RN-to-BSN New Student Checklist

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1 RN-to-BSN New Student Checklist NURSING PROGRAMS Name: Term: Program: RN-to-BSN Date Due Completed Pre-Admission Requirements Application ($25) Complete your FAFSA at (school code ) Post-Admission Documentation Requirements Student Portal Access Verified* All College Transcripts State Board Disclosure Form Copy of Picture ID RN License Sign Transfer Pre-Evaluation Disbursement Authorization Authorization to Release Educational Records Post-Admission Fees Enrollment Agreement and Fee ($100) *Please note: Your student portal user name and password are not the same as your student . A separate will be sent approximately one month prior to the start of classes granting access to the Hondros student . Questions? Contact: Zachary Selby Admissions Fax Val Beaupre Admissions x2041 Fax Julie Switzer Student Services Coordinator Fax Lindsey Bowers Financial Aid Adviser Fax Created 6/12 Hondros College nursing.hondros.edu HONDROS

2 Application For Admission NURSING PROGRAMS APPLICATION FOR ADMISSION Program: PN ADN RN-BSN RN-to-BSN only: Part-time Full-time Application for class beginning: Winter Spring Summer Fall Year Campus: Columbus Cincinnati Cleveland Dayton PERSONAL INFORMATION (please print clearly) Legal Name LAST FIRST MIDDLE (required) Maiden/Alternate Names Social Security Number Daytime phone number Alternate phone number Cell phone provider Do you agree to receive text messages from Hondros College? Yes No Date of Birth Gender Male Female address Address City County State Zip Country of citizenship (if not a U.S. citizen) Resident alien registration # LPN/RN license #, if applicable DEMOGRAPHIC INFORMATION The items in this section are optional. No information you provide will be used in a discriminatory manner. Do you designate your ethnicity as Hispanic or Latino? Yes No Indicate one or more ethnicity by checking boxes below. Black or African-American Asian Hispanic/Latino White American Indian or Alaska Native Native Hawaiian or Pacific Islander Non-resident alien Two or more races MILITARY HISTORY Are you currently on active military duty? Yes No Are you a veteran of the U.S. armed services? Yes No Date of military service (to/from)? A-1 Hondros College nursing.hondros.edu HONDROS

3 EDUCATIONAL BACKGROUND Do you have a high school diploma? Yes No Year graduated School name City State If you do not have a high school diploma, do you have a high school equivalency (GED) certificate? Yes No What is the state in which you received your GED? Do you have ACT or SAT test scores (within the past five years)? Yes No (If yes, please provide proof of scores.) POST-SECONDARY EDUCATIONAL BACKGROUND List in chronological order, including college, university, vocational/technical school, nursing school, etc. and any degree earned. Name of School City/State Diploma/Degree Earned or Semester/Quarter Hours Completed EMPLOYMENT EXPERIENCE Begin with the most recent and include healthcare and non-healthcare experience Copy if additional forms are needed. Organization Phone number Address City State Zip Dates employed: From To Supervisor Position Reason for leaving Organization Phone number Address City State Zip Dates employed: From To Supervisor Position Reason for leaving Comments Do you plan on being employed while attending Hondros College? Yes No If yes, how many hours per week? A-2

4 DISCIPLINARY HISTORY If you answer YES to any of the questions below, please provide a statement listing all offenses with the date of conviction and disposition. A criminal conviction does not automatically disqualify an applicant from admission. Determination of admittance will be considered on an individual basis after the BCI/FBI background check has been received. Applicants who are admitted to Hondros College must meet with the Director of Nursing to discuss prior criminal offenses. Were you ever convicted of a criminal offense regardless of the adjudication? Yes No Are you currently under pending charges for a criminal offense? Yes No Have you ever had any action taken against your professional license or certification? Yes No RN-to-BSN Applicants: Hondros College does not require a background check or drug screen prior to being enrolled into the RN-to-BSN Completion program. However, some clinical agencies may have this requirement, and it is the student s obligation to meet the established criteria of each clinical agency. Failure to complete these requirements may prohibit attendance at the clinical, thus impacting the student s progression and completion in the program. HOW DID YOU HEAR ABOUT US? How did you hear about our program? TV commercial Mailer to home Newspaper/magazine Radio Career/College Fair Billboard Referral (name ) Internet ( Facebook Google Hondros College Website) Other The information given on this application is complete and accurate. I realize that failure to disclose fully and accurately all facts relating to this application shall be grounds for dismissal from Hondros College. If admitted, I pledge to comply with all the rules and regulations of Hondros College and Clinical agencies. I give my permission to contact the educator and employers listed as references; and I authorize all persons, schools, companies, credit bureaus and law enforcement agencies to supply any confirmation concerning my background, which may include a formal criminal background check. I have read and understand this application. I understand that I may cancel this application, and receive full refund of monies I have paid, my mailing a written notice to Hondros College, postmarked no later than midnight on the fifth business day after initial signing of this application. I also understand that I may use this application as my cancellation notice by writing I hereby cancel at the bottom, and adding my name, address and signature, and delivering, or mailing it to Hondros College. Legal signature of applicant Date EQUAL OPPORTUNITY ADMISSIONS Hondros College maintains and enforces a policy of affording equal opportunity to all individuals regardless of individual characteristics. This policy prohibits Hondros College, its faculty, staff and employees from discriminating against any applicant or student because of gender, race, age, color, disability, national origin, religion, or other category protected by applicable federal, state or local law. Revised: 5/31/12 A-3

