APPLICATION & ADMISSION INSTRUCTIONS

APPLICATION & ADMISSION INSTRUCTIONS The following describes the application and admission process for prospective students. Admission to the Idaho State (ISU) (SON) is competitive and meeting the admission criteria does not assure acceptance into the program. You must be admitted to before you can apply to the. Please read all information in this Application Instructions packet carefully. The online application process must be completed and all documents submitted by 5:00pm on March 11, 2016 to be considered for 2016 admission. After the review process, the will notify all applicants of the acceptance decisions via e-mail by early-april 2016. APPLICATION CRITERIA The following criteria must be met to be eligible for application and consideration for acceptance to the Baccalaureate Completion Program for the Bachelor of Science (BS) with a major in Nursing: 1. Application/acceptance to a. Applications are available on the ISU website at www.isu.edu/apply. The ISU application fee is $50.00. Upon acceptance to ISU, a student identification number is assigned. This ID number is required on the SON application. b. Official transcripts from all colleges attended must be submitted to ISU Office of Admissions as part of the application process. 2. Completion of Associate of Science in Nursing Degree a. Applicants must have completed an Associate Degree in Nursing (ADN) prior to submitting the School of Nursing application. b. Applicants currently enrolled in an Associate Degree in Nursing program must complete their degree and pass the NCLEX prior to enrollment in the ISU SON. Acceptance to the ISU SON is conditional based upon submission of transcripts showing successful completion of the Associate Degree in Nursing prior to the semester of enrollment in the SON. 3. Completion of nursing prerequisite courses a. At least 20 credits among the prerequisite courses must be completed and on the applicant s transcript at the time the electronic application is submitted. Some courses may have been taken as part of the applicant s ADN program. b. Each course must be completed with a grade of C or higher. c. Applicants must have a cumulative GPA of 3.0 or higher among the completed prerequisite courses combined with the completed ADN courses to be eligible for admission. Prerequisite Courses: At least 20 credits must be completed prior to application submission BIOL 1101/1101L Biology with Lab BIOL 2221/2221L Introductory Microbiology with Lab BIOL 3301/3301L & 3302/3302L Anatomy and Physiology I & II with Lab BIOL 3305 Pathobiology MATH 1153 Introduction to Statistics NTD 3340 Nutrition for Health Professionals Credits 4 cr. 4 cr. 8 cr. 1

Prerequisite Courses, continued: PHIL 2230 Medical Ethics PPRA 3315 Pharmacology for Nursing PSYC 1101 Introduction to General Psychology PSYC 2225 Child Development Credits 4 cr. 4. Meeting with Adviser by 5:00pm on February 12, 2016 to determine eligibility a. Applicants are strongly encouraged to meet with a SON adviser well in advance of the February 12, 2016 deadline. Application to will not be considered without verification of meeting with adviser. b. ISU SON Academic Adviser: 208-282-4481 or sonadvis@isu.edu c. Applicants MUST meet with adviser in person or by phone for review of transcripts and assessment of application criteria. d. Applicants are requested to bring copies of all college transcripts and proof of RN licensure to the inperson meeting with the adviser, or send copies of transcripts and RN licensure via email to the adviser prior to a phone meeting. e. Course petitions may be required to determine equivalency and transfer into ISU and/or the School of Nursing. Processing of petitions may take 6-8 weeks. 5. Submission of Advising Certification Form a. After meeting with the adviser and determining eligibility, the adviser will sign the Advising Certification Form on page 7 to verify the applicant s completed prerequisite course and cumulative GPA among the completed prerequisites and ADN courses. b. The Advising Certification Form must be submitted electronically as a part of the SON application. The applicant will not be able to access the online application until the Advising Certification Form has been submitted by the applicant and processed by staff. 6. Submission of Course Petitions and/or Undergraduate Petitions (if needed) a. Petitions may be required for the to consider a given transfer course(s). A course title that is different than the ISU course title specified, out-of-state credits, or a combination of two or more courses that together cover the material for an ISU course could require completion of a petition. b. The process for petitioning a course must be completed, approved by the, and on file before the application is submitted. Consult the SON Academic Adviser at 208-282-2132 or sonadvis@isu.edu well in advance of applying to the program regarding transfer equivalency and the petition process. 7. Completion of the electronic application by 5:00 PM on March 11, 2016 a. After meeting with adviser and determining eligibility, eligible applicants will be given access to the electronic application and instructed on the process for electronic submission of required documents. b. Application and all supporting documents must be submitted by March 11, 2016 to be considered for acceptance to the. c. Please ensure that your name matches on your application, the application fee, and the background check documentation. If your name has changed, include any alternate names in your application. 8. Submission of the $50 application fee a. Submission of a non-refundable SON application fee of $50.00. The application web-site includes a link for online payment. There is a $1.50 (3%) charge for this process. E-mail confirmation of fee payment is provided. 2

