3) Anatomy: One four or five semester unit college human anatomy course with laboratory (Biology 120).

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1 Registered Nursing Program Enrollment Procedures for Returning, Transfer, or Challenge Students We are pleased that you have selected the College of Marin Registered Nursing Program to continue your preparation for a career in the Nursing profession. The following information has been prepared to assist you in the planning and enrollment process. Please read and follow directions carefully. We recommend that all applicants meet with a college counselor prior to applying to the program to plan their course of study. Because clinical placements require day and evening scheduling, it is strongly recommended that ALL course requirements for RN licensure and AS college requirements be taken prior to entry into the nursing program. Prerequisite courses taken at institutions other than The College of Marin must be evaluated prior to acceptance to the nursing program. Transcripts are required by the Counseling Department to verify pre-requisite and corequisite courses. DEFINITIONS: Returning student = student who left College of Marin Nursing Program in the second, third, or fourth semester after successfully completing the first semester. Transfer student = student who successfully completed one or more semesters of nursing education courses in another program. Challenge student = student or individual who had prior nursing education (LVN or PT) or individual with other health care education or experience who wishes to enter the nursing program with advanced standing and receive credit for previous education or work experience. APPLICATION DATES: Applications are accepted JANUARY 2 THROUGH FEBRUARY 28 for Fall Semester. APPLICATIONS are accepted SEPTEMBER 1 THROUGH NOVEMBER 15 for Spring Semester. Applications for admissions will NOT be accepted for consideration after the closing dates. Incomplete applications on the closing dates will not be considered for admission review. PREREQUISITES: Prerequisites must be fulfilled PRIOR to admission into the program. All prerequisites must be met with a grade of "C" or higher. A minimum grade of 2.0 is required for all courses required for RN licensure. Courses required for the nursing program may have their own pre-requisites. See College of Marin catalogue for complete information. Note: Admissions pre-requisites to the Registered Nursing Program are currently under review. Contact the nursing department for current information. PREREQUISITES include:*,**,*** 1) NE 90, Introduction to Nursing Education and Practice. See the College of Marin "Schedule" for specific dates and time. 2) Chemistry: One semester of college chemistry (Chem 110 or Chem 114 or 115 or one year high school chemistry). 3) Anatomy: One four or five semester unit college human anatomy course with laboratory (Biology 120). 4) Physiology: One four - five semester unit college human physiology course with laboratory (Biology 224). 5) Microbiology: One 4-5 semester unit college microbiology course (Biology 240). 6) Math: Math 101 or Math 101 R or College of Marin Math Assessment Test qualifying for Math 103. (Challenge Option) 7) English: English 120, 150, or 120 SL. 8) Nursing Education 115 and 120: Required for Psychiatric Technicians only. PLEASE NOTE: 30 UNIT OPTION LVN's COMPLETE #4 AND #5 ONLY * Students who intend to apply for licensure as a non-graduate: Please note that Title 16, Section 1412 of the California Code of Regulations states that proof of high school education or the equivalent (high school diploma, GED, high school equivalency, college degree) is required by the person applying for a license as a registered nurse. The nursing department requires this proof for licensure application. ** If you are considering transfer of these courses, see Academic Transfer Program information in the College of Marin catalog. ***Students who believe they have met the pre-requisite through course work at other institutions or equivalent experience have a right to challenge a course pre-requisite. Contact the nursing department for the RN challenge information. Forms/ Apply Information - Revised 10/2000 LVN \LPT\Transfer Application Form-11/02 page 1 of 4