5 Enrollment Agreement - RN-to-BSN Completion 4140 Executive Parkway, Westerville, OH Phone (614) NURSING PROGRAMS Student s name Address City State Zip Home phone ( ) Work phone ( ) Congratulations and welcome to Hondros College! We are excited to help you achieve your goal of obtaining a Bachelor of Science in Nursing. As part of our enrollment process Hondros College outlined below the terms of our RN to BSN program to show you what it takes to be a Hondros College graduate. I understand that this Agreement is valid only if I receive notification of Official Acceptance into the Hondros College RN-to-BSN Completion program., hereby enrolls in the Hondros College RN to BSN Completion program to pursue a Bachelor of Science in Nursing. I understand classes will begin on. The RN to BSN program is 72 quarter credit hours (44 weeks/4 quarters). CONDITIONAL ACCEPTANCE: I understand I will only be enrolled into the RN to BSN program if I have graduated with an Associate s Degree in Nursing or Nursing Diploma program. However, if I have not taken the NCLEX-RN exam, I may be conditionally accepted into Hondros College and be permitted to complete General Education courses. I understand that if I do not produce my active unencumbered RN license before I have completed all of the General Education requirements, I will not be permitted to complete any nursing courses until I produce the RN license. BACKGROUND CHECK, DRUG SCREEN, IMMUNIZATIONS: Hondros College does not require a background check or drug screen prior to being enrolled into the RN to BSN Completion program. However, I understand some practicum agencies may have this requirement and it is my obligation to meet the established criteria of each practicum agency. Failure to complete these requirements will prohibit me from attending a practicum, thus impacting my progression and completion in the program. TUITION AND BOOKS/MATERIALS: The tuition and other costs for the RN to BSN Completion are shown on the reverse. I understand that I will be charged for only one term at a time. Charges for tuition and other costs for future terms becomes payable as they occur. I know that all textbooks are a requirement for each course and will be purchased by me from Hondros College as part of the overall program. I understand all book costs are estimated on Page 2. I also understand that the school reserves the right to make changes in course/program content or text materials as the college deems necessary. Tuition and fees are subject to periodic reviews and change. TERMINATION by the SCHOOL: I agree that the school may terminate my enrollment if I: 1) fail to maintain Standards of Academic Progress; 2) fail to pay tuition and fees on time; 3) maliciously destroy, damage, or steal from the school, staff or other students (I know that I may also be held liable for the costs of repair or replacement as a result of such action); 4) engage in improper, unlawful, or unprofessional conduct; 5) engage in activity that brings discredit to the school; 6) engage in behavior that interferes with the educational process, or the human or civil rights, of another student(s) or staff member(s), or 7) engage in any behavior which violates the student code of conduct; 8) experience a loss or restrictions placed on my RN license. SCHEDULE CHANGES: I will be available for synchronous activities as they are scheduled. I agree that the school reserves the right: 1) to reschedule the starting date and/or combine classes for any quarter by reason of institutional need.; 2) to reschedule class breaks, or instructors; 3) to change dates or hours of my attendance, and to change program content to maintain relevancy. Such changes will not adversely impact the costs I have agreed to herein, unless part of an overall institution tuition & fee change as noted above. GRADUATION REQUIREMENTS: I understand that a Bachelor of Science in Nursing Degree will be awarded to me when I have: 1) successfully completed all program requirements with a minimum of a C in all courses; 2) achieved the 185 quarter credit hours required to graduate as defined in the Hondros College Student Catalog; 3) satisfied all financial obligations; and 4) completed the program within 1.5 times the published full-time or part-time program length; 5) I understand Hondros College will award 63 quarter credit hours for holding a valid, unencumbered Registered Nurse license; 6) I understand Hondros College has a 44 quarter credit hour residency requirement, all of which are nursing courses; 7) unencumbered RN license. TRANSFER OF CREDITS: I understand that the school does not guarantee the transferability of my credits to any other institution. I also understand that if I wish to transfer credits to Hondros College, I must arrange for official transcript(s) to be sent directly to the Admissions Manager, prior to the start of my first quarter in the program. PLACEMENT ASSISTANCE: I understand that placement assistance is available to me while I am a student and as a graduate. I understand that the school does not guarantee my placement but does recognize its responsibility to serve, to the fullest extent possible, my requests for assistance. And, I understand that this and all other student services will be withheld from me if I am in violation of school policy or if my account is not paid as agreed. THE TERMS AND CONDITIONS WRITTEN ON ALL THREE PAGES OF THIS AGREEMENT APPLY AS THOUGH THEY APPEARED ON THE SAME PAGE Ohio Registration # T Rev. 5/31/ Hondros College nursing.hondros.edu HONDROS

