Umpqua Community College Practical Nursing Certificate Program Application

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1 Dear Practical Nursing Applicant: Thank you for your interest in the Practical Nursing program at Umpqua Community College (UCC)! The Practical Nursing program is both exciting and challenging; offering graduates the opportunities for employment in a variety of settings and for a lifelong career that is personally fulfilling. The practical nursing program at UCC is structured to help the nursing student build a strong foundation, thus building confidence to achieve the goal of becoming a Licensed Practical Nurse (LPN). Success in the program takes a firm commitment, and the nursing faculty members are here to help you succeed. The Program focuses on the practical nursing role of providing care under the supervision of a registered nurse or physician in long term care, outpatient clinics, and other health care settings. Curriculum includes coursework from the biological and applied sciences including anatomy and physiology, social sciences and humanities. Students study fundamental principles and procedures of practical nursing, medication administration, infection control, pharmacology and the practical nurse s contribution to the nursing process. Theory and lab course work includes concepts that address the practical nurse role in patient teaching and the delivery of nursing skills according to current standards of practice. Practical Nursing is a demanding field and admission to nursing schools is a very competitive process. We strongly suggest you prepare well by talking with nurses in various settings, talking with an advisor in order to help you with your career plans, and by reading through the application materials thoroughly. Thanks again for your interest. If you have any questions about admission to this program, please call LaVera Noland, Admission Officer at Sincerely, Tamra L Samson, MSN, RN, Director of Nursing Umpqua Community College 1

2 PROGRAM OVERVIEW: CAREER DESCRIPTION: The program focuses on the practical nursing role of providing care under the supervision of the registered nurse or physician in a variety of health care settings. PROGRAM APPLICATION TIMELINE: April 1, applicants may begin submitting program applications April 30, DEADLINE-please note completed applications must include all required documentation listed on the program application checklist on page 8. All documents, whether by mail or not, must be received or postmarked no later than 5 pm. HYBRID CURRICULUM. The Practical Nursing courses are face to face with on-line modules plus lab and clinical. Students must have access to a personal computer with a web browser and Internet connection (preferably high speed internet). LENGTH OF PROGRAM: 3 Quarters TERM PROGRAM BEGINS EACH YEAR: Entrance is offered once a year FALL term. CREDENTIAL AWARDED WITH COMPLETION OF REQUIRED COURSEWORK: Certificate plus ability to apply for PN licensure in the state of Oregon. NEW PN STUDENT ORIENTATION: - A mandatory student orientation will be held for admitted students. Attendance is required, or the next eligible alternate will be given your assigned place in the program. Students will be informed of the orientation date, time, and location in their acceptance letter. EMPLOYMENT OUTLOOK Employment of licensed practical and licensed vocational nurses is projected to grow 25 percent from 2012 to 2022, much faster than the average for all occupations. As the baby-boom population ages, the overall need for healthcare services is expected to increase. LPNs and LVNs will be needed in residential care facilities and in home health environments to care for geriatric patients (U. S Department of Labor/Bureau of Labor Statistics, 2014) NON-DISCRIMINATION In compliance with state and federal laws, Umpqua Community College (UCC) does not discriminate on the basis of race, religion, color, national origin, age, gender or disability in employment, or in any of its educational programs, or in the provision of benefits to students. For information about UCC s policy of non-discrimination, contact the Student Development & Services Department. NON-DISCRIMINATION STATEMENT ON THE BASIS OF SEX Umpqua Community College complies with all applicable federal and state regulations that prohibit discrimination on the basis of sex. No student at UCC shall, on the basis of sex, be excluded from participation in, be denied the benefits of or be subjected to discrimination in any education, program, service or activity. Any student who believes he or she has been denied any service or benefit because of sex discrimination may follow the steps outlined in the Sex Discrimination Grievance Procedure. In addition to utilizing the College s Grievance Procedure, a student may contact the Office of Civil Rights or the Equal Employment Opportunity Commission at the following address: Seattle Office, Office of Civil Rights, United States Department of Education ;915 Second Avenue Room 3310, Seattle, WA ;Telephone: , FAX: , TDD: ; ;Seattle Field Office, United States Equal Employment Opportunity Commission ;Federal Office Building, 909 First Avenue, Suite 400, Seattle, WA ;Telephone: , Fax: , TTY:

3 ACADEMIC ACCOMMODATIONS Any student who feels that she or he may need an academic accommodation for any disability should make an appointment with the Disability Services Office. Once the Disability Services Office notifies the program director or faculty of a requested accommodation, reasonable accommodations will be made. These accommodations will not substitute for the basic requirements for entrance or academic and technical standards (i.e. essential functions) required for successful completion of the practical nursing program. ADMISSION GUIDELINES Admission of all students is centralized in the Admissions Office. Admission to the College does not guarantee admission to this program. The Enrollment Service Office is the final authority on what constitutes equivalency for all admission criteria and has the sole authority to inform students of their admission status. WAITLIST Students are ranked by GPA and points for CNA work hours. If there are more applicants than spaces available, students will be placed on a waitlist. If a space becomes available, students will be notified first by phone and then by letter. Notifications can come as late as the week before school begins. ADMISSION PROCESSING TIMELINE - April 1, 2015 Admission Packet Available on-line and at the Admissions Office in Welcome Center. April 1, 2015 through April 30, 2015 Applications may be submitted to the Nursing Admission Office in Welcome Center by 5 pm. Applications mailed in must be postmarked by deadline date. April 30, 2015, 5:00 pm Application deadline no exceptions Late May 2015 Notification of acceptance PROPOSED PROGRAM CURRICULUM Pre-Requisites Requirements: It is your responsibility to show proof of your completed grade with an official transcript from any previous colleges attended by Winter 2015 and must be included with application (if not previously sent). For coursework completed at Umpqua Community College, those transcripts will be ordered and placed in your application packet if it has been indicated as a college attended. Minimum courses required are: 1. MTH 65 or a higher level math course. with a grade of C or higher 4-5 Credits 2. WR 121 English Composition with a grade of C or higher. 3-4 Credits 3. BI 231,232, Anatomy & Physiology Series completed with a grade of C or higher within the last 5 years. 8 Credits. BI 233 MUST be completed if accepted into the PN program before fall term. Applicants will be disqualified if not completed. Total pre-requisite credits = Applicant must provide a copy of OSBN CNA certification or proof that you completed and passed an accredited Nursing Assistant class. 3

4 PN Program of Study Credits FIRST QUARTER (fall) PN 101 Introduction to Practical Nursing...9 SECOND QUARTER (winter) PN102 Foundations of Practical Nursing THIRD QUARTER (spring) PN103 Foundations of Practical Nursing ADMISSION CRITERIA & SCORING (Total of 60 points possible) 1. GPA ACADEMIC PERFORMANCE- Maximum 40pts College Coursework applicants need a minimum of college credits completed with a C grade or better in those courses identified. Their pre-requisite GPA will then be calculated and a point value given. MTH 65 Elementary Algebra or higher Writing WR121 English Composition BI 231 & BI 232, Human Anatomy & Physiology. These courses must be completed within the past five years (during or after 2010) NOTE: BI 233 MUST be completed if accepted into the PN program before fall term. Applicants will be disqualified if not completed. 2. CERTIFIED OREGON NURSING ASSISTANT CERTIFICATE Maximum 20 pts Application must include completed & signed verification form. (See page 9) Applicants are awarded points for having a CNA Certificate with work experience > 1000 hrs. in 1 year = 20 pts CNA Certificate with work experience less than 1000 hours in 1 year = 15pts CNA Certificate or Nursing Assistant class with no work experience =10pts In the event of a tie in the number of points, the applicant with the higher prerequisite GPA will be offered admission first. 4

5 UPON ACCEPTANCE - Notification Upon notification of acceptance, admitted students must indicate in writing by the stated deadline their intention to enroll or their position will be given to the next eligible alternate. Mandatory Orientation A mandatory orientation will be held for admitted students. Attendance is required, or the next eligible alternate will be given your assigned place in the program. Students will be informed of the orientation date, time, and location in their acceptance letter. History and Physical Exam This form is to be completed by a healthcare provider with CBC, UA, and Hearing Test by the first day of class. Proof of Immunizations Due by the first day of class, accepted and alternate students must submit proof of the following immunizations (this includes any titers with results) by the stated deadline or their space will be given to the next eligible alternate: Immunity to measles, mumps, rubella, and varicella (chicken pox) Current Tuberculin Skin Test or a chest x-ray (within 6 mos.) Tetanus-Diphtheria-Pertussis Toxoid within the last 10 years Hepatitis B-the series must be completed or a titer done. Current CPR Card Due by the first day of class: each accepted and alternate student must provide a current Healthcare Provider CPR card approved by the American Heart Association. Background History Check Due by the first day of class: all accepted students will be required to undergo a background history check prior to entering the program. Individuals with a criminal record may not be allowed into a healthcare facility as a student. Because it is not possible to meet the objectives of the program without having clinical experience, anyone with a positive criminal or abuse history may not be eligible for acceptance in the practical nursing program. In addition, the Oregon State Board of Nursing (OSBN) requires a background history check upon application for licensure. For more information on OSBN licensing requirements see HIPPA and Blood Borne Pathogens and other Federal OSHA Safety Guidelines Training Students will be provided with training online or in the NSRC. Drug Screening Upon acceptance students will be required to complete and pass a drug screening test scheduled through an outside company prior to the beginning of the program. The student will be given the information on how to complete this requirement after acceptance. Consent to Photograph Sign and turn in by Fall term