9. Submission of transcripts a. It is the responsibility of the applicant to make sure all official transcripts of courses taken at other colleges or universities (either by classroom, correspondence, or online) are on file with the ISU Admissions Office at the time of nursing application submission. Course grades for prerequisite and ADN courses must be on the transcripts. If there is no record of the transcripts on file with the ISU Admissions Office by March 11, 2016, the applicant will not be considered for admission to the. b. Unofficial copies of transcripts with completed prerequisite courses visibly highlighted must be submitted with the application to the. 10. Submission of a copy of Registered Nurse (RN) license a. The applicant must submit a copy of their current, unencumbered Idaho license as a Registered Nurse (RN). b. Applicants currently enrolled in an Associate Degree in Nursing program must complete their degree and pass the NCLEX prior to enrollment in the ISU SON. Acceptance to the ISU SON is conditional based upon submission of the current, unencumbered Idaho Registered Nursing license prior to the semester of enrollment in the SON. 11. Additional Information a. If accepted to the Baccalaureate Completion program, the student may be expected to travel 200 miles and spend the night as necessary for clinical experiences. The online application process must be completed and all documents submitted by 5:00 pm on March 11, 2016 to be considered for Fall Semester 2016 admission. ADMISSION CRITERIA If the applicant is accepted to the Bachelor of Science with a major in Nursing Baccalaureate Completion Program, admission to the nursing program for the Fall 2016 semester is contingent upon meeting the following criteria by the specified dates. Failure to submit documentation by the specified deadline(s) will result in retraction of acceptance to the. 1. Completion of all Prerequisite Courses a. All prerequisite courses (see above prerequisites chart) must be successfully completed and documentation showing proof of successful completion must be submitted prior to starting the Fall 2016 semester. b. Each course must be completed with a grade of C or higher. c. Applicants must maintain a cumulative GPA of 3.0 or higher among all prerequisite courses combined with ADN courses. d. If courses are taken outside of, official transcripts verifying successful completion must be submitted to the ISU Registrar s Office prior to the start of the Fall 2016 semester. Documentation of course completion must also be submitted to the (can be an unofficial transcript). Prerequisite Courses: At least 20 credits must be completed prior to application submission BIOL 1101/1101L Biology with Lab BIOL 2221/2221L Introductory Microbiology with Lab BIOL 3301/3301L & 3302/3302L Anatomy and Physiology I & II with Lab Credits 4 cr. 4 cr. 8 cr. 3

