Associate of Applied Science Degree Full Time Nursing Application Fall 2015 / Winter 2016

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1 Moving Mountains Transforming Lives Building Communities Degree Full Time Nursing Application Fall / Winter 2016 Open date: Monday, November 3, 2014 Applicants can begin submitting program applications. Close date: Monday, February 16, All required documentation listed on the application checklist must be received by the Admissions, Registration and Records office no later than 5 p.m. No postmark date allowed, no exceptions. Submit all application materials to: Mt. Hood Community College Admissions, Registration and Records Full Time Nursing Application SE Stark St. Gresham, OR 97030

2 Thank you for your interest in applying to Mt. Hood Community College s Full Time Nursing program! Our program offers students award winning faculty, state of the art training, cutting edge technology, and a challenging curriculum. After graduation, our graduates are expected to manage and care for groups of patients in complex nursing situations, including acute care, long term care, and in a variety of other health care settings. Please use the following information and the nursing application guide as a resource in answering any questions that arise. Helpful Hints: Go to an information session. Information sessions are a great way to learn more about the program, admissions process, meet other applicants, and ask questions. Nursing information sessions are typically offered at the beginning of every month. Check the schedule here: See the Nursing FAQ link listed under the application guide on: All communication with applicants is done via always make sure the Admissions Evaluator has your current address. The Admissions Evaluator will always use the address written on the applicant s application form (even if you change it with Admissions) unless told otherwise. Make sure you add MHCC.edu to your safe senders list. If you are ready to turn in your application, but have some questions about the process, or a piece of the application, come see Katelyn Goslin, Admissions Evaluator during open hours. Sessions are offered from 2 3 p.m. on the following days in AC2256 (the Student Services Conference Room inside Student Services): October 2014 November 2014 December January February Additional Resources: Oregon Consortium for Nursing Education: Oregon Health & Science University Nursing School Program: Oregon State Board of Nursing: Nursing programs in the US: National Student Nurses Association: Oregon Center for Nursing: March We Ask That You: Do not submit your application in double sided format. Double sided applications are more time consuming and difficult to process. Follow the directions carefully and ask questions if need be. Do not submit this page or the front cover with your application. Do not submit paperwork we do not ask for (i.e. letters of recommendation, awards, etc.). Anything that is not asked for will be shredded. Only submit a work experience form if it applies to you we don t need a blank work experience form. Page 2 of 6

3 APPLICATION PACKET CHECKLIST Applicant Name: Date: MHCC ID# Every item on this checklist needs to be submitted by the application deadline February 16, by 5 p.m. Only completed applications containing all the required documents will be considered for review. You will not be given notification if items are missing. It is the responsibility of the applicant to make sure everything was received by the deadline. Item 1. Online General Admissions Form ( 2. Application Checklist Page 3 3. Allied Health Division Application Page 4 4. Prerequisite Course Planning Sheet Page 5 5. Work Experience Form Page 6 6. $75 Non Refundable Application Fee Make check payable to MHCC. Bank card/cash is only payable in person in Student Services (AC2253). 7. Official (in a sealed envelope) College Transcript(s) from EVERY COLLEGE EVER ATTENDED (Do not include MHCC transcripts). 1. MHCC s Admissions, Registration and Records office will send all application notification by . It is my responsibility to set my spam filter system to accept mail addresses even if I am currently receiving s from MHCC. MHCC cannot be responsible for notices which are not received due to spam or junk mail handling. I will make sure to add MHCC to my safe senders list. MHCC recommends applicants to check their on a computer and NOT on a smart phone. 2. I have read, completed, and fully understand the admission criteria as listed in the Full Time Nursing Program Application Guide for the Nursing program at Mt. Hood Community College and OCNE. 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. I give my permission for release of pertinent application information to the OCNE partner schools, including Oregon Health and Science University, and the State Board of Nursing, as necessary to facilitate my program of study and to enhance the application process for future applicants. 3. I understand it is my responsibility to ensure all items are received by the application deadline and only complete applications will be evaluated for admission. Furthermore, I have read and understand the admission requirements and procedures for applying. I understand that withholding information or giving untruthful answers to questions on this application could be cause for nonacceptance or dismissal from the program. By signing below, I am confirming each item above is included with my application or I have confirmed they are already on file at MHCC. I understand it is my sole responsibility to submit the required documents, and I will not be given notice if my application is incomplete until after the deadline, at which time it will be too late to submit missing documents. Signature Date For Office Use Only: Received Date: Received By: Page 3 of 6

