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1 P I E R C E C O LLEGE ASSOCIATE DEGR EE IN N U R S I N G ADN P R OGRAM APPLICATION PACKET P R O G R A M S T A R T S W I N T E R Application Due Date is Monday, JULY 7, : 0 0 pm ( U p d a t e d 4 / 2 5 / 1 4 ) The Pierce College Puyallup Associate Degree Nursing Program s mission is to provide students with a comprehensive, quality education based upon current professional practice and incorporating respect of the individual, to meet the diverse needs of our community. WORKSHOP FOR ADN WINTER 2015 APPLICANTS Application Workshop: Fri. June 6, 2:00 4:00pm Room AAH 130 Arts and Allied Health Building (This is a complimentary workshop and attendance and sign-up is not required.)

2 SECTION ONE Letter from the Director Program Introduction Program Contact Information Faculty and Support Staff

3 LETTER FROM THE DIRECTOR Greetings! It is my pleasure to welcome you to Pierce College. The application process for the Pierce College Nursing Program is challenging yet rewarding. Our aim is to ensure that all individuals have an equal opportunity to shine during this process; we support prospective students in their endeavor toward achieving the next step in the academic journey toward becoming a professional registered nurse and obtaining an Associate Degree in Nursing. You will find that the Pierce College Nursing Program is outstanding and distinctive. We are built on a foundation of respect for all individuals in our community. We strive for inclusion of all from our diverse community by training qualified registered nurses and developing each student s unique abilities. Our commitment to quality nursing education and teaching excellence prepares learners to live and work successfully as registered nurses in an ever-changing healthcare environment in this new millennium. I urge you to take advantage of the rich resources that are available to you at Pierce College during this application process. Nursing is a rewarding career choice, and our application and selection process are rigorous. We will ask many questions to assess your academic qualifications. Remember, the faculty and staff of the Pierce College Nursing Program support you in this endeavor and we encourage you to ask questions throughout the process. Good luck! Warmest Regards, Becky Piper, M.N., R.N. Nursing Director, Associate Professor Pierce College Puyallup Allied Health

4 PROGRAM INTRODUCTION Pierce College offers the Associate Degree in Nursing for students who wish to become Registered Nurses. This program begins with a strong foundation in basic nursing skills, from which students then advance to more complex nursing concepts. A solid base in the natural and social sciences is included to provide students with a greater understanding of patient care in a variety of settings. During the course of the program, students receive experience in acute care, maternal/child, acute care specialties, community and mental health settings. Graduates will earn an Associate Degree in Nursing from Pierce College, then must take and pass the NCLEX-RN examination in order to be licensed as Registered Nurses in their state of residence. Licensed graduates qualify to be employed as entry-level nurses in hospitals, long-term care facilities, rehabilitation centers, clinics, health care providers offices, and home care agencies. They are also able to plan and coordinate patient care. In addition, Pierce College ADN graduates have the option of enrolling in the BSN Completion program at UW-Tacoma or St. Martin s University. The Pierce College Puyallup Nursing Program seeks students who are committed to the profession of nursing. Before applying to our program, applicants should explore all facets of a nursing career, which may include, but not be limited to: infection control, practice settings, and the law as it pertains to nursing practice. Our program is distinctive. We are built on a foundation of respect and openness to change. We strive to meet the needs of our diverse community by training qualified registered nurses and developing each student s abilities. Our commitment to quality nursing education and teaching excellence prepares learners to live and work successfully as registered nurses in an ever-changing healthcare environment. Please read the enclosed information carefully and follow the application procedures exactly. EACH APPLICANT MUST MEET ALL DEADLINES AND SPECIFIC REQUIREMENTS IN ORDER TO BE CONSIDERED A QUALIFIED APPLICANT TO THE PIERCE COLLEGE ASSOCIATE DEGREE IN NURSING PROGRAM. THERE WILL BE NO EXCEPTIONS MADE. Send Completed Application Packet To: Pierce College Puyallup Associate Degree in Nursing Program ATTN: Stania Kasjan/Nursing Pierce College Puyallup th Ave. SE Puyallup, WA Pierce College District does not discriminate on the basis of race, color, national origin, sex, sexual orientation, disability, or age in their programs and activities. Admission to the Pierce College Associate Degree in Nursing Program is competitive. Completion of prerequisite coursework and this application does NOT guarantee admission into the program. The Pierce College Associate Degree in Nursing program forms a community of learners committed to the discipline of nursing. Our specialized community is built on a foundation of respect and an openness to change. Together we strive to meet the needs of our diverse community for qualified registered nurses and develop each nursing student s abilities in nursing. Our commitment to quality nursing education and teaching excellence prepares learners to live and work successfully as registered nurses in an ever-changing health-care en

5 PROGRAM CONTACT INFORMATION Nursing Program Office / Staff Pierce College Nursing / Allied Health th Avenue SE Puyallup, WA (253) Full Time Nursing Faculty Becky Piper, M.N., R.N. Ronda Durano, R.N., M.N. Elizabeth Webber, RN, MSN, CCRN Leah Webster Program Coordinator Nursing Front Office Assistant (253) lwebster@pierce.ctc.edu Becky Piper, M.N.,R.N. Other Pierce College Support Offices Nursing Program Director Pierce College Puyallup-Financial Aid (253) (253) bpiper@pierce.ctc.edu Federal School Code: Eustenia (Stania) Kasjan, M.A. Pierce College-Puyallup Testing Center Allied Health Program Manager (253) Pre-Nursing Advising/Admissions (253) Pierce College Puyallup Access ekasjan@pierce.ctc.edu Disability Services (253) Leslie Watts Faculty and On Call Advisor Ft. Steilacoom lwatts@pierce.ctc.edu Mike Peluso General Advising/Faculty Pre-Nursing Advising (On Call) mpeluso@pierce.ctc.edu