2 Registered Nursing Program Enrollment Procedures for Returning, Transfer, or Challenge Students CHALLENGE PROCEDURES Informational Meeting - Challenge students (LVN or LPT) should attend in November. This meeting explains the challenge process. HS education or equivalent: HS diploma, GED, HS equivalency (waived with a college degree). Please note that Title 16, Section 1412 of the California Code of Regulations states that proof of high school education or the equivalent (high school diploma, GED, high school equivalency, college degree) is required by the person applying for a license as a registered nurse. The nursing department requires this proof for licensure application. 1) LVN Challenge Degree Option Procedures: To receive advanced placement for NE 115, 120, 130, 130L, 150, 150L, 133, 133L, 230 and 230L, submit: A. Transcript from state-accredited LVN/LPN Program, showing coursework completion. LVN's who challenged boards must have their portfolio evaluated for the degree option, and; B. Current California L VN license. 2) 30 UNIT OPTION/NON-DEGREE OPTION FOR LVN'S: MUST COMPLETE pre-requisite #4 physiology, #5 microbiology only. Submit l A and 1 B as above. 3) Challenge Procedures for Psychiatric Technician: To receive advanced placement for NE 130 and 130L, submit: A. Evidence of current experience within the last three years in a mental health facility, and; B. Current California Psychiatric Technician license. C. Transcript of coursework from Psychiatric Technician Program. REQUIREMENTS FOR A COMPLETED APPLICATION Submit the following to the Nursing Department, Harlan Center 111, College of Marin, Kentfield, CA ) College of Marin Registered Nursing Program Application. Typed or printed in ink. 2) Completed Health Clearance Form upon acceptance into the program. Due Date will be announced. 3) College of Marin Courses Required for RN Licensure/Graduation Evaluation Form. 4) Petition for Substitution for RN Students form. There are two methods for students to obtain credit for required courses taken at other institutions: A. Evaluation prior to application to the program. Students who have received prior approval of courses taken at other institutions need only submit their approved copy of the Petition for Substitution with the application materials. B. Evaluation as part of the application process. Students who wish to obtain approval of courses taken at other institutions as part of the application process must submit catalog descriptions for the year in which the class was completed. The nursing department will send the Petition for Substitution, the catalog descriptions, and student transcripts to the Director of Admissions & Records for approval/denial. LVN \LPT\Transfer Application Form-11/02 page 2 of 4

3 Registered Nursing Program Enrollment Procedures for Returning, Transfer, or Challenge Students REQUIREMENTS FOR A COMPLETED APPLICATION continued 5) Official Transcripts. The applicant is responsible to insure that official transcripts from high school, psychiatric technician program, nursing school, or college, verifying successful completion of requirements or of requirements in progress are mailed directly to the Nursing Department from the issuing institution. College of Marin transcripts are not required. An official transcript is one with a college seal that is mailed directly from the registrar's office to the Nursing Department at College of Marin. 6) License. Submit a copy of a valid California LVN or LPT license, if applicable. 7) Work Experience: Submit proof (a written statement from your employer) of one year of continuous employment in an acute hospital or mental health facility in the last three years as an LPT. 8) NON-DEGREE OPTION LVN: SUBMIT #1, #2, #3, #4, #5, #6 listed above. 9) Self-Addressed stamped envelope: include a self addressed stamped envelope with your application. 10) Proof of residency. Please provide documentation of proof of residency in Marin County for one (1) year prior to application: Xerox of California driver's license and one of the following: income tax form from previous year, P G & E or Marin Municipal Water district bill. 11) Criminal Background Check completed by College of Marin Campus Police (processing fee paid by student). NOTE: All materials submitted during the application process become the property of the College of Marin. Incomplete applications will not be considered. All materials will be kept on file for one year following the selection process. Materials on file past this time period will be destroyed. A new application form with supportive documents will be required for each re-application to the program. ENROLLMENT IN THE PROGRAM: Returning, Transfer and Challenge Students. Enrollment occurs on the basis of available clinical spaces. The Program is committed to providing equal educational opportunities for qualified students. Each semester the Nursing Program receives more requests for enrollment than the program is able to accommodate. Enrollment is limited because of the need to maintain a safe student/teacher ratio in the clinical setting. Each application received is reviewed (by a screening committee) to determine that the basic entry prerequisites and challenge procedures have been met. Applications which are not complete or which do not satisfy the listed prerequisites shall not be considered further and shall not be eligible for admission into the program. To be considered for enrollment, all students must complete the basic entry course work and requirements listed below: 1) All pre-requisite courses must be completed with a "C" or better prior to admission in the program. Prerequisites include NE 90, Chemistry, Anatomy, Physiology, Microbiology, English and Math except for LVN 30Unit Option. L VN 30-unit option students must only complete physiology and microbiology. PT's must also complete NE 115 and NE ) All required application materials must be submitted to the Nursing Department office by the closing deadline. 3) All challenge procedures to courses as described on page 2 must be satisfied prior to application deadline. 4) Any courses required for RN licensure must have a letter grade of "C" or better. These courses include the above pre-requisites and Speech 110 or 120 or 128; Psychology 110 and 112 or 114; and three units from any of the following: Anthropology 102, 103, 208 or Sociology 110, 140. LVN \LPT\Transfer Application Form-11/02 page 3 of 4