Prerequisite Courses, continued: BIOL 3305 Pathobiology MATH 1153 Introduction to Statistics NTD 3340 Nutrition for Health Professionals PHIL 2230 Medical Ethics PPRA 3315 Pharmacology for Nursing PSYC 1101 Introduction to General Psychology PSYC 2225 Child Development Credits 4 cr. 2. Submission of the Individual Plan of Study Form a. The Plan of Study Form on page 8 must be completed in conjunction with the SON Academic Adviser to document the anticipated degree plan for the student s nursing course work. Acceptance to the is conditional based upon completion and submission of the Individual Plan of Study Form by June 1, 2016. 3. Submission of Health Evaluation Form a. The Health Evaluation Form on pages 10-11 must be completed by a health care provider verifying the applicant s physical, cognitive, and sensory capacity to meet the requirements of being an active and capable student in the nursing program. Acceptance to the is conditional based upon completion and submission of the Health Evaluation Form by June 1, 2016. 4. Submission of Clinical Agency Consent and Release and Health Insurance Agreement Form a. The Clinical Agency Consent and Release and Health Insurance Agreement Form on page 12 must be completed and signed by the applicant. Acceptance to the is conditional based upon completion and submission of the Clinical Agency Consent and Release and Health Insurance Agreement Form by June 1, 2016. 5. Submission of Required Immunization Records a. Verification of screenings, immunizations, and/or titers identified in the table on pages 13-15 must be submitted to the. Acceptance to the is conditional based upon submission of all required immunization verifications by June 1, 2016. b. Verification records submitted to the must be official from your health care provider and/or include the signature or initials of your health care provider on the document. Verification records must also include the applicant s name on the document(s). Submission of the checklist included in this packet is NOT acceptable documentation for your immunization records. 6. Submission of Current Cardiopulmonary Resuscitation (CPR) Certification a. All applicants are required to provide proof of current American Heart Association (AHA) Basic Life Support (BLS) for Health Care Providers CPR certification. The accepts ONLY the American Heart Association Basic Life Support for Health Care Providers. (AHA HeartSaver certification is not accepted.) Note that advertising for CPR courses may include statements such as follows AHA guidelines but the language may not mean it is a formal AHA course. b. Certification must remain current throughout the duration of the nursing program, and students are responsible to provide documentation of current CPR certification. Acceptance to the School of Nursing is conditional based upon submission of proof of CPR certification by June 1, 2016. 7. Submission of Criminal History Evaluation a. Applicants must have a background investigation performed between April 1st and April 30th of the application year. b. The ISU-approved online vendor for criminal background checks is CertifiedBackground.com. No other background investigation will be accepted. 4

c. Go to www.certifiedbackground.com and click on Students. Enter package code: id13. You will be directed to set up your Certified Profile account. The cost is $45.75 for the id13 evaluation. d. A copy of the order confirmation (one page) from CertifiedBackground must be submitted to the. Acceptance to the is conditional based upon the submission of a copy of your Order Confirmation from CertifiedBackground.com by April 30, 2016. e. Please be advised that any agency may prohibit/deny/restrict student clinical placement if there is a significant criminal background history. Any such prohibition consequently limits that applicant s ability to successfully complete the SON clinical hours and graduation requirements for our nursing program. Applicants who have questions about this issue should contact the SON Academic Adviser at 208-282-2132 or the State Board of Nursing. The Idaho Board of Nursing may be reached at 208-334-3110 ext. 21. f. Nursing students are required to have a criminal history check performed annually while in the nursing program, following the same process discussed in part 7-C. The required documents for the admission process must be completed and submitted to the by 5:00 pm on Wednesday, June 1, 2016 to be considered for Fall Semester 2016 admission. ALTERNATE STATUS An alternate admission list is implemented when more applicants meeting the admission criteria have applied than there are available positions. If space becomes available to accommodate additional eligible applicants, the alternate list will be activated. Alternate status is recognized only for the year of application. Applicants who are not admitted to the fall semester for which they initially apply must reapply for the next year and will be reviewed for admission with the new group of applicants. 5

APPLICANT CHECKLIST Application Checklist: Complete application requirements by 5:00 PM on Friday, March 11, 2016 Acceptance to verified with student identification number on nursing application Meet with Academic Adviser by February 12, 2016 to determine eligibility Upload copy of Advising Certification Form to the nursing application website (page 7) Complete the electronic Application for Admission to Bachelor of Science with a major in Nursing Completion Program o Application available at http://elearning.isu.edu/community/enrol/index.php?id=274 o Application and documents for the application process can be submitted through this site Submit non-refundable $50 nursing application fee Upload copy of current and unencumbered Idaho RN license to the nursing application website Upload copy of Course Petition Form(s) to the nursing application website (if applicable) Official transcripts on file at ISU Admissions Office Upload unofficial transcripts to the nursing application website o Verify successful completion of Associate Degree in Nursing highlight degree conferred o Verify successful completion of at least 20 prerequisite course credits highlight courses o Verify minimum GPA of 3.0 among completed prerequisite courses combined with ADN courses o Verify current enrollment and/or plan for completion of all prerequisite courses Evaluate personal immunization status and begin assembling documentation to prepare for possible admission. These documents will need to be in electronic format to upload for admission. Admission Checklist (if accepted): Complete admission requirements by 5:00 PM on Monday, June 1, 2016 Submit transcripts verifying successful completion of any remaining prerequisite courses by the beginning of the Fall 2016 semester Upload completed Plan of Study Form (page 8) Upload completed Health Evaluation Form completed by health care provider (page 10) Upload completed Clinical Agency Consent and Release and Health Insurance Agreement Form (page 12) Upload completed official verification of current required immunizations/titers Upload copy of current AHA BLS for Healthcare Provider CPR certification Upload order confirmation for Criminal History Evaluation by April 30, 2016 This form is for applicant use only do not submit with application materials Appointments to meet Academic Adviser can be scheduled by calling 208-282-2132 or 208-282-2185 6