6 SECTION TWO Nursing Prerequisite Requirements Other Prerequisite Information

7 NURSING PREREQUISITE REQUIREMENTS Please see the Course Equivalency Chart at the back of this packet for course transferability from other Washington State schools. For credits earned outside Washington State or courses not listed on the Course Equivalency Chart, please contact the nursing program office to obtain the proper waivers prior to submitting your application to the nursing program. MINIMUM QUALIFICATIONS ENGL& COMPOSITION EXPOSITION BIOL& ANATOMY & PHYSIOLOGY I / LAB BIOL& ANATOMY & PHYSIOLOGY II / LAB BIOL& MICROBIOLOGY CHEM& INTRO TO CHEMISTRY (Inorganic) PSYCH&200 - HUMAN LIFESPAN DEVELOPMENT - MINIMUM QUALIFICATIONS MUST BE SUCCESSFULLY COMPLETED BY END OF AUGUST APPLICANTS MUST EARN A 3.0 (B) OR BETTER IN EACH COURSE - ALL COURSES MUST HAVE BEEN TAKEN WITHIN THE LAST 7 YEARS OF APPLICATION DATE Eng. & Psych Course may be more than 7 years old if part of a degree. TRANSFER-READY COURSE WORK FOR ADDITIONAL 4 POINTS TRANSFER-READY APPLICANTS MUST HAVE ALL OF THE ABOVE COURSES, INCLUDING THE FOLLOWING: MATH& INTRO TO STATISTICS = 2 POINTS WORLD LANGUAGES 10 COLLEGE CREDITS, OR 2 YEARS HIGH SCHOOL (of same language), or native speaker* = 2 POINTS *Must meet native speaker requirements (see advisor for details) - GRADES MUST BE NO LOWER THAN A 2.0 (C) - STATISTICS COURSE MUST HAVE BEEN TAKEN WITHIN THE LAST 7 YEARS OF APPLICATION DATE RECOMMENDED COURSEWORK (WILL ADD 1 EXTRA POINT) CHEM& INTRO TO ORGANIC AND BIOCHEMISTRY = 1 POINT - GRADE MUST BE NO LOWER THAN A 2.0 (C) - CHEM COURSE MUST HAVE BEEN TAKEN WITHIN THE LAST 7 YEARS OF APPLICATION DATE. IMPORTANT NOTES ON ALL PREREQUISITE REQUIREMENTS: Only the grades in these required courses or their equivalents will be considered in the qualifying phase. Successful completion of the required prerequisites does NOT guarantee admission to the Nursing Program. Only ONE repeat of EACH required prerequisite course will be accepted within the past 7 years and a W - withdrawal counts as one take.

8 Previous Degrees For students with previously earned Certificates, Associate or Bachelor degrees, the seven (7)-year limit for non-science prerequisite courses may be waived for credits earned within that degree. Only the Nursing Program Director or Pre- Nursing Advisors at Pierce College Puyallup may consider exceptions to this requirement, and it is the responsibility of the applicant to obtain a waiver prior to the application deadline (Pre-Nursing Advisor will prepare the form). This waiver will then be added to the Course Prerequisite Listing Form in the application packet after submission. Other Programs and BSN Completion Requirements for other nursing and BSN completion programs in the area may be different. If you are planning to apply to other programs in addition to this one, or intend to complete a Bachelor of Science in Nursing, please contact the nursing program at the two or four-year college you wish to apply to. Because admission into this program is competitive, we encourage all of our applicants to prepare to apply to other nursing programs as well. Course Equivalence of Prerequisite Courses from Other Colleges All applicants must completely fill out and submit the Course Prerequisite Listing Form (as part of the application process) to the Pierce College Puyallup Nursing Office to be considered in the selection process. When evaluating transcripts, the Course Prerequisite Listing Form is a necessary tool. Equivalence of courses taken at colleges in the State of Washington may be determined by referring to the Prerequisite Course Equivalency Chart. Any course not indicated on the Prerequisite Course Equivalency Chart MUST be accompanied by a signed Pierce College Nursing Waiver Form, along with a copy of the course description, course outline, or course syllabus, in order to be eligible for admission consideration. Please see the Pierce College Puyallup Pre-Nursing & Allied Health Advisor to prepare the form, if applicable. All required prerequisites/courses must be completed no later than August 2014 to be eligible to apply. There may be questions regarding course transferability. It is the applicant s responsibility to ensure that all prerequisite coursework will transfer to Pierce College. Please contact the Pierce College Puyallup Pre-Nursing & Allied Health Advisor to obtain the necessary support paperwork WELL IN ADVANCE of the application deadline, as this may take some time. Any information provided in this packet is subject to change without notice. Please keep abreast of departmental changes by visiting your advisor regularly, attending information sessions and visiting the program website often.