6 GRIEVANCE PROCEDURE: I understand that Hondros College is committed to helping me achieve my goals. If I have a grievance, I understand the college prefers I first try to address the issue directly with the other party (faculty, Campus Director or Director of Nursing, as applicable). If not resolved, I understand the procedure is to direct my grievance to the State Board of Career Colleges and Schools 35 E. Gay Street, Suite 403, Columbus, OH 43215, (614) or ; and the Accrediting Council for Independent Colleges and Schools, ACICS 750 First Street, NE, Suite 980, Washington, DC, 20002, Tel: (202) , Fax: (202) , REFUND POLICY: I understand that the following is the approved refund policy for a registered school in Ohio, and is applicable to each term: a. A student who starts class and withdraws during the first calendar week of the academic term shall be obligated for twenty-five (25%) of the tuition and refundable fees for that academic term plus the registration fee. b. A student who withdraws during the second full calendar week of the academic term shall be obligated for fifty (50%) percent of the tuition and refundable fees for that period plus the registration fee. c. A student who withdraws during the third full calendar week of the academic term shall be obligated for seventy-five (75%) percent of the tuition and refundable fees for that period plus the registration fee. d. A student who withdraws beginning with the fourth full calendar week of the academic term will not be entitled to a refund of any portion of the tuition and fees. RN-to-BSN Completion Program Costs Enrollment Fee $100 State of Ohio Registration Fee $5 Tuition $12,600 Graduation Fees $50.00 Textbooks/Materials (Estimated) $1,500 Total Direct Costs $14,280 STUDENT S RIGHT TO CANCEL: I have read and understand this agreement. I understand that I may cancel this agreement, and receive a full refund of monies I have paid, by mailing a written notice to Hondros College, postmarked no later than midnight on the fifth (5th) business day after initial signing of this agreement. I also understand that I may use this Agreement as my cancellation notice by writing I hereby cancel at the bottom, and adding my name, address and signature, and delivering, or mailing it to Hondros College. I also understand that if I cancel this agreement, prior to the start of classes, I am entitled to a refund of all my tuition payments per Hondros College s refund policy. A refund will be granted within 30 days. I will only receive a refund of my application and enrollment fees if I cancel within 5 days of the initial signing. I agree and acknowledge that this document constitutes the entire agreement between Hondros College RN to BSN Completion Program and me, and that no representations have been made that are not fully expressed herein. I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND, AND HAVE RECEIVED A COPY OF THIS AGREEMENT Student Signature Date Signed Admissions Representative s Certification: I hereby certify that meets all the requirements for acceptance as an RN to BSN Completion student. I also agree and certify that there have been no verbal or written agreements or promises other than those appearing on this agreement. Finally, I certify that this AGREEMENT HAS BEEN DUPLICATED, AND THE DUPLICATE GIVEN TO THE STUDENT AS A RECORD OF THIS TRANSACTION. I have retained the original for inclusion in the Student s file. Where necessary, this agreement may also serve as a receipt for any payment indicated below. State of Ohio Registration Fee Paid $ Hondros College Enrollment Fee Paid $ Accepted By: Hondros College RN-to-BSN Completion Program Representative: Date / / THE TERMS AND CONDITIONS WRITTEN ON ALL THREE PAGES OF THIS AGREEMENT APPLY AS THOUGH THEY APPEARED ON THE SAME PAGE Ohio Registration # T Rev. 5/31/12 2-2