4 Registered Nursing Program Enrollment Procedures for Returning, Transfer, or Challenge Students Courses required for state boards and General Education Graduation Requirements must be completed prior to graduation, but it is highly recommended that these courses be completed prior to entry into the program. Applications that are complete shall be ranked by the Screening Committee. Vacancies that occur in the RN Program in the second, third, or fourth semester are filled according to the following priority: 1) Returning students who left the College of Marin Nursing Program in good standing 2) Successful challenge student (LVN or LPT) 3) Transfer student or other returning student In the event that more than one application is tied in ranking and there are fewer openings available for the admission to the Program, ties will be broken through random selection process. It is not necessary to contact the Nursing Department regarding your application status. You will be notified by mail using your self addressed stamped envelope of your application status. Please be patient, it will take time for us to complete this procedure. All applicants will be notified by mail no later than January 15th for Spring admission and June 15th for Fall admission regarding their acceptance or non acceptance status. Spaces, should they occur, will be filled by the next qualified applicant until the semester begins. The College of Marin Nursing Program does not maintain a waiting list of students for admission once classes have begun. Each year Nursing students are selected from the current set of applications for that year. Students who are selected for the program and who drop from the program prior to completion of the semester, must reapply for subsequent admission. All applicants are bound by any new admission requirements and should contact a college counselor or the Nursing Department to determine such requirements. All application materials will be kept for one year should an applicant wish to reapply. If you need assistance with the application process, please contact the Nursing Department (415) only during the following times: Tuesday or Wednesday between the hours of 1:00 and 4:00 p.m. REFERENCE INFORMATION The College of Marin catalog may be purchased through the bookstore. It contains the most complete information on the RN Program, the requirements for Associate degrees, and the many services available at the College of Marin. Be certain to read any addenda that may be published after the catalog is in print. RELEVANT COLLEGE OF MARIN PHONE NUMBERS Admissions Office (415) Bookstore (415) Counseling Office (415) Financial Aid (415) RN Program (415) Student Health Center (415) Testing Office (415) Website: hartman@marin.cc.ca.us LVN \LPT\Transfer Application Form-11/02 page 4 of 4

5 Application Status: Admission to Fall 1st Semester Psychiatric Technician Transfer Nursing School Applicant Challenge Applicant - LVN Re-Applicant 30 Unit Option - LVN Foreign Nurse REGISTERED NURSING PROGRAM Enrollment for: Fall Spring Social Security # - - Telephone (H) / - Telephone (W) / - Last Name First Middle Previous Names Address City/State Zip Address: Sex: * Male Female Birthdate: * Month Day Year Ethnic Group *... Asian... = 01 Asian/Indian... = 02 Black... = 03 Filipino... = 04 Guamanian... = 05 Hawaiian... = 06 Hispanic... = 07 Indian... = 08 Pacific Islander...= 09 Samoan...= 10 White...= 11 Other...= 12 Do you claim to be a Marin County Resident? Yes = 1 No = 2... Previous Education... High School Diploma = 1 Foreign Secondary School Diploma or G.E.D. or H.S. Cert. of Equivalency/Completion = 2 Certificate of Graduation = 4 Certificate of California High School Proficiency Exam = 3 AA/AS = 5 BA/BS = 6 Primary Language: English = 1 Not English = 2... I. Please list the names of the High School and/or Colleges from which you requested transcripts, HS diploma, or test scores. Name of High School/College(s) Date of Transcript Request Date received - RN Program * Information is optional and is collected for statistical analysis only. Completing this information does not affect entry into the program.