9 SECTION THREE Application Materials Notes on Scored Requirements Scoring, Priority Status, Qualification Information and Timeline Application Checklist Program Application Course Prerequisite Listing Form Professional Recommendation Form Personal Recommendation Form Personal Statement Post-Acceptance Requirements

10 Recommendations NOTES ON SCORED REQUIREMENTS Two letters of recommendation are required for application. Forms are provided in this application packet and may be accompanied by additional documentation. Applicants are to submit ONE professional and ONE personal recommendation. It is essential that the applicant carefully choose who will be submitting their recommendations. The following are some examples of the type of recommendations the Nursing Program is looking for: Note: We are looking for letters of recommendation that address health care SPECIFICS rather than generalities. Discuss this with your recommenders and ask them to include our 4 C s in their comments about you. Personal: This would include someone who could attest to your personal attributes or soft skills such as compassion, integrity, empathy, etc. Examples include, but are not limited to: long-time co-workers, first-line supervisors, a former teacher/professor, a professional nurse (RN, MN, ARNP, FNP) who you have known for some length of time. This CANNOT be your best friend, a fellow student, relative, parent, or significant other. Professional: This would include someone who could attest to your professional characteristics or potential such as reliability, professionalism and conduct. Examples include, but are not limited to: current employer, second-line supervisor, member of the clergy, recent college professor, a professional nurse or physician you have known for some time. This CANNOT be your best friend, a fellow student, landlord, relative, parent, or significant other. NOTE-CHANGE: Have these SEALED letters sent to you and then include them in your application packet. Functional Resume (Keep as close to 1 page as possible) (Not the employer based/chronological one we all have) A functional resume enables you to highlight the skills and accomplishments as well as work and life experiences that best relate to your job objective (becoming a Registered Nurse). By creating relevant skill headings, you can incorporate all the experiences that have contributed to each listed skill i.e. co-curricular activities, life experience, family, work history, job shadowing, volunteer work, prior schooling, etc. Include our 4 C s. You are encouraged to seek out resources about writing functional resumes online, in our libraries, or in the Job Connections area of the Advising Centers at Fort Steilacoom or Puyallup campuses. Personal Statement A Personal Statement is required as part of the application process. Questions to address are outlined in Section Three of this packet. Applicants are encouraged to seek assistance from the Writing Center or an instructor in writing/editing their Personal Statement. The essays should accurately reflect the applicant s critical, creative, and reflective thinking as well as their writing ability. Personal Statements will be judged on both content and syntax and are weighed quite heavily. Include our 4 C s. In order to ensure that all applicants have carefully considered all aspects of a Registered Nursing career in today s health care system, we encourage using as many of the extrinsic motivators as possible. These may include, but are not limited to: Employment any type of job that has allowed you to work with or be exposed to registered nursing in a nursing care environment. Volunteering in a facility that provides the direct delivery of nursing care or gives you the opportunity to assist or work beside RNs. Job Shadowing/Observation in a nursing care environment, observing RN s or ARNP s. Informational Interviews of an RN working in an area or specialty you might be interested in. This enables applicants to learn about different types of specialties available to RN s. Informational interviews are also written up in Vocational Biographies available in the Library at Puyallup or on the Internet. Nursing Research In order to increase your knowledge about the field of nursing BEFORE you get started, a lot of information is available in professional nursing journals, reference books, websites, databases, etc. Ask one of our reference librarians for a Nursing Career Pathfinder resource sheet. This research is full of information about nursing history, trends, and scope of practice. If quotes from research are incorporated within your personal statement, be sure to give credit to the source. Information on citing is available via the Library link on the Pierce College website Research Question A research question is required as part of the application process. You will be required to list at least three peer reviewed reference sources. The content of the paper should not exceed two double spaced pages. NOTE: Transcripts It is the applicant s responsibility to make sure that all sealed, official transcripts are included in your application packet. DO NOT have them sent to Pierce College in general (either hard copy or electronically) or to me directly in the nursing office. Have them sent to you and then include them in your packet. This is now your responsibility. If coursework is remaining, another official transcript will be required at the end of spring/summer quarter, and again, you are to deliver them directly to me. Thank you.

11 SCORING, PRIORITY STATUS and QUALIFICATION INFORMATION Scoring The following elements will comprise the scoring of the application: Required Elements Personal Recommendation Professional Recommendation Functional Resume Personal Statement Total Required Elements 8 points 8 points 6 points 28points 50 points Transfer-Ready course work for Additional Points Math&146 - Intro to Statistics 2 points World Language - 10 college credits, or 2 years high school 2 points (of same language), or native speaker Total additional points Recommended Additional Coursework (Optional) Intro to Organic and Biochemistry (CHEM& 131 or equivalent) Total Optional Points 4 points 1 point 1 point Determination of Qualification Applicant has: Applicant is qualified. Paid $65 Application Fee Sent in a complete application (see Application Checklist) Achieved a minimum 3.0 in ENGL& 101, BIOL& 241, BIOL& 242, BIOL& 260, CHEM& 121and PSYCH 200 (or equivalents) Taken the above courses within the last 7 years Completed the Research paper and the Kaplan Entrance Exam Additional Materials from the Checklist Application is missing any of the above criteria Applicant is not qualified. (There will be NO exceptions and reminder phone calls will NOT be made) Timeline for Selection Process Applications available on Pierce College Web Site. June 1, 2014 Complete applications due in Pierce College-Puyallup Nursing Office. July 7, 2014 (Applications turned in before deadline will be appreciated) Applications processed and scored. July 7, 2014 Sept 4,,2014 Applicants notified of status and interview invitations sent to those with Est. Sept 11/12, 2014 the highest scores. Half-Day group interviews conducted. Est. Mid-Oct Candidates notified of acceptance to program. Week after Int Proof of Spring/Summer class completion and grades due (if applicable) End of June &/or August 2014 Program starts January/Winter Qrt If there are any changes in the dates I will post notice on the website. NOTE: Dept hours on campus change during the summer months. Please refer to the following website as you plan your application timetable or follow-up questions.

