Santa Ana College Registered Nursing Program APPLICANT S CHECKLIST- Entry: Spring 2016

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1 APPLICANT S CHECKLIST- Check as you go This Checklist is to assist you as you gather your paperwork. Application materials listed below are to be received by, Health Sciences/Nursing Office (see contact information at the bottom of this checklist) between September 15 th and 30 th (Postmark accepted): A) Application Must be completed accurately and honestly and signed. B) Unofficial Transcripts High School/GED and any Colleges/ Universities attended (if you have a college degree showing on your college transcripts, then high school/ged transcripts are not required). All transcripts must have your name and institution listed along with grades and dates of graduation/completion/degree. Upon acceptance to the program, official transcripts must be submitted by December 4, 2015 in a sealed envelope to the Health Sciences/Nursing Office (Preferably), or Admissions & Records Office. C) Unofficial Test of Essential Academic Skills (TEAS) Version V Results Submit results of: The first time you took the test OR Testing within 1 year but following documented remediation after the first failure (attach unofficial transcripts of remediation or letter from counselor on letterhead stating remediation completed) OR Testing after 1 year following a failure OR Testing after 1 year to improve results (only the most recent results will be accepted if you have re-taken the test to improve the results). Upon acceptance to the program, you must contact ATI at to have official transcripts sent to by December 4, 2015 (unless you tested at ) D) Proof of Relevant Work Experience (if applicable) Letter on letterhead from Human Resources or Supervisor confirming hours, years, and title. E) F) G) H) I) Veterans status (if applicable) Copy of DD-214 showing above a dishonorable discharge. Statement of Relevant Life Experience (if applicable) Letter to identify and describe the life experience(s) being claimed. Refugee Status (if applicable) Copy of an I-94 Arrival/Departure Card. Low Family Income (if applicable) Evidence of fee waivers within the last 3 years, or letter/documentation of financial aid. Proficiency in a Second Language (if applicable) Letter stating fluent in speaking, reading, and writing language and explaining how fluency obtained. J) St. Joseph Hospital Employment Verification (if applicable) Letter from Human Resources confirming employment of at least 6 months. Health Sciences/Nursing Department, R-213 Admissions & Records, S W. 17 th Street 1530 W. 17 th Street Santa Ana, CA Santa Ana, CA Phone: (714) Phone: (714)

2 Dear Nursing Program Applicant: APPLICATION INFORMATION Thank you for your interest in the Registered Nursing (RN) program. Based on students who have applied to the nursing program before you, we have assembled this information to help make the application process as easy as possible. Please read this information carefully. Step 1 Qualifications To be eligible to apply for admission to the nursing program, you must: Be at least 18 years of age at the time of admission; and Have transcripts of high school graduation, GED, or a college degree from an American institution or evaluated equivalency (your name, institution, and date and graduation/completion/degree must be listed); and Complete Anatomy (Bio 239), Physiology (Bio 249), and Microbiology (Bio 139 or Bio 229) within the last seven years (completed no earlier than Fall 2008) and have a GPA of 2.5 or higher; and Complete English 101 or equivalent (must be from a United States college/university); and Pass the Test of Essential Academic Skills (TEAS) Version V at 62% or higher. Note: o Licensed Psychiatric Technicians must meet with the Program Director or designee to determine placement. o Licensed Vocational Nurses enter third semester and are not eligible to apply to first semester. Step 2 Turning in your application Beginning September 15 th your application must be turned in, received by, or postmarked by 5:00pm September 30 th to the Health Sciences/Nursing Office, R-213, (714) (no exceptions). Office hours during Fall 2015 are: Monday through Thursday 7:30am to 5:00pm and Fridays from 7:30am to 4:00pm; closed weekends. You need to: Complete your application Attach unofficial high school graduation transcripts or GED results (not needed if you have a college degree showing on your college transcripts). Date of graduation/completion/degree must be listed. Attach unofficial transcripts from all colleges/universities you have attended (including Santa Ana and Santiago Canyon Colleges). Attach unofficial TEAS Version V score sheet (results) Attach other documentation if applicable Submit your application, supporting documents, and transcripts all together to the Health Sciences/ Nursing Department in person or by mail by the deadline. *Note: All unofficial transcripts must include your name, school, courses, dates of completion, and grades when printed (handwritten information will not be accepted). [It may be necessary to submit or copy official transcripts in order to have your name and institution on transcripts.]