7 STATE BOARD OF CAREER COLLEGES AND SCHOOLS 35 East Gay Street, Suite 403, Columbus, OH (614) Fax (614) Toll Free (877) Website: State of Ohio Student Disclosure Form Name of School This school is registered with and approved by the State Board of Career Colleges & Schools 1. Enrollment Agreement & Catalog I have read and received a copy of the enrollment agreement and received a copy of the school catalog. Student s initials 2. Written Contract I understand that the terms and conditions of the enrollment agreement are not subject to amendment or modification by oral agreements. All changes must be in writing and signed by both parties. Student s Initials 3. Placement & Graduation Rates I have been informed of the school s placement and graduation rates for the program I am entering (as applicable) Student s Initials 4. Employment I understand that upon successful completion of my training program, this school will provide placement assistance. However, I understand that the school does not guarantee any graduate a job. I have not been guaranteed employment or been guaranteed to earn a specific salary range upon graduation. Student s Initials 5. Transferability of Credits I understand that the transferability of credits to another institution is determined exclusively by the receiving institution. No person can imply or guarantee that my credits will be transferrable. Student s Initials 6. Grievance Procedure I understand the grievance procedure listed on the enrollment agreement and my right to contact the State Board at the address and phone number listed above Student s Initials Student s Signature School Representative Signature Date Date * Student must receive a copy of this form and a copy must be kept in student s file. PSR 0017 (Revised 9/06)

8 Financial Aid Disbursement Authorization NURSING PROGRAMS To enable Hondros College to disburse your financial aid in accordance with federal regulations, please affirm the following by reading each statement and signing below. If I have been awarded funds from any of the Federal Student loan programs, I must notify the financial aid office 10 days before the scheduled disbursement date if I want to cancel all or a portion of my loan. I also understand, any canceled amount will be returned to my lender thereby, reducing my outstanding loan balance. Further, I understand that I must maintain satisfactory progress according to the school s policy (see school catalog) in order to be eligible for the funds to be disbursed as scheduled. If I withdraw or drop out before completing the academic period or drop to less than halftime status for the academic period for which my award was intended, I understand that I may no longer be eligible to receive any Federal Funds; and, if I have a credit balance it may be used to satisfy any funds owed the U.S. Department of Education as a result of my withdrawal from school. I understand that receipt of the award(s) is contingent upon the school receiving these funds from the Federal Government and that change in Federal Laws or regulations could alter the amount now being offered to me. I understand my responsibilities as I accept this aid and realize if I have any questions I can contact my financial aid office. CURRENT ALLOWABLE CHARGES: I authorize Hondros College to use any federal financial aid awarded (including Federal Work Study) to pay all allowable obligations to Hondros College. I understand that Title IV aid must apply toward my tuition and mandatory fees. But I also authorize Hondros College to apply my aid to any other obligations such as registration fees, books, etc. Prior Term Charges: I authorize Hondros College to apply federal financial aid funds to minor prior-term and year charges. Prior term charges not to exceed $2500 and prior award year $200 as federally mandated. Disbursement of excess Financial Aid: I authorize Hondros College to release my funds (including Federal Work Study) thru the US Bank AccelaPay Card method. I know and understand that this does not provide me with an account at US Bank; however it does provide me with a Prepaid Debit Card where my funds will be automatically deposited in accordance with Federal Law. I also acknowledge that I have received the information concerning the use of the US Bank AccelaPay Card, I understand that a paper check will not be issued to me for any account balances, and I will abide by the rules and regulations outlined in the information provided TERM & YEAR of START Fall Winter Spring Summer STUDENT INFORMATION (please print clearly) - - LAST NAME FIRST NAME M SOCIAL SECURITY # ADDRESS CITY STATE ZIP - - PHONE NUMBER Student Signature - - DATE OF BIRTH Date By signing this document I agree to all terms and conditions listed above. Hondros College nursing.hondros.edu HONDROS

9 Important reminders! NURSING PROGRAMS Have you completed these tasks? 1) Order all official college transcripts. Please order copies of all official college transcripts and have them sent to: Hondros College, Attn: Zach Selby, 4140 Executive Parkway, Westerville, OH ) Send in a copy of your photo ID. Please fax a copy of your driver s license or photo ID to Julie Switzer at (888) Your prompt completion of these tasks will help ensure a smooth enrollment process. Thank you! Hondros College nursing.hondros.edu HONDROS

10 Practicum and Preceptor Approval Form NURSING PROGRAMS Student Information: Name: Address City/State/Zip: Home Telephone: Work Telephone: Cell Telephone: Fax (if applicable): Address: Please check the Course in which student will be enrolled: N343 Community Health Nursing Practicum N463 Leadership & Management Practicum Term with which student will be enrolled in the above selected course: Practicum Field Site: Agency Name: Type: Address: City/State/Zip: Is this site the student s place of employment: Current Accreditations & Approvals: Name of Contact Person (if different from preceptor identified below): Title: Telephone: Fax: Reason for selecting this site: Hondros College nursing.hondros.edu HONDROS