12 APPLICATION CHECKLIST Completed application due July 7, 2014 or Before Pierce College Admissions Form All nursing program applicants must currently be in the Pierce College system and have a Pierce College Student ID Number. In order to do so, all applicants must complete and submit, or reactivate if you are a former student, a Pierce College Application for Admission. Admissions forms can be obtained on-line at or at any of the Pierce College campuses (Puyallup, Ft Steilacoom, Ft Lewis, McChord) & take about 72 hrs. to process. Nursing Program applications cannot be processed without a Pierce College Student ID number. (I do NOT need a copy of this Admission form) As of January 2, 2009, all former students must fill out a new application form to Pierce College, even though they may already have a Student Identification Number. Receipt Indicating Payment of $65 Application Fee from Pierce College-Puyallup Cashier. Payment must be paid to Pierce College Puyallup Cashier PRIOR to applying. Receipt indicating payment must be included with the application. Do not send the check to the Nursing Dept. or include the check in your application packet. Pay it directly to the Cashier before applying and include receipt in packet. If you are mailing in your application, checks must be mailed separately to: Pierce College Puyallup/Cashier th Ave. SE Puyallup, WA (you may request that a copy of your receipt be forwarded to the Nursing Office -- they just it to me. NOTE Cashier s office may not be open on Fridays during the summer). To ensure proper filing, please send payment early, if possible, so that you may follow up with the Nursing Program Office before the application deadline. Pierce College Associate Degree in Nursing Program Application (included in packet) Course Prerequisite Listing Form (included in packet) The Nursing Program Advising Office should have an Equivalency Waiver Form with the attached documentation in your file for any classes taken outside of the state of Washington. Please verify with the Nursing Advising Office that this form has been completed prior to submitting your application. The applicant is responsible for completing the Course Prerequisite Listing Form included in this packet. Please cross-reference with the Washington State College and University Course Equivalency Chart in this packet. OFFICIAL Transcripts from ALL Colleges Previously Attended (excluding Pierce College) If you met the language requirement in High School a High School transcript is also required. All transcripts need to be mailed directly to you NOT the college itself (either hard copy or electronically) & NOT the nursing office. Please include the sealed transcript(s) in your packet. Proof of Spring and/or Summer Quarter classes 2014 Registration (if applicable) Proof entails a receipt from the registration office of the college you are currently attending (Spring) or plan to attend (Summer). This receipt will show the course number and title for which you are registered and proof that you have paid. ANOTHER OFFICIALTRANSCRIPT showing successful completion will be required. Proof of 1 st Hepatitis B Injection (in a series of 3 as it takes 6 months to complete the series) Must have documentation from medical facility administering injection. Professional Recommendation (form included in packet) Delivered to you and included in packet. Personal Recommendation (form included in packet) Delivered to you and included in packet. Functional Resume (as close to 1 page as possible) Personal Statement (directions included in packet) Please follow directions carefully. ** Research Paper Content not to exceed 2 double spaced pages. ** Kaplan Entrance Exam (New Requirement) If you have taken this exam at Pierce College, we will retrieve your scores through our Nursing Kaplan Account. If you have taken the exam at another

13 institution, you will need to request an official transcript of your Kaplan test result and include it in this packet. ** For LPN to RN/BRIDGE Application cycle only Copy of UNENCUMBERED LPN License or Certificate of Completion or Proof of registration in final quarters of practical nurse training. All Necessary Waivers-Already completed and on file with Nursing Advisor (if applicable) Please submit every element (except application payment itself and the Admissions form to Pierce College) in your packet - directly to the Nursing Department. Deadlines and requirements will be strictly adhered to. Failure to submit the proper paperwork and all required elements on time to the Nursing Program Office will result in a non-qualifying application and will be dismissed from consideration. Due Date Postmarks will be accepted on your packet if you are mailing it in.

14 PIERCE COLLEGE ASSOCIATE DEGREE IN NURSING - PROGRAM APPLICATION Application Due: July 7, 2014 or Before Pierce College Student ID # Name Previous Names Mailing Address *Social Security # Last First Middle DOB: mm/dd/yy Street Address Apt # City State Zip Code Primary Phone Cell Phone Address Emergency Contact Relationship Primary Phone Cell Phone Declaration of Ability to Meet Essential Qualifications: It is essential that nursing students be able to perform a number of physical activities during the clinical portion of the program. These will include, but are not limited to the following: effective communication, lifting/transferring patients, observation/assessment of clients using the physical senses, standing for long periods, performing bending activities, and executing movements required to care for patients in all health care settings. The clinical experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties that impact patients lives. Students must be able to demonstrate rational and appropriate judgment and behavior under stressful conditions. Individuals should carefully consider the mental and physical demands of the program prior to making application. I certify the following to be true: I have provided true, correct and complete information with this application. I have read and understand the information included in this application packet. I have read and understand the Declaration of Ability to Meet Essential Qualifications and certify that I will be able to perform the essential functions as a nursing student in the Pierce College Puyallup Associate Degree in Nursing Program. Applicant Signature Date Applicant Name (please print) *Your social security number is confidential and, under a federal law called the Family Education Rights Privacy Act, the college will protect it from unauthorized use and/or disclosure. In compliance with state/federal requirements, disclosure may be authorized for the purposes of state and federal financial aid, Hope/Lifetime Learning tax credits, academic transcripts, assessment or accountability research.

