Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program

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1 Lee College Student Application for Admission For Vocational Nursing (L.V.N.) Program Type of complete in ink. (Immunizations must be submitted with application.) Desired DATE OF ENTRY into program: Semester Social Security Number: - - 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: Address: Year (Last) (First) (Middle) (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 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 Thee Board of Nursing Examiners for the state of Texas at LVN Applicant: Please furnish a copy of your high school diploma transcript and/or GED transcript to the Allied Health Office. 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 my 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 05/10 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 Certificate of Completion in Vocational Nursing Lee College Vocational Nursing The purpose of the vocational nursing program is to prepare individuals to perform basic nursing skills as defined in the Nurse Practice Act. The VN program is accredited by the Board of Nurse Examiners for the State of Texas. The program is one year in length. Applicants must be high school graduates or have a GED, and read at the 13 th grade reading level. You are required to complete MATH 350 Allied Health Math prior to entering with a grade of C or higher. To be considered for admission to the Vocational Nursing program, all students must attend a mandatory applicant information session for the year in which they are applying. It is recommended, that the student complete the BIOL The Human Body OR BIOL 2401 and 2402 Anatomy and Physiology I & II, HITT 1305 Medical Terminology, ITSC 1309 Integrated Software Applications I, and LSSS 300 College Study Skills prior to entering the program. (Science courses must be passes with a grade of B or better, all other courses with a C or better.) After successful completion of this program, the graduate is eligible to take the National Council Licensure Examination for Practical Nurses. Upon passing the examination, the graduate is licensed as a vocational nurse. Job opportunities include hospitals, clinics, doctors offices, long-term care, correctional facilities, military, and home health care facilities. The following guidelines must be followed! Ø Apply for admission to Lee College and submit to the Admissions and Records office transcripts from high school (or GED certificate) and/or from all colleges attended before applying to the nursing program. Ø Apply for VN program admission. Obtain a VN admission packet in the Nursing Department or the Counseling Center. Admission is based on a point system criteria see the attached yellow sheet for specific information on how to earn points. Class size is limited and there are more applicants than slots. Completion of recommended bonus courses does not guarantee admission to the program. Ø Applications will not be accepted without documentation of completed required immunizations. Ø Applications are taken year-round; students are strongly encouraged to turn in applications by February 1 st for consideration for admission. Enrollment is limited. Ø Complete Lee College assessment/placement test (Counseling Center). If minimum test scores are not achieved, follow advisement of counselor/faculty advisor until minimal competencies are accomplished. Ø Make an appointment for degree planning in the Counseling Office (281) Ø Attend a mandatory applicant information session for the year in which they are applying. Ø Bring copies of your high school diploma (or GED certificate) and any college transcripts and test scores to the Allied Health Office. Ø Criminal background screening. See Allied Health Office for procedure. Ø Students will be informed of their status (selected or wait list) between June 15 th and 30 th. * See the attached Texas Department of Health and Human Services Immunization Requirement sheet.

4 Lee College Vocational Nursing Program Application to the Vocational Nursing Program Requires: Application to Lee College before applying to the nursing program. Application to V. N. program. Applications are taken year around, students are strongly encouraged to turn in applications by February 1st. Applications will not be accepted without documentation of completed required immunizations. Admission to the Vocational Nursing 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 for timely evaluation. Criminal Background screening. There are more applicants than slots in the program. Meeting minimum requirements does not guarantee admission. The VN Admission Committee informs applicants of admission status. Students are responsible for furnishing official transcripts to the Admissions and Records office for any course transfers. The VN Admission Committee informs applicants of admission status. All admission requirements must be satisfied before students may register. 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 website, for the Declaratory Order form. See the attached Texas Department of Health and Human Services Immunization Requirement sheet.

5 Lee College Vocational Nurse Program Acceptance Criteria Student Name SS# Date Telephone Number The following criteria will be used for acceptance into the Vocational Nurse Program. Selection for the fall class begins in May of each year. REQUIRED CRITERIA: (If any of the required steps are not completed prior to the selection process, the applicant will not be considered.) 1. (1 point) Application to the V.N. program on file in the Nursing Department. Date on application: 2. (1 point) Attend a mandatory applicant information session for the year in which the student is applying. Call the Nursing Department at for the date of the information session. 3. (.5 point) 13 th Grade Reading Level (Documentation of reading level must be in VN folder in the Nursing Office.) 4. (.5 point) Degree Plan from Counseling Office signed by a Counselor. 5. (.25 point) Copy of high school diploma or GED certification in VN folder in the Nursing Department. 6. (1 point) MATH competencies: C or better in MATH 350 or C or better on advanced placement test for Math 350.

6 BONUS POINTS: Individuals are not required to take any of the bonus point courses before admission, but will be rewarded additional points if any of the recommended courses are taken prior to entry into the VN Program. PLEASE NOTE that taking any or all of these courses does not guarantee acceptance into the VN Program. The biology courses must be passed with a B or better, all other courses with a C or better. 1. a. (1 point) Biology 2404 The Human Body (may not be more than 2 years old and received a B or better) Date Taken: Grade: If this course is taken prior to entering the VN Program, the student will not have to take Biology 2404, which is required during the fall semester of the VN Program. 1.b. (1.5 points) Biology 2401 Anatomy & Physiology I, AND Biology 2402 Anatomy & Physiology II (both semesters must be taken and may not be more than 2 years old and received a grade of B or better) BIOL 2401 Date Taken: Grade: BIOL 2402 Date Taken: Grade: If these courses are taken prior to entering the VN Program, the student will not have to take Biology 2404, which is required during the fall semester of the VN Program 2. (.5 point) HITT 1305 Medical Terminology Date Taken: Grade: If this course is taken prior to entering the VN Program, the student will not have to take HITT 1305, which is required during the fall semester of the VN Program. OR 3. (.5 point) LSSS 300 Study Skills Date Taken: Grade: 4. (.5 point) ITSC 1309 Integrated Software Applications I Date Taken: Grade: 5. (.5 point) Early application date: NOTE: This point is not used unless there is a tie of point scores. 6. Point GPA (based on BIOL2404 or 2401 & 2402, Math 350 and HITT 1305) ( point, point, point) NOTE: If any of the bonus courses are taken at another college and contain equivalent content, they may be considered for transfer. The individual requesting the transfer credit must bring an official transcript and a college catalog that contains the appropriate course description (please bring at the time of the interview). I have attended the mandatory applicant information session and had the acceptance criteria explained; therefore my signature indicates my understanding of the acceptance criteria process. Student Signature: Faculty Signature: Date: Date:

7 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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