4 OCNE/MHCC FULL TIME NURSING ALLIED HEALTH DIVISION APPLICATION Please print and complete fully, do not leave blank. Attach extra paper if needed. Name: SSN or MHCC ID: Previous Last Name(s): ALL notifications will go out via to this address Current Mailing Address: Street City State Zip Phone Number and Alternate Phone: ( ) ( ) Home Cell Name of Nearest Relative and Their Relationship to You: Address of Named Relative: Name Relationship (i.e. Mother) Education Record: List ALL colleges EVER attended. Omission of any college transcript will result in non admittance or dismissal from the program. We will need an official copy of each transcript regardless of program length, course of study, or program applicability. Failure to submit these transcripts will result in an immediate incomplete application. College: Major: Degree earned or approximate number of credits completed: Date of completion (if applicable): Previous Applications: List all Allied Health programs you have previously applied to (including MHCC). If you have previously been admitted into an Allied Health program but did not finish the program, you must get a letter from the department at your prior institution stating you left in good standing and are eligible to reapply. College: Program Title: Application year(s): Were you accepted? Page 4 of 6

5 PREREQUISITE COURSE PLANNING SHEET Full Time Nursing Program Applicant Name: Date: MHCC ID#: Fill out each section accurately and in its entirety. No points will be awarded if the class is not documented or fully documented below or is listed in the wrong category. Submit one official (unopened) transcript from every college or university ever attended. Do not include MHCC transcripts. From these transcripts, list a minimum of 30 credit hours from the prerequisite courses listed below. The 30 credit hours must include BI231 and MTH095 (or competency through the College Placement Test) and must be completed by the application deadline date of February 16,. If the math requirement is met by CPT placement into MTH105 or higher, students must select from any other prerequisite courses to obtain the minimum 30 credits. For point assessment, only courses completed by the end of Fall term 2014 with a letter grade of C or better will be used. List the courses as they appear on your transcript. For course not taken at MHCC, do not use the MHCC equivalency, convert to quarter credits, or include +/ on your grades (i.e. B = B). If the class is in progress for Fall term, put IP in the term/year box. Submit updated transcripts documenting your grade once the class is completed. Do not list courses you are planning to take Winter or Spring term. Pass or Satisfactory grade(s) will be counted as a C grade. PREREQUISITE COURSES COURSE TERM YEAR GRADE CREDITS GRADE POINTS INSTITUTION EXAMPLE BI231 FA13 A (4.0) X 4 = 16 MHCC ANATOMY AND PHYSIOLOGY I, II, III: 12 credits Cannot be completed prior to Winter term 2008 BI231 Anatomy & Physiology I BI232 Anatomy & Physiology II BI233 Anatomy & Physiology III MATHEMATICS: 0 5 credits Test scores cannot be older than 02/17/2013; coursework cannot be completed prior to Winter 2008 MTH095 Intermediate Algebra or higher OR College Placement Test PLACEMENT INTO: TEST DATE: ENGLISH COMPOSITION : 6 8 credits WR121 English Composition I* WR122 English Composition II OR WR227 Technical Report Writing NUTRITION: 4 credits Cannot be completed prior to Winter term 2008 FN225 BIOLOGY WITH GENETICS: 4 5 credits BI102/BI112/BI212 MICROBIOLOGY: 4 credits Cannot be completed prior to Winter term 2008 BI234 HUMAN DEVELOPMENT: 4 credits PSY237 GENERAL EDUCATION: 9+ CREDITS Social Science Elective (at least 3 credits) Humanities Elective (at least 3 credits) Social Science or Humanities Elective (at least 3 credits) * APA style is strongly advised TOTAL NUMBER OF CREDITS = TOTAL GRADE POINTS = For the purpose of calculating your GPA: A=4, B=3, C=2 Grade point total: / Total number of credits: = My GPA: You are not eligible to apply if your above GPA is under a 3.0. Page 5 of 6

6 WORK EXPERIENCE FORM Student s Name: Date: / / MHCC Student ID #: Dear Human Resources Associate: The above individual is planning to apply to the MHCC Nursing program and can earn points in the selection process with proof of work experience in the healthcare field. In order to receive those points, each applicant must provide official documentation. We are asking you to assist this applicant with the process. Please do the following: Fill out the appropriate information below as it pertains to the employee Seal it in an envelope and sign across the seal. The sealed envelope must be received no later than February 16, by 5 p.m. to earn points, no exceptions. Applicants may submit the paperwork with their application materials, or it can be mailed directly to us at: Mt. Hood Community College Admissions, Registration and Records Full Time Nursing Program Application SE Stark St. Gresham, OR The employee held the following position: LPN (License Practical Nurse) CNA (Certified Nursing Assistant) if you have less than 601 work hours do not submit this form, just submit your CNA credentials off the OSBN website. EMT (Emergency Medical Technician) CST (Certified Surgical Technician) CMA (Certified Medical Assistant) Must have 1,000 hours or more of work experience. The employee has worked a total of hours. Employment begin date: / / Employment end date: / / Please note: Applicants that were/are employed as an LPN or CNA 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 a CNA certification or LPN license. Signature of Human Resources Associate/Title Human Resources phone number Printed Name of Human Resources Associate Facility APPLICANTS you must submit BOTH this work experience form and your current, state issued credentials (credentials can be from outside the state of Oregon). Submitting just this form will result in zero points. Please do not submit a CNA work experience form if you have less than 601 work hours, or an EMT, CST, or CMA work experience form if you have less than 1,000 hours. Volunteer hours do not count. Page 6 of 6