15 Application Due: July7, 2014 or Before Name: COURSE PREREQUISITE LISTING FORM Please fill out this sheet completely. Applicant s Spring and Summer course registration information must accompany this form (if prerequisites remain to be taken). If any of the following prerequisites were taken at an accredited Washington State college, their equivalencies can be found on the Course Equivalency Chart. It is the responsibility of the applicant to provide proof of equivalency if courses were taken at an institution that is not listed on the equivalency form. Equivalency must be reviewed and approved by the Nursing Program Director or Coordinator prior to application deadline. When seeking a waiver for coursework taken at a non-washington college, a course description, syllabus, or course outline must be submitted. All official transcripts (excluding Pierce College) must be sent to Pierce College Nursing Office. It is the responsibility of the applicant to ensure that these documents are received prior to the application deadline. Transcripts may be hand carried by the applicant as long as they are in their original sealed envelopes. SID: College Course College name you attended or plan to attend QTR/Year taken or plan to take (i.e. Fall 2003) Course # you took or plan to take (i.e. CHEM 121) Course name you took or plan to take (i.e. Inorganic Chemistry) Number of credits earned Specify Credit type: (quarter or semester) - Official use Only- Course Last Grade Equivalent 7 Years Received??? English Composition (ENGL&101) Anatomy Physiology I (BIOL& 241) Anatomy Physiology II (BIOL& 242) Microbiology (BIOL& 260) Inorganic Chemistry (CHEM& 121) Organic Chemistry (CHEM& 131) Dev. Psych (PSYCH& 200) Statistics. (MATH& 146) Foreign Language (or high school Equivalent) List all Colleges Attended: Rcv d? Date: Copy to TO? Do you have a prior degree? _ASSOC. BA/BS What Year?. I have completed the Kaplan Entrance Exam: Date Institution. Applicants Signature Date.

16 PROFESSIONAL RECOMMENDATION/REFERENCE FORM Due By: July 7, 2014 or Before PLEASE PRINT: Pierce College Associate Degree in Nursing Program I,, Nursing Program applicant, give my permission to (Applicant s Name), to complete this reference form and return it to me in a sealed envelope with her/his name written across the back seal. (Recommending person s name) Nursing Program Office TO THE PERSON MAKING THE RECOMMENDATION: Please respond to the following questions carefully in the space provided. If you need additional space, please respond to each question separately on ONE sheet of paper. Generic letters of recommendation will not be accepted. The Nursing Program carefully considers all recommendations for nursing applicants, and as much insight, detail and clarity in answering the following questions will be of great benefit to the applicant. Thank you very much. Describe the professional traits that this applicant possesses that you would look for in a nurse taking care of you or one of your family members. Describe the applicant s work ethic and competence. You may comment on his/her perseverance, dependability, initiative, teamwork, punctuality and his/her dedication and commitment to quality performance, workmanship or product.

17 Speak to the applicant s leadership ability, character, and well-roundedness. Please complete the following: I have known the applicant for years and months. (Approximations OK) During this time the applicant was a (student, employee, co-worker, etc.) of mine at (name of school, business or other organization). Please Print Your Name Title Company or Organization Phone Alternate Phone (if applicable) Signature Date NOTE: Please mail or deliver - the completed form BACK to the Applicant. Please seal the envelope and write your name across the seal. The Applicant will need to include your recommendation in their Application Packet which then needs to arrive in our office no later than Monday, July 7, 2014.

18 Due By: July 7, 2014 or Before PLEASE PRINT: PERSONAL RECOMMENDATION/REFERENCE FORM Pierce College Associate Degree in Nursing Program I,, Nursing Program applicant, give my permission to (Applicant s Name), to complete this reference form and return it to me in a sealed envelope with her/his name written across the back seal. (Recommending person s name) Nursing Program Office TO THE PERSON MAKING THE RECOMMENDATION: Please respond to the following questions carefully in the space provided. If you need additional space, please respond to each question separately on ONE sheet of paper. Generic letters of recommendation will not be accepted. The Nursing Program carefully considers all recommendations for nursing applicants, and as much insight, detail and clarity in answering the following questions will be of great benefit to the applicant. Thank you very much. Describe the personal and ethical traits that this applicant possesses that you would look for in a nurse taking care of you or one of your family members. Describe the applicant s potential for service to his/her community.

19 Nursing school can be challenging and stressful, yet rewarding. Describe the applicant s potential to succeed as an adult learner. Please comment on the applicant s support system and his/her ability to adapt to change. Please complete the following: I have known the applicant for years and months. (Approximations OK) During this time the applicant was a (student, employee, co-worker, etc.) of mine at (name of school, business or other organization). Please Print Your Name Title Company or Organization Phone Alternate Phone (if applicable) Signature Date NOTE: Please mail - or deliver- the completed form BACK to the Applicant. Please seal the envelope and write your name across the seal. The Applicant will need to include your recommendation in their Application Packet which then needs to arrive in our office no later than Monday, July7, 2014.