Applicant Name (please print): ADVISING CERTIFICATION FORM 1. The applicant must schedule an appointment (in person or by phone) with a adviser before 5:00 PM on February 12, 2016. 2. The application will not be processed if this form is incomplete. Prerequisite Course Check: ISU Course BIOL 1101 and 1101L Biology I with Lab BIOL 2221 and 2221L Introduction to Microbiology with Lab BIOL 3301 and 3301L Anatomy & Physiology I with Lab BIOL 3302 and 3302L Anatomy & Physiology II with Lab BIOL 3305 Pathobiology MATH 1153 Introduction to Statistics NTD 3340 Nutrition for Health Professionals PHIL 2230 Medical Ethics PPRA 3315 Pharmacology for Nursing PSYC 1101 Introduction to General Psychology PSYC 2225 Child Development Cumulative Credits & GPA Institution & Course If Non-ISU Credit Nursing Prerequisites & ADN Courses Credit Hours Grade Date Completed Semester/Year Taken or Planned Student has completed all necessary application requirements. Student must complete the following application requirements: I certify that I have met with a adviser to discuss my application to the Bachelor of Science in Nursing Completion Program and that I will complete and submit all outlined requirements prior to the March 11, 2016 application deadline. Student Signature: Date: Adviser Signature: Date: 7

BS Completion Student Individual Plan of Study Name: Student ID#: Adviser: Date Established: Target Graduation Date: Required Nursing Courses Credits Planned Enrollment Completion Date DHS 4426 Evidence Based Practice and Research NURS 3100 Professional Nursing 2 cr. NURS 3120/3120L Health Assessment with Lab NURS 4200/4200L Population Health Nursing with Clinical 5 cr. NURS 4180 Nursing Informatics 2 cr. NURS 4220 Leadership and Management NURS 4440 Synthesis 1 cr. Courses planned to meet ISU upper division and resident credit graduation requirements (if applicable) Credits Planned Enrollment Completion Date Adviser Signature: Date: 8