3 APPLICATION INFORMATION, page 2 Step 3 Selection Your application must be completed and signed with all of the materials attached or your application will not be considered. We will not check documents upon submission. We will not contact you if materials are missing. 20% of the available admission spaces for Spring 2016 will be filled with randomly selected students of qualified applicants. 75% of the available admission spaces for Spring 2016 will be filled with students with the highest number of points. In the case of a tie in points, a lottery will be conducted. An additional 20 students will be selected as alternates. 5% of the available admission spaces for Spring 2016 will be filled with students re-entering the program. Applicants who are not selected for entry are encouraged to re-apply during the next application period (February 2016). WE DO NOT MAINTAIN A WAITING LIST. Step 4 - Acceptance Notification of Acceptance letters will be mailed no later than November 6, The letter will include information about a mandatory orientation on December 1, 2015 from 1pm to 4pm, (location to be determined). You must contact the Health Sciences/Nursing Office by November 20, 2015 by or by phone ( ) that you will be taking one of the available spaces in Spring Acceptance to the nursing program is tentative until: o You obtain a student I.D. number by applying to the college; AND o All official transcripts from high school/ged, colleges/universities, and TEAS Version V score sheet (results) are received. You may bring your paperwork (official transcripts) to the orientation on December 1, If your paperwork is not received by December 4, 2015 at 4pm, you will lose your admission for entry to an alternate. NOTE: Any change to your contact information must be submitted in writing through or submitted to the Health Sciences/Nursing Office. If we are not able to contact you at the information you provided and/or you do not respond to our contact by phone within two days, your application will be disqualified. Thank you and I hope to see you in the Nursing Program, Becky Miller, MSN, RN Associate Dean of Health Sciences

4 Multi-criteria Admission Process - -Nursing Department Entry for First Semester: Spring 2016 Applications will be accepted September 15 th through September 30 th for the Spring semester and February 15 th through March 2 nd for the Fall semester. The applications and all required documents may be hand delivered or mailed; application and documents must be postmarked by the deadline. Incomplete applications or incomplete/incorrect transcripts will not be accepted, and the application will be deemed ineligible. Selected students will be provisionally accepted pending receipt of all official documents. Note: Psychiatric Technicians must meet with the Program Director or designee to review advance placement to second semester. Licensed Vocational Nurses enter the third semester. Licensed Psychiatric Technicians and Licensed Vocational Nurses are not eligible to apply for first semester. To apply, you must have: Graduated from High School, passed GED, or have a college degree, and GPA average of at least 2.5 in Anatomy, Physiology, and Microbiology (sciences must have been completed within seven years; no earlier than Fall 2008), and Passed English 101 with a grade of C or better, and Passed the TEAS test Version V with a score of at least 62%. 3 bonus points will be awarded for science courses taken within four years of the application date (science courses must have been completed between Fall 2011 and Summer 2015 for the bonus points). Proportionally, the Students invited to enter will be selected based on: 20% Random selection of those students who have transcripts verifying graduation from high school, GED, or college degree, completed the 3 science prerequisites with at least 2.5 GPA, passed English 101, and passed TEAS exam 75% Highest points 5% Re-entering status Category Maximum Breakdown Academic degree 8 BS/BA or higher = 8 AS/AA = 4 (Only one degree will be counted) Relevant work (Letter on letterhead from Human Resources or a Supervisor is required confirming hours, years, and title as proof of relevant work.) 20 Nursing Assistant, Emergency Medical Technician, Medical military experience, Medical Assistant (Back Office), Healthcare related experience = 20 (must have >1000 hours of Direct Physical Patient Care within the last 3 years) Phlebotomist, Hospital-based unit clerical or telemetry staff, Healthcare related therapists (Respiratory, Physical Therapy, Radiology, Telemetry, Dental Hygienist/Assistant), Medical Assistant (Front Office) = 14 (must have >1000 hours of work experience within the last 3 years) Any of the above with more than 200 but fewer than 1000 hours within the last 3 years = 8 Volunteer in Healthcare related area = 4 (must have at least 200 hours within the last 3 years) Other relevant work will be determined on a case-by-case review with appropriate points (0-20) assigned based on review ( can be combined to a maximum of 20.) Changes to the criteria may occur. Updates will be posted on the website as soon as possible after the change has occurred. The update will be dated. Init 11/2010; rev 11/2012; rev 2/2013 for one-time application acceptance; rev 3/2013 update; rev/updated 6/2013; rev 9/2013; 1/2014 update; 7/2014 update; 12/2014 rev and updated; 7/2015 rev. 9/2015 The maximum points for fluency in a second language was changed in the Multi-Criteria Grid to reflect the same number of points allocated in the Multi-criteria Admission Application as 2 (not 5). Additionally, we have taken note that the maximum GPA score is 51 (not 45 as listed in the Grid).