20 PERSONAL STATEMENT - RESEARCH QUESTION KAPLAN EXAM Application Due By: July 7, 2014 or Before Instructions: In your personal statement, please respond to all questions. Please answer each question separately. Applicants are allowed one page for Question 1A, one page for Question 1B, and two pages for Question 2. The personal statement must be written in point font size, double-spaced, and Times New Roman font style on an 8½ x 11 standard sheet of paper. At the bottom of EACH page print and sign your name. The Personal Statement MUST specifically address the following: 1. Since nursing continues to be the #1 high-demand health occupation, it is critical that applicants to nursing programs make an informed decision and know this is what they really want to do. This question is the opportunity to describe not only the intrinsic motivators but also extrinsic motivators that you have pursued to help you develop realistic expectations of this profession. Intrinsic motivators could include: personal desire, skills, strengths, attributes, self knowledge and personal growth gained through life s challenges and significant emotional events, etc. Extrinsic motivators could include: work or volunteer experiences in a nursing care environment, job shadowing, informational interviews with RN s (currently working), or nursing research about scope of practice and changing trends in nursing practice). Question 1A: Describe the factors that influenced your decision to choose nursing as a career. Be sure to include intrinsic motivators as well as extrinsic motivators. (1 page maximum) Question 1B: Illustrate how you are a good fit for our program and, in turn, how our program would be a good fit for you. (1 page maximum) 2. With the changing demographics in our region, the nursing profession is faced with an increasingly diverse patient clientele. Nursing requires an understanding of underrepresented cultural, racial and social groups along with awareness of economic issues related to healthcare. As a result, there is a growing need for nursing professionals who are sensitive to language barriers and human differences. Question 2: Describe your experiences working and interacting with diverse groups of individuals. Share the lessons you feel you ve learned from these experiences. (2 pages maximum)

21 The Research Question: Using three current peer reviewed references (5 years old or newer), describe the three functions of the kidney. Support your writing through use of in-text citations and a reference list. Use 12 point font size, New Times Roman font style, double space and limit the paper to 4 total pages to include a title page, content(2 pages) and reference list. (May be either APA or MLA) The Kaplan Entrance Exam will be offered at the Puyallup Campus testing center five (5) days a week from 8:00am to 1:00pm starting Jan 2, Please call the Testing Center at or for an appointment. The cost will be $25.00 payable at the Cashiers Office. There will NOT be a minimum required score. We will be retrieving your score through our Nursing Kaplan account and it will be added to the other required elements in your application to our program. The test must be taken within 1 year of the application date and only one (1) repeat is allowed. If you take the test at another institution, you will need to request an official transcript of your Kaplan test results and include it in your application packet.

22 APPLICATION INTERVIEWS INTERVIEW INVITATIONS CONTAINING DETAILS WILL BE SENT TO THOSE WITH THE HIGHEST OVERALL SCORES. SUCCESSFULLY PASSING A CRIMINAL BACKGROUND CHECK WILL BE REQUIRED BEFORE MOVING ON TO THE PHASE III INTERVIEWS. AS WELL AS A STATEMENT SIGNED BY YOU VERIFYING THAT YOU ARE ELIGIBLE FOR REHIRE AT YOUR PREVIOUS PLACES OF EMPLOYMENT AND WILL WORK NO MORE THAN 20 HRS A WEEK. POST-ACCEPTANCE REQUIREMENTS Admitted students and alternates will receive nursing program orientation paperwork upon final class selection. Please keep the following in mind during the application process: Proof of Immunizations/Titers: Completed Hepatitis B series (3 injections in all) and Positive Hep B titer result Tdap (in last ten years) 2-step TB screening (annually) or chest x-ray ( if history of positive TB skin test). Positive Varicella (Chicken Pox) titer or (2) injections Measles/Mumps/Rubella (2 injections or positive titer) for all 3 diseases Flu Vaccine (Proof of vaccination for current season) Immunization requirements may change based on CDC guidelines and/or clinical facility policies. Other Documentation Prior to the Phase III Interviews the student must receive a No Record on File report related to Crimes Against Persons from Certified Background Check (facilitated by nursing dept). (Refer to more information and links to disqualifying factors on our website.) Documentation of current American Heart Association CPR for Healthcare Provider Training (Must include Infant and child CPR). First Aid training course. Copy of Certification for 7-hour AIDS Training Course. HIPAA training (facilitated by nursing dept). Fire safety and blood born pathogens modules on line. Drug testing (facilitated by nursing dept). LPN License required for LPN/RN Bridge applicants only (During March Application Period) Proof of Personal Health Insurance Coverage. Any additional requirements will be included in the application packet. ***The occupation of RN requires physical strength and stamina. The student may be expected to lift up to 60lbs and stand for long periods of time. Please contact the Nursing Department at for more detailed information.

23 SECTION FOUR Appendix Prerequisite Course Equivalency Chart Estimated Program Costs Financial Aid, Scholarships and Loans Frequently Asked Questions Washington State Nursing Programs Associate Degree in Nursing Curriculum Sheet

24 PREREQUISITE COURSE EQUIVALENCY CHART Applicant please note: This course equivalency chart has been provided for your convenience, as a planning tool only. Please NOTE it is the applicant s responsibility to verify any transfer courses to match the Pierce College requirements prior to application. It is the applicant s responsibility to verify course equivalencies. Pierce College is not responsible for changes to the information below. Community College Courses Bellevue Big Bend Cascadia Centralia Clark CLOVER PARK TECH Columbia Basin Edmonds Everett Grays Harbor Green River Highline Lake Washington Lower Columbia N. Seattle Inorganic Chemistry Microbiology Anatomy & Physiology I Anatomy & Physiology II English Composition Statistics (Transfer-Ready Requirement) Lifespan Development (Transfer-Ready Requirement) Organic Chemistry (recommended) 101 BIO 250 BIO 260 BIO BIO 210 BIO OR BIOL 215 BIO 210 BIO BIO 211 ZOO 251 ZOO 252/ BOI 240 BIO 231 BIO232 BIO MAT /110.1 BIO 260/260.1 BIO 221/221.1 BIO 222/ / BIO 250/L BIO 230 BIO BIO 250 BIO235 BIO BIO 211 BIO 208 BIO BIO 210 A&P 205 A&P BIO 250 BIO 231 BIO 2323 WRIT BIO 257 BIO 221 OR ZOO 121 BIO 222 OR ZOO CHE 101 BIO 280 ANP 213 ANP CHE 102

