Lee College Student Application for Admission Generic A.D.N. (RN)

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1 Type or complete in ink. Lee College Student Application for Admission Generic A.D.N. (RN) Desire DATE OF ENTRY into program: Semester Year Social Security Number: - - (Optional) Lee College I. D. #: You are also required to turn in an application to Lee College in the Admission and Records Office. Have you turned this application in?! Yes! No Name: (Last) (First) (Middle) Address: (Street) (City) (State) (Zip Code) Home Phone: ( ) Work Phone: ( ) Ext. Cell Phone: ( ) Pager #: Address: CITIZENSHIP: U. S. Citizen Yes No Country of Citizenship: In Case of Emergency Notify: Name: Telephone Number: ( ) Relationship: EDUCATIONAL HISTORY: College/Universities Attended City/State Dates of Attendance Degree Awarded Have you ever attended ANY school under another name? Yes No If YES, by what name(s) were you listed: Have you ever enrolled in a NURSING or ALLIED HEALTH Program? Yes No If YES, Name of Program/School: Date of Graduation: Reason of Withdrawal? Lee College does not discriminate on the basis of race, color, age, gender, national origin, veteran status, or disability.

2 CREDENTIALS: If you are presently licensed/certified in NURSING or an ALLIED HEALTH specialty, please answer the following: Licensed/Certified by: Date: Licensure/Certificate Expiration Date: / / License/Certification #: Has your license/certificate ever been suspended or revoked? Yes No If YES, explain: Date of Reinstatement: / / Please indicate any Allied Health experience: GENERAL: Have you served in the U. S. Armed Forces? Yes No Dates: From: to Are you in the U. S. Armed Forces Reserves? Yes No LICENSURE: The Texas Nursing Practice Act provides a process for individuals who have reason to believe they may be ineligible for licensure to request the Board of Nurse Examiners for the State of Texas to make a determination of that issue. A frequent reason for seeking such a determination is a prior criminal conviction, a misdemeanor that involves moral turpitude, offense involving the abuse of drugs, including alcohol, or conduct resulting in the revocation of probation imposed under a conviction. Declaratory Order forms are available by contacting the Board of Nurse Examiners for the State of Texas at I certify that the above statements are true and correct. It is understood that withholding or giving false information on this application will invalidate the application and/or acceptance to the program and will result in your dismissal from the program. I understand my responsibility to complete the Texas Department of Health and Human Services required Immunization requirements prior to registration and realize registration will be blocked for non-compliance. Signature of Applicant Date Revised 5/10 If mailing application, please return the completed application and copies of required immunizations to: Lee College Nursing Department P.O. Box 818 Baytown, Texas

3 Lee College Associate of Applied Science in Nursing A.D.N. Program - Generic Entry Application to the Generic A.D.N. Program Requires: Application to Lee College before applying to the nursing program. Application to the A.D.N. program. Applications are taken year around, students are strongly encouraged to turn in applications by February 1 st No applications for fall entry will be accepted after May 1 st. Applications will not be accepted without documentation of completed required immunizations. Admission to the Generic A.D.N. Program Requires: Admission requirements are monitored continuously and may change between catalogs. Contact the Allied Health office for the most current requirements. Students are responsible for furnishing official transcripts to the Admissions and Records office for any course transfers. All foreign transcripts must be evaluated by the Registrar. Submit those transcripts prior to February 1 st for timely evaluation. Criminal Background screening. There are more applicants than slots in the program. Meeting minimum requirements does not guarantee admission. The ADN Admission Committee informs applicants of admission status. All admission requirements must be satisfied before students may register. Class selection is based on: Overall GPA in degree plan must be 2.0 or higher in degree plan courses GPA of prerequisite courses GPA 2.5 or higher (RNSG 1301, BIOL 2401, ENGL 1301, PSYC 2301) GPA of science courses completed in the degree plan GPA 2.5 or higher (BIOL 2401, 2402, 2421) Number of courses completed in the degree plan Non-degree plan science courses completed, such as Chemistry, Biology, Life Science, Pathophysiology, Nutrition Non-degree plan academic courses such as; Sociology, History, Government, Statistics Previous unsuccessful degree plan attempts may impact admission The Board of Nurse Examiners for the State of Texas requires schools to inform enrolled students (verbally and in writing) about eligibility requirements and to maintain students signed receipt of the required information. The Board of Nurse Examiners has identified certain circumstances that may render a potential candidate ineligible for licensure as a registered nurse in the State of Texas. The Board provides individuals the opportunity to petition the Board for a Declaratory Order as to their eligibility in accordance with article 4519 (a) of the Nursing Practice Act. Refer to The Board of Nurse Examiners for the State of Texas at for the Declaratory Order form. See the attached Texas Department of Health and Human Services Immunization Requirement sheet.