6 How much will the Certificate-PN degree program cost? (3 terms in nursing school at UCC) Nursing Program Cost (estimated) for Fees: Admission application and Nursing Application Immunizations and physical Background History check (fingerprints are required) Drug Screening (10 panel) Tuition based on 27 credits Lab & clinical fees Uniforms, school patch, name tag and shoes Equipment (watch w/ second hand, scissors/hemostat, stethoscope, pen lights etc.) Books CPR card current for 2 years Laptop computer/and or PDA P.N. Licensure Application and NCLEX Exam Graduation Fee Exit NCLEX Prep Testing Nursing Pin (included in student lab fees) Subtotal First year prerequisites (26 credits plus fees) * Grand Total These costs are approximate and are subject to change. Students are responsible for transportation costs to clinical practicum sites. Costs are based on 3 terms Current tuition cost is $ per credit. A laptop computer and/or a PDA are required *Does not include Nursing Assistant Class 6

7 NAME: Student ID # PN PRE-REQUISITE COURSE PLANNING SHEET credits THIS FORM MUST BE FILLED OUT AND SUBMITTED AS PART OF A COMPLETED APPLICATION. COURSES College Term/year completed SECTION B - MATHEMATICS: 4 credits MTH 65 or higher Math course / Grade Credits SECTION C - ANATOMY AND PHYSIOLOGY I, II, III: 12 credits BI 231 / BI 232 / BI 233 / * BI 233 must be completed prior to the start of the PN program / SECTION D - ENGLISH COMPOSITION : 3-4credits WR121 or higher / CNA Certificate &/or Work Experience: must complete the verification of employment form & be signed by employer. Or proof of class. 20 pts 1000 Plus Hours 15 pts <1000 hours 10 pts CNA or class For Office Use Only Total Point Calculation GPA Points CNA Points Total 7

8 2015 PRACTICAL NURSING APPLICATION PACKET CHECKLIST Please complete this verification checklist as part of your Practical Nursing application. Be sure to attach all worksheets, official transcripts, and other supporting documentation as well as this checklist to your application. Applications will be notified late May. It is the responsibility of the applicant to ensure that all required documents listed below are received by the April 30, REQUIRED Signed and Completed Practical Nursing Application Checklist. (This Page) Completed Umpqua Community College 2015 Practical Nursing form WITH $25.00 non-refundable Practical Nursing application processing fee; attached. DO NOT SEND CASH I understand that by making application to Umpqua Community College I am also authorizing my information to be released to the State Board of Nursing for research purposes only. (Page 10) Completed Umpqua Community College admission form. (Page 12) Completed and signed statement of understanding (Page 11). PN Prerequisite Course Planning Chart. I have completed and attached the chart indicating where all prerequisites have been completed. I understand I must complete it entirely and only the courses I list will be assessed for application. (Page 7) Official (unopened) College Transcripts (Non-UCC) I understand the instructions (provided in this application) for documenting the credits of prerequisite coursework. Official transcripts from other colleges are due with application. Do Not Include UCC Transcripts. OSBN CNA Certificate OR proof of Nursing Assistant Class. Attach copy of license or certificate to application. CNA Work Experience Verification- Complete the form with an employer signature, if applicable. (Page 9) Name (printed) Signature Date Please mail or bring all application materials to: Umpqua Community College, Admissions Practical Nursing Application, 1140 Umpqua College Rd, PO Box 967, Roseburg, OR

9 CNA WORK EXPERIENCE VERIFICATION FORM CNA experience must qualify the individual for renewal of CNA certification by the Oregon State Board of Nursing (OSBN). In other words, the individual must have been performing authorized duties as defined by the OSBN and must have received ongoing or regular supervision by a licensed nurse, and must have been in a position that required CNA certification. Please verify the amount of hours this applicant has worked as a CNA using the scale provided: 1000 hours in a year (within last 2 years) = 20 Points < 1000 hours in a year (within last 2 years) =15 Points have certification by the Oregon State Board of Nursing (OSBN) but have never worked, but have attended a Nursing Assistant class. (No signature needed 10 Points) Please note: Employment Beginning Date: and Employment End Date: Does a licensed nurse regularly supervise this individual? Yes No Name/ Signature of Supervisor: Printed Name of Supervisor: Supervisor s phone number: Facility Position/Title: Name of Facility: Permission for verification of Employment Hours: I give my consent to release information verifying my hours of employment the school officials at Umpqua Community College. Student Signature Date 9