11 Practicum and Preceptor Approval Form (continued) NURSING PROGRAMS Preceptor Information: Name: Title/Position held: Academic Degrees earned: Area of Specialization: Agency Name: Address: City/State/Zip: Work Telephone: Other Telephone: Fax Number: Address: Preceptor s verification of RN licensure and CV/Resume must be included with this approval form Additional Information/Comments: The student is responsible for assuring all information contained on this approval form is accurate and true. The student s signature below attests to the truth of the information provided. Signature of Student: Date signed Approved Not Approved. State Rationale below: College Representative Signature/Title: Date signed Hondros College nursing.hondros.edu HONDROS

12 Guidelines for Practicum Experiences NURSING PROGRAMS Overview A practicum is a defined field experience whereby students have an opportunity to apply concepts and integrate professional knowledge learned during a distinct supervised learning experience. Students are required to complete two practicum courses in the Hondros College RN-BSN Completion Program with a specified numbers of hours assigned to each of the two courses: NUR 343 Community Health Nursing Practicum (2 quarter credit hours): In a practicum experience in the community, the student will use skills in community health assessment, program planning as well as interventions to help identified populations attain and maintain their optimum level of health. Students will spend 60 hours in an identified community setting with a preceptor. NUR463 Leadership & Management Practicum (2 quarter credit hours): In a practicum experience, students will work with an identified nurse leader and utilize leadership and management skills to manage problems in a rapidly changing healthcare environment to improve quality and safety of nursing care. Students will spend 60 hours shadowing this preceptor. Possible settings: hospitals, long term care facilities, community agencies. A Hondros College Faculty Member teaches each practicum course and guides the development of individual student learning objectives consistent with course and program objectives through direct collaboration with the student. The student is responsible for locating and securing the practicum site and preceptor which best meets the learning objectives formulated by the student in collaboration with course faculty. A practicum site is a health care agency or other appropriate setting, in which preceptors selected by students are employed. Practicum sites and the preceptors utilized help students obtain practical experiences consistent with the student s educational goals. Site(s) utilized enter into a Practicum/Field Site Affiliation Agreement with Hondros College Nursing Programs in which they agree to provide appropriate support and supervision for the students learning objectives during the experience. Practicum sites do not receive monetary support for the learning experience from the College. A preceptor is a qualified individual employed by the practicum site responsible for mentoring and guiding the student s experience. Preceptors are selected and secured by the student. Preferred preceptors are Master s prepared, professional nurses, appropriately licensed with a minimum of one year current post graduate nursing experience in the field of interest chosen by the student. A Baccalaureate degree is required to precept a RN-BSN student from Hondros College. The preceptor provides access to the practicum site, assures all regulatory requirements of the agency are met and guides the learning experience in accordance with the learning objectives developed by the student in conjunction with Hondros College faculty. It is expected that preceptors be available and accessible to students throughout the course and provide guidance and feedback that promotes the educational growth of the students consistent with professional nursing practice, established learning objectives and Hondros College program objectives. Preceptors are not monetarily compensated by Hondros College. Upon securing the practicum site and obtaining a preceptor who has agreed to mentor the student, a conference call is coordinated with the faculty member, student and preceptor. The intent of the conference call is to assure practicum goals are being addressed, and assure the student and preceptor agree on the purpose of the practicum, the role of the student and the preceptor, and the objectives established for the experience. An opportunity to answer questions is provided and a plan is established for continued follow-up. Upon completion of the course, the preceptor provides feedback and input regarding the student s performance to the student and course faculty member. However, the course faculty member remains responsible for determining satisfactory completion of course objectives. Practicum field experiences may not begin until the practicum course in which the student has enrolled has officially started and the following are completed: Submission of all required documents Approval of preceptor and practicum site from Director of Online Programs or designee Students must successfully complete all course requirements outlined in the respective syllabus to successfully complete a practicum course. Hondros College nursing.hondros.edu HONDROS