4 Lee College Associate of Applied Science in Nursing A.D.N Program Generic Entry FIRST SEMESTER PREREQUISITES BIOL 2401 Human Anatomy and Physiology I RNSG 1301 Introduction to Pharmacology ENGL 1301 English Composition I PSYC 2301 Introduction to Psychology It is suggested that the * courses are taken prior to program admission if schedule allows. Once admitted into the program all courses must be taken in the sequence listed at the time of admission. SECOND SEMESTER *PSYC 2314 RNSG 1413 RNSG 1205 RNSG 1247 RNSG 1261 *BIOL 2402 Life Span Growth and Development Foundations of Nursing Nursing Skills I Concepts Clinical Decision Making Clinical - Nursing (R.N. Training) Human Anatomy and Physiology II THIRD SEMESTER RNSG 1343 Complex Concepts of Adult Health RNSG 1362 Clinical - Nursing (R.N. Training) RNSG 2201 Care of Children and Families RNSG 2161 Clinical Nursing (R.N. Training) *BIOL 2421 Microbiology FOURTH SEMESTER *ITSC 1309 Integrated Software Applications I Humanities/Fine Art *ENGL 1302 English Composition II Oral communications FIFTH SEMESTER RNSG 1251 RNSG 1162 RNSG 2213 RNSG 2160 *SPNL 1301 Care of Childbearing Family Clinical Nursing (R.N. Training) Mental Health Nursing Clinical Nursing (R.N. Training) Health Care Spanish SIXTH SEMESTER RNSG 2432 Advanced Concepts of Adult Health RNSG 2121 Management of Client Care RNSG 2263 Clinical - Nursing (R.N. Training) RNSG 1146 Legal and Ethical Issue for Nurses Progression requires: Overall 2.0 GPA in degree plan Students not maintaining this standard will be dropped from the program and counseled regarding a repeat/reentry plan and/or career direction. Graduation requires: Completion of RNSG prefix courses within 5 years of graduation Overall GPA of 2.0 in degree plan

5 Program Requirements for Nursing Students Applications will not be accepted without documentation of completed required immunizations. Texas Department of Health and Human Services Required Immunizations Students in institutions of higher education enrolled in health related courses which involve direct patient contact must show evidence of these immunizations: Ø One dose of Tetanus/Diphtheria toxoid (Td) 10 year limit. Ø Students who were born on or after January 1, 1957, must show documentation of two doses of measlescontaining vaccine administered since January 1, Ø One dose of rubella vaccine. Ø Students born on or after January 1, 1957, must show documentation of one dose of mumps vaccine. Ø Two doses of varicella vaccine or acceptable documentation of chicken pox disease. Ø Completed hepatitis B vaccination (series of three) including dates, or serologic confirmation of immunity of hepatitis B virus. Students cannot be provisionally enrolled without at least one dose of measles, mumps, and rubella vaccine if direct patient contact will occur during the provisional enrollment period. Upon acceptance into the program students need to document the following: A physical examination inclusive of laboratory work: CBC and urinalysis current within six months. TB skin test yearly or Chest x-ray every two years if reactive to skin test Documentation of current pandemic and seasonal flu vaccinations (annually) Cardiopulmonary Resuscitation (CPR) and First Aid Requirements A current CPR card and current First Aid card is required prior to clinical for nursing students and must be renewed as required thereafter. You can check the schedules at the following locations for class times; Lee College Continuing Education - American Heart Association - and American Red Cross -

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