10 P r a c t i c a l N u r s i n g Applic P atio n Practical Nursing Application $25.00 Application Fee (Required for the Practical Nursing Application to be processed) DO NOT SEND CASH Please type or print neatly in blue or black ink. Providing your social security number is voluntary. If you provide it, the college will use your social security number for keeping records, doing research, aggregate reporting, extending credit and collecting debts and providing the Internal Revenue Service with the information required under the Taxpayer Relief Act of Your SSN will not be given to the general public. If you choose not to provide your SSN, you will not be denied any rights as a student. Please refer to the disclosure statement in the college catalog and schedule of classes. However, providing your SSN is required to receive Federal Financial Aid. Ethnic data information is required for institutional compliance with the Civil Rights Act of Your cooperation is appreciated. Applicant Demographics: for information only. Last Name First Name Middle Initial Previous Last Name(s) Social Security Number Date of birth (mm/dd/yy) Male Female Current mailing address number and street City State Zip Physical address if different from mailing address City State Zip Daytime phone Evening phone Message/Cell phone address Ethnicity (optional): American Indian/Alaskan Native Asian/Pacific Islander Black/Non-Hispanic Hispanic White/Non-Hispanic High school diploma or college degree earned? Yes No GED earned? Yes No English is my: Primary Language Secondary Language Education Information List all colleges where you have completed nursing prerequisites and/or a degree and attach sealed official transcripts College State Dates of attendance Degree earned/number of credits I have read and understand the admission criteria for the nursing program at Umpqua Community College. I understand that it is my responsibility to meet all program and application criteria. I verify that all statements on this application are complete and true and I understand that falsification of any information may lead to disqualification or dismissal from the program. Signature Date MAIL TO: UCC ADMISSIONS PRACTICAL NURSING APPLICATION P.O. BOX 967 ROSEBURG, OR Date Received: Initial Affirmative Action: It is the policy of Umpqua Community College to provide equal educational and employment opportunities and to provide service benefits to all students and employees without regard to sex, race, color, religion, national or ethnic origin, age, sexual orientation, marital status, disability or any other status or characteristic protected by applicable state or federal law. This policy is in accordance with the laws enforced by the Department of Education and Department of Labor, including Presidential Executive Order 11246, as amended by the Civil Rights Act of 1991, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Acts of , the Americans with Disabilities Act of 1990 and Oregon Revised Statute Questions or complaints may be directed to Lynn Johnson, Affirmative Action: Administration, P.O. Box 967, Roseburg OR 97470, (541) r a c t i c a l N u r s i n g A p p l i c a t i o n

11 P r a c t i c a l N u r s i n g Applic P atio n Umpqua Community College STATEMENT OF UNDERSTANDING Please indicate that you have read each paragraph by initialing each line, then sign below and date. I have read and understand the admission criteria for the Practical Nursing Program at Umpqua Community College. I understand it is my responsibility to meet all program and application criteria. I verify that all statements on this application are complete and true and I understand that falsification of any information may lead to disqualification or dismissal from the program. I understand that if I am accepted into the program I will be expected, with or without accommodation, to demonstrate the UCC Practical Nursing Program academic and technical standards outlined in the program information (available from UCC Nursing website or nursing office) to successfully complete the program. I understand that students accepted into the practical nursing program must show proof of a current Oregon State Board of Nursing CNA Card or Nursing Assistant class by application deadline. Certain clinical facilities may require a background history check be completed while the student is enrolled in the practical nursing program. I understand that if I am accepted into the program, for the purposes of public safety and health, if I have or develop any type of psychological, medical, drug or alcohol problem that impairs my ability to provide safe client care, or if I have an arrest or conviction history that would disqualify me from patient care in a clinical facility or licensure by the Oregon State Board of Nursing (OSBN), the practical nursing faculty/selection committee may consult with legal counsel and/or the OSBN and reject or dismiss me from the program. (Upon application for licensure, applicants will be subject to a history background check performed by the Oregon State Board of Nursing (OSBN). Certain crimes may disqualify an applicant from licensure. Any individual who supplies false or incomplete information to the Board regarding the individual's criminal conviction record will be denied licensure. Specific questions regarding these issues should be directed to the OSBN at SW Upper Boones Ferry Road, Portland, OR 97224, (971) , or I understand that the college uses a learning management system called Canvas which is an integral part of all practical nursing courses and have access to a computer with software that includes Microsoft Word and Power Point. Internet access will be required on a daily basis. Student Signature Date r a c t i c a l N u r s i n g A p p l i c a t i o n