13 Guidelines for Practicum Experiences (continued) NURSING PROGRAMS Steps to Planning the Practicum: 1. Identify a practicum site N343 Practicum is to take place in a community health setting. N463 Practicum may take place in one of many types of settings including hospitals, long term care facilities or community agencies. A student may only have one practicum site per course. Although, students may complete the practicum in the agency in which they are employed, the experience must occur in a setting other than the student s usual assigned work setting and be completed outside of scheduled work hours. 2. Locate a preceptor The student is to identify a preceptor who will mentor the student and supervise the practicum field experience. If the practicum site is the agency in which the student is employed, the preceptor may not be the student s immediate supervisor. The student is to contact the preceptor and assure the preceptor is willing to fulfill the role of preceptor during the practicum experience and meets the following requirements for the role: a. Minimum of a BSN degree (MSN preferred) b. Active license to practice as a registered nurse in the state of the practicum experience c. At least one year of full time experience as a registered nurse, or part time equivalent. For preceptors in N343, the preceptor must have experience in community or public health nursing d. Desire and willingness to work with the student throughout the practicum 3. Once the student has secured a site and preceptor, the student should begin to gather and submit all the required documents for the practicum experience as listed below. These documents are to be submitted as one file via with the subject title Student s First Initial and Last Name, Course Number and Term practicum is scheduled. a. Preceptor Approval Form, including Preceptor s CV/resume and verification of RN licensure b. Practicum Field Experience Affiliation Agreement c. Verification of Student s RN license d. Proof of Student s Professional Liability Insurance e. FERPA Release Form 4. Once approved, the Director of Online Programs or designee will return the signed approval form to the student via . Students may not begin the practicum until all required documentation has been submitted, practicum site and preceptor have been approved and the course has officially started. Ensuring the quality of practicum experiences is a priority for the College. The student must ensure his/her preceptor submits the required student performance evaluation as outlined in the course syllabus as well as the Preceptor Evaluation of Practicum Experience. Students must also complete the Student Evaluation of the Practicum Experience. In the event a student experiences a problem in the practicum setting which the student either cannot resolve effectively or feels ill-equipped to manage, the student should immediately notify their course faculty. Course faculty shall help guide the student in resolving the issue or concern. Depending on the severity of the situation, the Director of Online Programs or other administrative personnel may become involved. Students are expected to adhere to all policies outlined in the Student Catalog throughout the program including during practicum field experiences. Students are further expected to abide by all applicable policies and procedures of the agency whereby the practicum is being completed. It is expected that the Agency utilized for the Practicum Field Experience provide an orientation to the site which includes an overview of all applicable policies, rules and regulations. Hondros College nursing.hondros.edu HONDROS

14 Practicum Site Affiliation Agreement NURSING PROGRAMS RN-BSN Completion Program This agreement is entered into on this day of, 20, by and between Educational Seminars, Inc, dba Hondros College (herein after the school ) and Agency Name: Address: City/State/ZIP: (herein after, the named agency ) WITNESSETH: WHEREAS, Hondros College, accredited by Accrediting Council for Independent Colleges & Schools (ACICS,) offers an RN-BSN Completion Program approved by the Ohio Board of Regents and seeks to partner with field sites (practicum sites) for practical educational experiences for students enrolled in said RN-BSN Completion Program; and WHEREAS, practicum field experiences shall include the student education program conducted at the Practicum Field Site; and WHEREAS, the practicum field site has appropriate and adequate facilities for such practicum experiences and is willing to avail its resources to Hondros College students; and WHEREAS, named agency sees its cooperation in this effort as contributing to helping to increase the number of baccalaureate prepared nurses in the United States, NOW THEREFORE, in consideration of the mutual covenants and agreements herein contained, the parties agree as follows: RESPONSIBILITIES OF THE SCHOOL: 1. The school shall be responsible for the assignment of students to the Practicum Field Site. The school agrees to refer to the Practicum Field Site only those students who are duly enrolled. 2. The Director of Online Programs or designee shall act as a liaison between the school and the named agency. The liaison will be responsible for maintaining communication with the named agency including but not limited to the following: a. Confirming contact information for students to the named agency prior to the student assignment b. Providing information regarding the student s enrollment and progress in the academic program as may be required by the named agency c. Securing preceptor agreement forms and affiliation agreements 3. The school shall provide the named agency with information pertaining to the requirements of the practicum field experience including course syllabi, specific student learning objectives/outcomes and specify the required hours for completion of the specific practicum experience. 4. The school shall advise faculty, teaching assistants and students of their responsibility regarding the confidential nature of all information that they may obtain from the practicum field experience in the named agency following HIPAA guidelines. 5. The school shall maintain a General liability insurance policy in the minimum amount of $1,000,000 per occurrence and $3,000,000 aggregate and shall provide the named agency with proof of coverage upon request. RESPONSIBILITIES OF THE STUDENT 1. The student shall provide their own transportation to and from the named agency 2. The student shall agree to abide by the policies of the field site as provided to the student during orientation to the practicum site Hondros College nursing.hondros.edu HONDROS