25 Community College Courses N.W. Indian College Olympic Peninsula PIERCE COLLEGE Renton Technical College Seattle Central Shoreline Skagit Valley S. Puget Sound South Seattle Spokane or Spokane Falls Inorganic Chemistry Microbiology Anatomy & Anatomy English Statistics Lifespan Physiology I & Composition (Transfer-Ready Development Physiology Requirement) (Transfer- II Ready Requirement) 111 BIO 245 BIO 242 BIO Organic Chemistry (recommended) 121/121L BIO 260 BIO 250 BIO /122L 101L BIO 240L BIO 201/L BIO 202/L L 121 MICRO 260 BIO 241 BIO CHEM 140 BIO 210 BIO 220 BIO PSY or BIOL 140 CHE 101 BIO 280 A&P 213 A&P CHE BIO SCI MATH BISC 215 BISC 242 BISC BIO 211 BIO 205 BIO 206 WRIT CHE 101 BIO 280 ANP 213 ANP CHE OR 161 MBIOL 231 A&P 242 A&P Tacoma C.C. Walla Walla Wenatchee Valley Whatcom 101 BIO 201 BIO 220 BIO or BIO 240/ 241/ BIO 230 BIO 210 BIO BIO 223 BIO 221 BIO BIO 240 BIO 270 BIO Yakima 109/110 BIO 232 BIO 230 BIO BA 256 Business Stats 213 & /210

26 University Courses Central WA University Eastern WA University Gonzaga Northwest Pacific Lutheran U. Seattle Pacific U. Seattle U. St. Martin s Univ. of Puget Sound Inorganic Microbiology Anatomy & Anatomy English Statistics Lifespan Organic Chemistry Physiology I & Composition (Transfer-Ready Development Chemistry Physiology Requirement) (Transfer- (recommended) II Ready Requirement) 111/111L BIOL 322 BIOL 355 BIOL (4cr) (4 cr) 112/112L 161 BIO 335 BIO 232/ 233/ NURS & 101/L BIOL 170/170L EXSC 241/241L EXSC 242/242L 101 NURS 320 NURS SCIE SCIE2104 SCIE 2203/1 SCIE PSYC SCIE 1204/ / / BIO 201 BIO 205 BIO STATS ?? CHM 1211 BIO 3351 BIO 2129 BIO HSC 4044 or M CHM BIO 220 BIO 200 BIO NURS or BIO 351 BIO 328 BIO & /201L 110 BIO 350 BIO 221 BIO & Univ. of WA 120 MICRO 301 BIOL 118/119 Walla Walla College WA State University BSTR , 121 or 131 QMETH 201 or STAT 220 NURS BIO 222 BIO 201 BIO & & / MBIOS 101 BIOL 251 BIOL STAT 212 HD Western WA University 115 BIO 345/346 BIO 348 BIO Whitman 125/ Whitworth CH 101/101L or CH 161/161L BI 204 BI 220 BI PY 210W CH 163/163L Most Washington community colleges are participating in the Common Course Numbering System as of January 1, This chart is to be used for courses taken Summer, 2008 or after at any of the schools listed below. For courses taken at a State of Washington school not listed below, you must refer to the above chart and cross-reference it with the chart below. Bates, Bellevue, Bellingham, Big Bend, Cascadia, Centralia, Clark, Clover Park, Everett, Grays Harbor, Lake Washington, Olympic, Peninsula, Pierce, Renton, Seattle Central, Seattle North, Seattle South, Shoreline, Skagit, South Puget Sound, Spokane, Spokane Falls, Tacoma, Wenatchee, Whatcom, Yakima. Intro to Chemistry Microbiology Human A&P I Human A&P II English Composition Intro To Statistics (Transfer-Ready Requirement) Lifespan Development (Transfer- Ready Requirement) Intro to Organic/ Biochemistry (recommended) CHEM& 121 BIOL& 260 BIOL& 241 BIOL& 242 ENGL& 101 MATH& 146 PSYC& 200 CHEM& 131

27 APPENDIX Estimated Program Cost Financial Aid, Scholarships and Loans Frequently Asked Questions Washington State Nursing Programs Pierce College Associate Degree in Nursing Estimated Program Costs The following information is based on the current Pierce College Winter tuition table and Amazon.com list prices for new textbooks. The information provided is subject to change without notice and does not include sales tax. Initial Pre-Program Costs (estimated) Application Fee $65.00 (Bridge $50.00) HIV/AIDS Training, CPR/First Aid Certification Cost varies Immunizations, Titers and Health Assessment - Health Insurance Cost varies Pierce College Nursing Student Uniform (2 sets). $ Clinical Supplies (lab coat, shoes, socks, long sleeve shirt, stethoscope, watch, etc.) $ Kaplan Entrance Exam Estimated Current Costs for Tuition (Tuition calculated for Washington state residents.) This estimate does not reflect the upcoming tuition increase. Quarter I $ Quarter II $ Quarter III $ Quarter IV $ (Bridge Students $ ) Quarter V $ Quarter VI $ Total Estimated Tuition Cost Estimated Cost for Books $300 - $500 per Quarter* $7, (Bridge Students $ Plus additional Listed expenses) Testing fee for each quarter: $83.50 Lab fee for each quarter: $75.00 *(Recommended/Optional Book List is also available) NCLEX-RN Exam and State Fees $ (Additional fees and supplies may occur and the cost would vary) TOTAL ESTIMATED COST $11,000 - $13,000