5 Multi-criteria Admission Process - -Nursing Department, Page two Entry to First Semester: Spring 2016 Category Maximum Breakdown GPA 45 Anatomy, Physiology, and Microbiology GPA average (GPA below 2.5 = Ineligible). Scores = = = = 6 Note: Each science course can be repeated one time for a better grade. Courses cannot be repeated after being passed within 7 years at the same college. All 3 science courses must be completed within 7 years (completed no earlier than Fall 2008). Three bonus points will be awarded if all 3 science courses are within 4 years of the application date (science courses must have been completed between Fall 2011 and Summer 2015 for the bonus points). No penalty will be assessed for withdrawing from courses. English 101, N-RN 103 Pharmacological Concepts for Nursing (catalog description must contain nursing process and be for the Registered Nurse), and N-RN112 Concepts for Nursing (N-RN112 must be taken at Santa Ana College) are awarded points as follows: 5 points for each A 3 points for each B 1 point for each C *3 bonus points will be awarded for pharmacology course taken within two years of the application date (course must have been completed between Fall 2013 and Summer 2015). General Education courses for the Nursing degree (Math 080/081, Sociology 100, Psychology 100, Communication Studies (Speech) 102 or 145, Humanities, and American Institutions) = 2 points for each course completed Veteran 2 DD-214 showing above a dishonorable discharge Life experiences 5 Disabilities (Letter describing (1 point for First generation of family to attend college issue/situation each area; Need to work required except as maximum Disadvantaged social or educational environment noted.) 5 points) Fluency in a second language (TEAS) Version V Test of Essential Academic Skills HESI= (math, reading, science, and English) PAX-RN= (math, reading, science, and English) Difficult personal or family situations or circumstances Refugee (evidence of I-94 card) Low family income (evidence of financial aid assistance) 2 American Sign Language, Arabic, Chinese, Farsi, French, Russian, Spanish, Tagalog, and the various languages of the Indian subcontinent and Southeast Asia. Letter stating fluent in speaking, reading, and writing language and explaining how fluency was obtained is required. 15 For first-time testers, OR testing within 1 year but following documented Scores remediation after the first failure, OR testing no sooner than 1 year = = 12.5 following a failure OR testing after 1 year to improve results are awarded points = 10 as follows: = 7.5 (Any repeat test results that are submitted within 1 year of the original test date and not accompanied with remediation documentation will be deemed ineligible. HESI and PAX-RN = 5 results will be pro-rated; at least 70 required for HESI, 114 for PAX-RN.) = = 0

6 PLEASE PRINT THE FOLLOWING INFORMATION: Student Application Name: Last First Middle Maiden or previous name (s) used Cell Phone # Alternate Phone # Address Mailing Address: City State Zip Code Are you applying as a St. Joseph Hospital Employee with verification letter? Yes No MUST BE COMPLETED (For statistical purposes only) Birth Date Gender: (circle one) Female Male Are you a Licensed Psychiatric Technician or a Licensed Vocational Nurse (LVN)? Yes No Ethnicity: (circle one) African-American, Alaskan Native, American Indian, Asian, Filipino, Hispanic, Other Non-White, Pacific Islander, White Non-Hispanic High School Grad/ GED/College Degree Date: Primary Language at Home: Did You Graduate? Degree Awarded Grad Date NAMES OF COLLEGES AND UNIVERSITIES ATTENDED (List in order, beginning with the most recent) Name City State NOTE: Unofficial transcripts pertinent to earned degrees, pre-requisites, and nursing curriculum must be included with this application. Fully complete the tables below with course information Course Term/Year Taken at (College) Course # & Course Title Units Grade Anatomy Physiology Microbiology Calculate Sciences GPA: A=4 points, B=3 points, C=2 points. Add GPA points of Anatomy, Physiology and Microbiology and then divide by 3. Sciences GPA Course Term/Year Taken at (College) Course # & Course Title Units Grade English