15 Practicum Site Affiliation Agreement (continued) NURSING PROGRAMS 3. The student shall have the responsibility for providing any information required of the named agency including but not limited to the following: criminal background checks, health information, verification of certification and or licensure, and insurance information. 4. The student shall maintain professional liability insurance coverage in the minimum amount of $1,000,000 per occurrence and $3,000,000 aggregate per year and shall provide proof of coverage to the named agency upon request RESPONSIBILITIES OF THE NAMED AGENCY: 1. The named agency shall provide access to its facility and patients for the practicum field experience of the student. 2. The named agency agrees to comply with the policies and procedures the school requires of its students as set forth in the school s Student Catalog available online at 3. The named agency shall indemnify and hold the school harmless from and against any and all claims, liabilities and causes of action arising out of negligence, errors, or omissions of the agency s personnel during the pursuit of activities related to the provisions of this agreement. 4. The named agency shall provide planned learning experiences for the student with mutually agreed upon educational objectives and guidelines. 5. The named agency shall provide a qualified staff member having appropriate and required credentials to serve as the preceptor for each student. Preceptors shall have a minimum of a BSN degree with one year experience as a registered nurse (or part time equivalent). The preceptor shall supervise the student in fulfilling the practicum field experience and shall not delegate such supervision. The named agency agrees to provide regular and coordinated opportunities for supervision and consultation by the preceptor. 6. The preceptor together with the student shall complete all written evaluations of the student s performance according to the process and timeline established by the school. Evaluations shall be submitted to the student s assigned faculty member as outlined in the course syllabi. 7. The named agency shall identify a staff member to serve as a liaison between the school and the named agency. The person may be the assigned preceptor. The responsibilities of this person shall include but are not limited to the following: a. Coordinate the educational arrangements between the named agency, student and the school b. Develop and administer an orientation program for the student which allows the student to be familiar with the practicum field site and all applicable policies and procedures, State and Federal laws and regulations that pertain to nursing practice at the named agency, including those pertaining to HIPAA. c. Assure practicum field experiences are distinct and separate from employment responsibilities in the event the practicum field site is also the student s place of employment d. Provide information and resources to the student for addressing ethical issues and concerns that may arise during the practicum experience 8. The named agency shall assure the student practices within the guidelines of any applicable professional ethics codes. 9. The named agency reserves the right to remove from the facility any student whose health or performance is determined to be a detriment to the wellbeing of the named agency s clients. Residents or staff. The agency shall notify the school promptly of any problem or difficulty arising during the practicum field experience. 10. The named agency shall maintain general and professional liability insurance and shall provide the school with proof of coverage upon request. MUTUAL RESPONSIBILITIES 1. The school and the named agency agree that they will not discriminate against any employee, applicant or nursing student affiliated with their respective establishments because of race, color, religion, national origin, socioeconomic status, marital status, gender, sexual orientation, age, ancestry, disability, military status or other legally protected status. Hondros College nursing.hondros.edu HONDROS

16 Practicum Site Affiliation Agreement (continued) NURSING PROGRAMS 2. This agreement may be terminated by either party upon at least thirty (30) calendar days written notice to the other party, provided however that both parties shall have exerted their best efforts to permit students enrolled in or scheduled for the practicum field experience to have the opportunity to complete the same. 3. Neither the named agency or the school shall assign or otherwise dispose of this AGreemnt, or the right, title, or interest therein to any other entity without the previous written consent of both parties. 4. The parties hereto recognize that in the performance of this agreement, the greatest benefits shall be derived by mutual commitment, therefore, they enter into this Agreement with the intention of loyally cooperating with the other in adhering to its terms., Each party agrees to interpret this Agreement so as to promote the interests of both parties and to render the highest service to the public. 5. This Agreement shall be effective on-going, from this day, unless terminated by either party by written notice as provided for herein. 6. All notices to the agency must be in writing, signed by the responsible party giving it, and served either personally or by certified mail, return receipt requested, addressed according to the address information that appears at the top of the first page. 7. This Agreement may be modified at any time in writing by mutual consent of the parties 8. This Agreement contains the entire agreement between the parties hereto and supersedes all prior agreements whether written or oral 9. This Agreement shall be governed by and construed in accordance with the laws of the State of Ohio. IN WITNESS WHEREOF the parties hereto have executed this Practicum Field Experience Affiliation Agreement the day and year first written above. For named agency: Name (please print): Title: Signature: Date Signed: For school: Signature: Date Signed: Please remit executed agreement to: Hondros College 4140 Executive Parkway Westerville, OH ATTN: Director Online Programs Hondros College nursing.hondros.edu HONDROS

17 Authorization to Release Educational Records NURSING PROGRAMS I understand under the provision of the Family Educational Rights and Privacy Act of 1974, my Hondros College records (academic and other) will not be released without my written consent. Part A: FOR RELEASE OF RECORDS TO CLINICALS AGENCIES I, (print name), hereby give permission to Hondros College to release information from only educational records, including but not limited to information regarding my general health and immunization to agencies where I have nursing clinicals. Signature Date Part B: FOR RELEASE OF ACADEMIC AND FINANCIAL RECORDS I, (print name), hereby give permission to Hondros College personnel to release records, including but not limited to, academic and financial records upon request to the following individual(s) Please Print: Name: Relationship: Address: City, State, Zip: Signature Date Part C: REVOCATION TO RELEASE ACADEMIC AND FINANCIAL RECORDS I, (print name), hereby revoke any previously granted permission to release my information to: Please Print: Name: Relationship: Address: City, State, Zip: Signature Date Hondros College nursing.hondros.edu HONDROS