6 II. Have you ever been enrolled in any kind of nursing education program? Yes No If yes, what type? Name and address of school: Dates enrolled to Did you complete the course? Yes No If yes, date of completion? If no, why not? III. Work or Volunteer Experience in a health related field (LVN, LPT, NA, CNA, MA, Volunteer, Ward Clerk, etc.) From/To # Hrs Per Wk Employer Name and Address Type of Work Immediate Supv. Completion of this section signifies consent for the College of Marin to contact former supervisors/employers. Application materials are to include (but are not necessarily limited to): RN Program Application... College of Marin Courses Required for RN Licensure and Graduation... Petition for Substitution (if applicable)... Catalog Descriptions.... Challenge Scores (if applicable)... Transcripts College... Transcript - High School (for HS Chemistry)... Proof of Residency... Self-addressed stamped envelope... CERTIFICATION: I hereby swear under the possible penalty of perjury that the information submitted on this document is complete and accurate. I understand that furnishing incomplete or inaccurate information is grounds for disciplinary action. Name Date Forms \Application 03

7 COLLEGE OF MARIN COURSES REQUIRED FOR RN LICENSURE AND GRADUATION Name: (H) Phone #: Address: (W) Phone #: City/State/Zip: Social Security #: PLEASE TYPE OR PRINT ALL INFORMATION PREREQUISITES Course Date Completed Grade In Progress Yes No NE 90 HS Chemistry, Chemistry 110 or 114 or 115 Biology 120 Biology 224 Math 101 or 101XY English 120, 150 English 120SL Microbiology Biology 240 COREQUISITES Speech 110, 120 or 128 Psychology 110 Psychology 112 or 114 One of the following: Anthro 102, 103, 208 or Sociology 110, 140 GE REQUIREMENTS - not used in selection process Humanities Communication and Analytical Thinking American Studies Physical Education Cross Cultural Studies 1. Students are subject to requirements in the catalog in the semester of acceptance into the Nursing Program. 2. Courses can only be substituted with a C or higher grade. A C-minus is NOT accepted. Exam Placement Date Ordered Office Use Only Approved/Denied Petition for Substitution 2-03

8 PETITION FOR SUBSTITUTION - COLLEGE OF MARIN NURSING REQUIREMENTS TAKEN AT OTHER COLLEGES (See reverse for directions) Name: (H) Phone #: Address: (W) Phone #: City/State/Zip: Social Security #: Please complete for PREREQUISITES completed at other colleges (catalog descriptions must be attached). HS Chemistry, Chemistry 110 or Chemistry 114 or 115 Anatomy Biology 120 Physiology Biology 224 Math 101 or 101XY English 120, 150 English 120SL Course Title Lab Yes/No School Name Microbiology Biology 240 Please complete for COREQUISITES completed at other colleges (catalog descriptions must be attached). Speech 110, 120 or 128 Gen. Psychology 110 Child Psychology 112 Date Completed In Progress Yes/No Grade Units One of the following: Anth 102, 103, 208 or Sociology 110, 140 Please complete for GE REQUIREMENTS completed at other colleges - not used in selection process (catalog descriptions must be attached). Humanities Communications and Analytical Thinking American Studies Physical Education Quarter/ Semester Office Use Only Allowed Denied Cross Cultural Studies 1. Students are subject to requirements in the catalog in the semester of acceptance into the Nursing Program. 2. Courses can only be substituted with a "C" or higher grade. A "C-minus" is NOT accepted. Petition for Substitution 2-03

9 Procedures for Substitution of Required Courses for College of Marin Registered Nursing Program There are two methods for students to obtain credit for required courses. Evaluation Separate from Application to the Nursing Program. 1. Petitions for substitution may be submitted before applying to the Nursing Program. It will be the student's responsibility to request official transcripts and course descriptions for the year the course was completed. Attach catalog course descriptions to the petition. Official transcripts must be mailed directly from the issuing college to the College of Marin, Counseling Department, Kentfield, CA The Petition for Substitution will then be submitted and reviewed by Admission and Records (Academic Standards). The student will be notified and a copy will be sent to the Counseling Office. Decisions will be made part of the official record. 2. Students who obtain substitution approval in advance must retain the original approved copy and attach to their application for the Nursing Program. 3. Turn around time on petitions is generally two weeks, longer during busy periods. Evaluation as part of the Nursing Application. 1. The nursing application will include two forms. One will require the student to list all pre and corequisites completed at the College of Marin. The other will be a Petition for Substitution for courses required for the RN Program which were completed at another college. Catalog descriptions for the year in which the class was completed must accompany the Petition for Substitution. 2. The Nursing Department will send the Petitions for Substitution to the Director of Admissions and Records together with catalog descriptions and a copy of the student's transcript. 3. The petitions will be evaluated by Admissions and Records (Academic Standards). Decisions will be made part of the official record. The student, the Nursing Department and the Counseling Office will receive a copy of the petition indicating which courses are approved/denied. Petition for Substitution 2-03