28 FINANCIAL AID, SCHOLARSHIPS AND LOANS Financial Aid may be available to assist you. Deadlines are strictly adhered to, so students are encouraged to apply early. Pierce College Puyallup Financial Aid th Avenue S.E. Puyallup, WA (253) Federal School Code: Grants & Loans All award ranges listed here are valid for the current academic year and are only listed as a general indication. Federal Pell Grants Federal Pell grants are awarded only to undergraduate students who have not earned a bachelor s degree. To determine if you are eligible, the U.S. Department of Education uses a standard formula to evaluate the information you report on your Free Application for Federal Student Aid (FAFSA). This formula produces an Expected Family Contribution (EFC) number that appears in the upper right portion of page one on your Student Aid Report (SAR). This number will determine if you are eligible for a Pell Grant. Pell grants range from $400 to $4300. The amount of your award will depend on your Expected Family Contribution, your enrollment status (part or full time), and whether you attend college for a full academic year. You may not receive Pell Grant funds from more than one school at a time. Your Pell Grant will be used to pay your tuition and fees with any remaining funds paid to you after the academic quarter begins. Federal Supplemental Education Opportunity Grants (FSEOG) An FSEOG is for undergraduate students with exceptional financial need as shown by having the lowest Expected Family Contributions. FSEOG awards at Pierce College range from $100 to $600 per academic year. You will receive your FSEOG funds in a check after the academic quarter begins. State Need Grant The State Need Grant helps low income undergraduate students pursue degrees. To be eligible, a student s family income cannot exceed 65 percent of the state s median family income. The grant amount at Pierce College ranges from $1, per year. Students who have already earned an AA or BA are not eligible for this grant. State Need Grant recipients must be enrolled for a minimum of six credits each quarter. Day Care Grant These funds are used to assist students with child care expenses. State of Washington resident status is required. Pierce College Grant These funds are used to assist students with tuition, fees, books and living expenses. State of Washington resident status is required. Tuition Waiver This program pays resident tuition for students who are residents of the State of Washington and meet certain eligibility criteria. Tuition waivers do not include fees and no refunds will be issued to students.

29 Federal Perkins Loans A Federal Perkins loan is a low interest (currently 5%) loan for both undergraduate and graduate students with financial need made with funds from the federal government and Pierce College. Pierce College is your lender, and you must repay this loan to the college. Depending on when you apply, your level of need and the availability of funds, Pierce College may lend you up to $3000 for an academic year. You will paid by check after the beginning of the academic quarter. Repayment of your loan will begin after you cease attending Pierce College at least half time (six credits or more). You will have a nine month grace period before your first payment becomes due. Each student borrower is provided with specific information on any deferment and cancellation provisions that apply to the loan when you borrow and during your exit interview when you leave school. Stafford Loans These loans require that you complete a Free Application for Federal Student Aid (FAFSA). The funds are loaned by banks to the student. Loans are repaid after you graduate, leave school or drop below half-time enrollment (six credits); you will have a six month grace period before you begin repayment. If you have financial need remaining after you have been awarded grant, work and scholarship funds, you can borrow Stafford Loan funds. This type of loan is subsidized, which means that the government pays the interest while you are in school, during the grace period and when you qualify for deferments. If you do not have demonstrated financial need, you may be eligible to receive an unsubsidized loan. Unlike the subsidized loan, you are responsible for the interest from the time the unsubsidized loan is disbursed until it is paid in full. You can choose to pay interest or allow it to accumulate and be capitalized (that is, added to the principal amount of your loan). Loan funds are sent to the school for you on a quarterly basis by the lender. Students receiving their first loan for their first term of college attendance cannot be paid the funds until 30 days after the quarter begins. Dependent undergraduate students are limited to loans up to $3500 (first year students) or up to $4000 (students with more than 45 credits completed). Independent undergraduate students may be able to borrow up to $7000 as a first year student and $8000 if they have completed over 45 credits. However, at least $4000 of this amount will be in the form of unsubsidized loans. The interest rate on both of these loans is a variable rate that changes on an annual basis. However, the interest rate will never exceed 8.25 percent. PLUS Loans (Parent Loans) PLUS loans allow parents who have an acceptable credit history to borrow funds to pay the educational expenses of a child who is a dependent student enrolled at least half-time. The yearly limit on a PLUS Loan is equal to your cost of attendance minus any other financial aid you receive from Pierce College or other organizations. Contact the Financial Aid Office ( for more information. Scholarship Opportunities The Pierce College Foundation administers private scholarships for Pierce College students. These scholarships are awarded based on need, academic ability, artisitic talent, vocational goals, and/or other factors. Information on newly funded scholarships will be posted in the Financial Aid office. For more information about any of the scholarships, contact Ruth Ann Hatchett, District Scholarship Program Administrator, at (253) or rhatchett@pierce.ctc.edu. The Pierce College Foundation acquires private funding for the college, provides enhancements to college programs, improves access for students, and promotes the college to the community. For more information about the Pierce College Foundation, visit the Foundation Web site (