18 Learning Space Reference Guide NURSING PROGRAMS Ready to get started? Several informative lessons have been developed to help you get started in the RN-to-BSN online program at Hondros College. The Learning Space Reference Guide, which can be found in the Resources section of the course, will help you get familiar with the Hondros College Learning Space. This valuable document will help you learn about many important topics. Topics include: Accessing Online Courses News and Announcements Participating in a Discussion Forum Reading and Replying to Posts Grades for Discussion Forums Paper Assignments Using Turnitin Submitting a Paper Assignment Quizzes and Exams And more! Look for this information in the Resources section of the course! Hondros College nursing.hondros.edu HONDROS

19 The HONDROS Student Experience: Using Validation Online Bookstore STEP 1: Read the messages from the bookstore. The will come from the address: and have the Subject line Hondros College Textbook Order - Get Your Books Now! If this is the first time you will be using the bookstore, you will receive two s when your textbooks are available for you to order at your bookstore. The first includes your temporary password needed to log into your bookstore account. Please make sure to review the message thoroughly! The second will notify you that your course materials are now ready for you to review and order. If you have previously placed an order through ED MAP, you will only receive this , and will need to login in with the password you set during your previous shopping experience. STEP 2: Access the online bookstore. If this is your first visit, please log into your account by entering your address and temporary password when prompted. If you have previously placed an order through ED MAP, you will only receive this , and will need to login in with the password you set during your previous shopping experience. Page 1

20 If this is your first visit, you will be prompted to change your password for security reasons; be sure to follow the directions and create a password that contains at least eight characters. You ll also be asked to choose and answer a security question. After you ve finished providing the information, click <Submit>. Page 2

21 STEP 3: Review your course materials. After logging into the bookstore, click the <My Pending Items> link in the left-hand column. Page 3

22 The resulting screen displays all courses and items Hondros College requires for your next start date. You will see that there is an EBook and Print book available for each title. Hondros College includes the entire cost of the ebook in your tuition. If you choose to purchase a New Textbook, the price listed is the difference between the price of the ebook and the price of the New Textbook. The amount listed, plus shipping and applicable taxes will be due at checkout. Select the radial box that corresponds with the option you choose to receive (either ebook or print). Unselect the checkbox if you do not wish to receive either the ebook or the print book. Once you have made your selection click <Add Items to Cart>. Whatever items you select will be added to your cart once you click < Add Items To Cart>. Page 4

23 STEP 4: Review your shopping cart. The contents of your shopping cart will display on the next page. From here you can proceed to check out or, if you wish to purchase additional course materials, you can select <Continue Shopping>. NOTE: Hondros College is paying only for the items that were uploaded into your Pending Items cart. You will need to pay for any other items you add to your shopping cart. Page 5

24 STEP 5: Confirm your shipping address. You will be asked to confirm your shipping and billing addresses. If the displayed address is correct, click <Continue>; otherwise update your shipping information. If you have added items to your shopping cart that you will be paying for, uncheck the Shipping Address Same as Billing Address box if your shipping address is different than the billing address for the credit card you will be using. Page 6

25 STEP 6: Select Shipping Method. If you have ordered a print book you will need to select a shipping method and then select <Continue>. If you have only ordered ebooks, you will not be asked to select a shipping method. STEP 7: Review and place your order. A summary of your order information, including your courses, displays on the Review and Place Order page as well as any out of pocket amount you may owe. Click the edit icon to correct any incorrect information; enter the course start date if required. Enter your payment information if you have a balance due for the order. Click the <Place Order> button at the bottom of the page when all information is complete and accurate. Page 7

26 This is the page where you will be asked to enter your credit card information into our secure payment system if you have opted to purchase a print text. If you are only ordering ebooks provided by Hondros College, you will not be asked to enter any form of payment. Once you have entered your payment information, please select <Place Order>. Page 8

27 Step 8: Review your order confirmation page. The order confirmation page details the content and costs of all items in your order. The page also includes general information about your order. There will be important information about accessing your ebook on this page. Please be sure to review it carefully. NOTE: A confirmation message containing similar information as that shown on the order confirmation page will be ed to you. You will receive a shipping confirmation when the order has shipped. Page 9

28 Page 10

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