANITIES COURSES (6-8 credits) Humanities Elective Humanities Elective ELECTIVE COURSES (9 credits) General Education Nursing Elective General Education Nursing Elective General Education Nursing Elective LPN to RN Application (071416) Page 4 of 8

5 LPN TO RN OCNE ADVANCED PLACEMENT REFERENCE Applicant Name: Date: MHCC ID# Instructions to Applicants: References from two individuals with direct knowledge of your work as an LPN are required for your application to the LPN to RN program. One reference must come from a colleague or instructor who has worked with you in a healthcare setting and one reference must be from a healthcare facility supervisor who has been involved in supervising and/or evaluating your performance within the past year. Fill in your name and your colleague s or instructor s name or healthcare facility supervisor s name on the lines provided and sign and date the form in the space provided. The colleague, instructor or supervisor is asked to circle the appropriate number on each line, sign (including title and agency name and phone number) and date the form, place it in an agency envelope and return it to you to attach to your application. Instructions to Healthcare Colleague and Healthcare Facility Supervisor: The LPN whose name appears on the line above is applying for advanced placement to the Mt. Hood Community College Nursing Program. Their application will not be complete without the required references. Please take a few moments to answer the following questions based on your experience with this applicant. Once you have completed this form place it into a sealed envelope and give back to the applicant. Please circle the number that best matches your knowledge of the applicant. DO NOT write in partial points. The score, in a case where a partial point is written, will be rounded down to the lower whole number. 1 = Doesn t Meet Expectations; 2 = Meets at Least Minimum Expectations; 3 = Serves as a Role Model for Others. 1. How well would you say this individual interacts with individuals from varied backgrounds, cultures, ethnicity and lifestyles? How closely does this individual demonstrate the ethical behavior, honesty and integrity you would expect of a Nurse? How articulate is this individual when communicating orally and in writing? How suitable is this individual for transitioning from the Licensed Practical Nurse role to the role of the Registered Nurse? How likely is this individual to remain calm and stable when performing under pressure? How would you rate this individual s leadership and problem solving abilities? Colleague or Supervisor Signature and Title Date Agency Name Phone Number Comments: Applicant Make sure the colleague or supervisor completing this form seals it in an envelope prior to returning it to you. By signing below you waive your right to review this form after it has been completed. This form must be received by the application deadline. Applicant s Signature Date LPN to RN Application (0722) Page 5 of 8

6 LPN TO RN OCNE ADVANCED PLACEMENT REFERENCE Applicant Name: Date: MHCC ID# Instructions to Applicants: References from two individuals with direct knowledge of your work as an LPN are required for your application to the LPN to RN program. One reference must come from a colleague or instructor who has worked with you in a healthcare setting and one reference must be from a healthcare facility supervisor who has been involved in supervising and/or evaluating your performance within the past year. Fill in your name and your colleague s or instructor s name or healthcare facility supervisor s name on the lines provided and sign and date the form in the space provided. The colleague, instructor or supervisor is asked to circle the appropriate number on each line, sign (including title and agency name and phone number) and date the form, place it in an agency envelope and return it to you to attach to your application. Instructions to Healthcare Colleague and Healthcare Facility Supervisor: The LPN whose name appears on the line above is applying for advanced placement to the Mt. Hood Community College Nursing Program. Their application will not be complete without the required references. Please take a few moments to answer the following questions based on your experience with this applicant. Once you have completed this form place it into a sealed envelope and give back to the applicant. Please circle the number that best matches your knowledge of the applicant. DO NOT write in partial points. The score, in a case where a partial point is written, will be rounded down to the lower whole number. 1 = Doesn t Meet Expectations; 2 = Meets at Least Minimum Expectations; 3 = Serves as a Role Model for Others. 1. How well would you say this individual interacts with individuals from varied backgrounds, cultures, ethnicity and lifestyles? How closely does this individual demonstrate the ethical behavior, honesty and integrity you would expect of a Nurse? How articulate is this individual when communicating orally and in writing? How suitable is this individual for transitioning from the Licensed Practical Nurse role to the role of the Registered Nurse? How likely is this individual to remain calm and stable when performing under pressure? How would you rate this individual s leadership and problem solving abilities? Colleague or Supervisor Signature and Title Date Agency Name Phone Number Comments: Applicant Make sure the colleague or supervisor completing this form seals it in an envelope prior to returning it to you. By signing below you waive your right to review this form after it has been completed. This form must be received by the application deadline. Applicant s Signature Date LPN to RN Application (0722) Page 6 of 8

7 SKILL ASSESSMENT CHECKLIST Instructions to Applicants: Please fill out this form in its entirety. Note if the skill to the left is part of your current or past job requirements, and your experience level with that skill. In addition, please make comments as you deem appropriate. Skill Isolation Techniques Body Mechanics Vital Signs (including manual BP) Height & Weight Hand Washing Pressure Ulcer Care Focused Assessment Review Health History Interviewing Positioning, Transfers, ROM ADLs, Mobility, Fall Risk Nutrition, Elimination Procedures, I & O IM Injections SQ & Intradermal Injection Sites and Practice Medication Administration, including: -Topical -Oral -Inhaled -Pain Management -Nebulizer Treatments CBG Measurement Diabetic Care Insulin Colostomy Care, Including: -Replacement -Emptying Wound Care, Including: -Pressure Ulcer -Sterile Dressing Change -Drains (JP, Hemovac, Penrose, T-tube) NG Tube Maintenance Urinary Catheter Insertion & Maintenance Part of Job Requirement (Yes or No) Some experience / No Experience Comments LPN to RN Application (0722) Page 7 of 8

8 SKILL ASSESSMENT CHECKLIST (CONTINUED) Instructions to Applicants: Please fill out this form in its entirety. Note if the skill to the left is part of your current or past job requirements, and your experience level with that skill. In addition, please make comments as you deem appropriate. Sterile Technique IV Therapy, Including: -Hanging a Primary Line -Hanging IVPB - Setting Up An IV Pump -PICC Lines Tracheotomy Care & Suctioning Airway & Suctioning Perioperative Care -Preoperative & Postoperative Care Suture & Staple Removal Chest Tube Maintenance EKG LPN to RN Application (0722) Page 8 of 8