7 Student Application Multi-Criteria Grid Criteria Academic Degree Relevant Work Max. Explanation 8 BS/BA or higher = 8 points AS/AA = 4 points (Only one degree will be counted) 20 Nursing Assistant, Emergency Medical Technician, Medical military experience, Medical Assistant (Back Office), Healthcare related experience = 20 points (must have > 1000 hours of Direct Physical Patient Care within the last 3 years) Phlebotomist, Hospital-based unit clerical or telemetry staff, Healthcare related therapists (Respiratory, Physical Therapy, Radiology, Telemetry, Dental Hygienist/Assistant), Medical Assistant (Front Office) = 14 points (must have > 1000 hours of work experience within the last 3 years) Any of the above with more than 200 but fewer than 1000 hours within the last 3 years = 8 points Volunteer in a Healthcare related area = 4 points (must have at least 200 hours within the last 3 years) Required Documentation Unofficial transcripts Letter on letterhead from Human Resources or Supervisor confirming hours, years, and title as proof of relevant work Can combine and add categories. Maximum number of points is 20. Your Other relevant work will be evaluated on a case-by-case review with appropriate points (0-20) assigned based on review GPA 45 Anatomy, Physiology, and Microbiology GPA average Scores = = = = 6 Note: Each science course can be repeated one time for a better grade. All 3 science courses must be completed within 7 years (completed no earlier than Fall 2008). Three bonus points will be awarded if all 3 science courses are within 4 years of the application date (Fall 2011 to Summer 2015). No penalty will be assessed for withdrawing from courses. 5 points for each A, 3 points for each B, 1 point for each C: English 101 (from an American Institution) Pharmacological Concepts for Nursing (catalog description must contain nursing process and be for the Registered Nurse) N-RN 112 Concepts for Nursing (must be taken at Santa Ana College) Note: Three bonus points will be awarded if pharmacology course is within 2 years of the application date (Fall 2013 and Summer 2015). Unofficial transcripts Unofficial transcripts

8 Criteria GPA continued Max. Cont. Explanation General Education courses for the Nursing degree: (Math 080/081, Sociology 100, Psychology 100, Communication Studies (Speech) 102 or 145, Humanities, & American Institutions) are awarded 2 points for each course completed (CIRCLE each course completed) Veteran 2 DD-214 showing above a dishonorable discharge DD-214 Life 5 experience Fluency in a second language (TEAS) Version V Test of Essential Academic Skills HESI= (math, reading, science, English) PAX-RN= (math, reading, science, English) 1 point for each area; max 5 points Student Application Multi-Criteria Grid Disabilities First generation of family to attend college Need to work Disadvantaged social or educational environment Difficult personal or family situations or circumstances Refugee (copy of I-94 card is required) Low family income (evidence of fee waivers from any college within the last 3 years or copy of letter if receiving Federal Aid or documentation from FAFSA of Expected Family Contribution (ECF) less than $ ) 2 American Sign Language, Arabic, Chinese, Farsi, French, Russian, Spanish, Tagalog, and the various languages of the Indian subcontinent and Southeast Asia 15 For first-time testers OR testing within 1 year but following documented remediation after the first failure (attach unofficial transcripts) OR testing after 1 year following a failure OR testing after 1 year to improve results: Scores = = = = = = = 0 < 62 = Failure (HESI and PAX-RN results will be pro-rated; at least 70 required for HESI, 114 for PAX-RN.) Required Documentation Unofficial transcripts Letter identifying categories claimed and description of the issue(s) except as noted for refugee status and low family income Letter stating fluent in speaking, reading, and writing language and explaining how fluency was obtained is required. Unofficial copy of TEAS results (Any repeat test results that are submitted within 1 year of the original test date and not accompanied with remediation documentation will be deemed ineligible.) Your Total I certify that my answers are true and complete to the best of my knowledge for all pages of this application. If this application leads to enrollment, I understand that false or misleading information in my application may result in denial of admission and/or dismissal from the nursing program. Applicant Signature Date

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