12 Application for Admission Disclosure Statement: Providing your social security number is voluntary. If you provide it, the college will use your Social Security number for keeping records, doing research, aggregate reporting, extending credit and collecting debts. Your SSN will not be given to the general public. If you choose not to provide your SSN, you will not be denied any rights as a student. Please refer to the disclosure statement in the college catalog and schedule of classes which describes how your number will be used. Providing your social security number means that you consent to use of the number in the manner described. Intended Term & Year of Enrollment: Fall 20 Student Information Social Security Number: - - Date of Birth: (month/day/year) / / Last Name: First Name: M.I. Maiden Name: Current Mailing Address: Number & Street/PO Box City County State Zip/Postal Code Home Phone: ( ) Work / Cell Phone: ( ) Previous Home Address: (If at present address less than 90 days) Number & Street/PO Box City County State Zip/Postal Code General Information Citizenship: USA Other* Country of citizenship: *(Must complete the International Student Application.) Gender: (optional) Male Female Race/Ethnicity: (optional Black Hispanic American Indian Asian Other Are you a U.S. veteran? Yes No Will you receive veteran benefits? Yes No Did your parent(s) (natural or adopted) receive a Bachelor s Degree from a 4-year college/university? Yes No High School Information Check one and provide date of completion/or Expected date of Completion: HS Diploma GED Adult HS Diploma Date Completed: (month/day/year) / / School attended or currently attending : City State Enrollment Information Enrollment Status: (check one): Enrolling at UCC for the first time Returning student (absent for more than one full year) attendance / / Intended Program: Practical Nursing Approx. term of last College background: Please list ALL colleges and universities attended. Official college transcripts should be requested from each school and sent to Umpqua Community College. College/University Name City & State Dates Attended What is your goal at UCC? What is the highest degree you have attained beyond high school? 1. Two year program 6. Transfer to 2-year school 1. Some college credits 5. Masters Degree 3. Certificate 7. Transfer to 4-year school 0. None 4. Bachelors Degree 4. Job Preparation 8. Personal Interest 2. Certificate 6. PhD/Professional 5. Skill Improvement 9. Adult High School diploma 3. Associates Degree Affirmative Action It is the policy of Umpqua Community College to provide equal educational and employment opportunities and to provide service benefits to all students and employees without regard to sex, race, color, religion, national or ethnic origin, age, sexual orientation, marital status, disability or any other status or characteristic protected by applicable state or federal law. This policy is in accordance with the laws enforced by the Department of Education and Department of Labor, including Presidential Executive Order 11246, as amended by the Civil Rights Act of 1991, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Acts of , the Americans with Disabilities Act of 1990 and Oregon Revised Statute Questions or complaints may be directed to: Affirmative Action: Administration, P.O. Box 967, Roseburg OR 97470, (541) By signing this form, certify that the information on this form is correct and I understand that if it is later found otherwise, it is sufficient cause for rejection or dismissal. I authorize the use of my social security number as my student identification number and in follow-up studies. Signature Date 12

13 2015 Frequently Asked Questions Are there Pre-Requisites? Yes, there are Pre-Program Requirements (see pre-requisite planner). When does the Program begin? Fall Term 2015 ending in Spring Term Do I have to have my CNA? If you have a license you must provide a copy of OSBN CNA certification or proof that you completed and passed an accredited Nursing Assistant class. For College Transcripts do I need to submit transcripts from every college attended and not just the prerequisites? No, just the pre-requisites. How do I apply to the Practical Nursing Program? Pick the application at the Admissions Office or go to click on Quick Links, scroll down and click on Nursing, click on Practical Nursing Application. Please read the application thoroughly and follow directions to apply. Is admission based primarily on GPA? Admission to the Program is based on a point system; using your GPA and CNA experience. Please refer to the Admission Packet. What Hours and Days will I be in class (clinical sites) during the course of the Program? The Program is designed to be offered face to face, online, day shift and evenings. Do I need to submit a GED/High School Transcript? No. Will I have to pass a background check/obtain a background history clearance? Yes. Can I bridge to an RN Program from the Practical Nursing Program. Yes, UCC has an LPN to RN Bridge Application for students who have completed the PN program, received their licensure and have 500 hours of work experience. Please see the Bridge to RN application for more information. 13

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