Course Offerings for BS Completion Program DHS 4426 Evidence Based Practice and Research (3 credits) Offered in Fall, Spring Study of the use of current research evidence in health care decision-making. Topics include critical analysis of health-related information, biostatistics, and application of evidence-based practice to health care. PREREQ: MATH 1153 or MGT 2216. NURS 3100 Professional Nursing (2 credits) Offered in Fall Social, political, legal and economic forces affecting health care are analyzed in the context of their impact on the professional nurse s scope and standards of practice. Interprofessional verbal communication, evidence-based practice, time management/prioritization, delegation, the nursing process, and teaching and learning are presented. NURS 3120 Health Assessment Theory (2 credits) Offered in Fall Assessment and interconnectedness of physiologic, mental, emotional, spiritual, environmental, cultural, relational, contextual and psychological health status and health promotion needs of clients throughout the lifespan. Promoting patient-centered and culturally appropriate care using evidence-based methods for collecting and interpreting health history and assessment data. COREQ: NURS 3120L. NURS 3120L Health Assessment Lab (1 credit) Offered in Fall Application and practice of comprehensive and focused assessment of physiologic, mental, emotional, spiritual, environmental, relational, and contextual and health status and health promotion needs of clients using culturally and developmentally appropriate approaches to establish a foundation for clinical judgment. Communication of assessment will focus on professional written communication strategies for client and interprofessional interactions. COREQ: NURS 3120. NURS 4180 Foundations of Health Informatics (2 credits) Offered in Spring This course focuses on the use of health informatics principles with both consumers and health care professionals to transform data and information into knowledge and wisdom to assure the safe and effective use of health information and communication technologies that promote evidence-based, patient-centered health care. The course will highlight the nurses role using emerging informatics tools for practice, administration, research, education, quality improvement, and for rural and population health. NURS 4200 Population Health Nursing Theory (3 credits) Offered in Fall The course provides theoretical and evidence-based strategies to improve the health and quality of life for populations in geopolitical and phenomenological communities. An understanding of epidemiology, community assessment, health education, environmental health and health policy and legislation as it relates to the professional nurses role is established. COREQ: NURS 4200C. NURS 4200C Population Health Nursing Clinical (2 credits) Offered in Fall Application of the theoretical and evidence-based strategies to improve the health and quality of life for populations in geopolitical and phenomenological communities. COREQ: NURS 4200. NURS 4220 Leadership and Management (3 credits) Offered in Spring Evidence-based knowledge of leadership and management theories and concepts to prepare professional nurses to function across a variety of health care settings. Includes emphasis on nursing leadership accountability and influence in organizational structure, quality improvement, patient outcomes, role transition, and personal career development principles. PREREQ: NURS 4180. NURS 4440 Synthesis (1 credit) Offered in Spring This course is designed to provide students with an opportunity to integrate, improve, and evaluate their level of preparation for beginning practice as a graduate professional nurse and a future nurse leader. Through focused review of critical content, students will integrate the nursing competencies that are essential for high quality, evidenced-based, safe practice of nursing. PREREQ: Final semester of Nursing program; Approval of Instructor. 9

Applicant Name (please print): HEALTH EVALUATION FORM Directions for Health Care Provider (Physician, Nurse Practitioner or Physician Assistant) 1. A complete health history and physical examination is required for all individuals who are submitting an application to the ISU baccalaureate program. 2. Please complete the Health Care Provider Statement. a. Record all requested information directly onto the form. b. Attachments, such as lab reports and/or copies of health records are not an acceptable substitution for completion of the form. 3. Signature of health care provider with date is required on the form. I have obtained a health history and performed a complete physical examination. Yes No If no, please explain: In my opinion, based on my assessment, the applicant has no physical, cognitive, and/or sensory limitations, as defined in Appendix A, (such as vision, hearing, speech, touch, smell, movement, lifting) that would prevent him/her from fully participating in the Program, or providing safe nursing care. Yes No If no, please explain and include: Further diagnosis and treatment required. Verification statement that the applicant is able to provide care for patients in all health care settings. Health Care Provider Name (Please print): Title: Address: Phone: Signature: Fax: Date: 10

Health Evaluation Form: Appendix A PHYSICAL, COGNITIVE AND SENSORY REQUIREMENTS FOR STUDENTS Each applicant/student must meet objectives and competencies in the following areas in order to be admitted and continue in the nursing program: Vision The applicant/student must be able to: Make visual observations of patient s status Detect unsafe environmental conditions Possess visual acuity of near clarity of vision at 20 inches or less and far clarity of vision at 20 feet or more Hearing The applicant/student must be able to: Hear spoken verbal communications from others Hear sounds used for patient assessment such as breath sounds, blood pressure, apical pulse, and other sounds that would indicate changes in the patient s physiological status Speech The applicant/student must be able to: Utilize clear, effective speech when communicating with patients, families and health care team Touch The applicant/student must be able to: Possess the ability to sufficiently feel patient pulses, skin temperature and other important signs of changes in patient s physiological status Smell The applicant/student must be able to: Detect odors that indicate changes in the patient s physiological status Perceive odors that indicate unsafe environmental conditions Movement The applicant/student must be able to: Possess full manual dexterity of upper extremities, including neck and shoulders Possess unrestricted movement of lower extremities, back and hips Lifting The applicant/student must be able to: Lift and/or support at least 50 pounds to safely transfer, ambulate, and reposition patient If an applicant/student should present with any limitation in the above areas, each case will be reviewed on an individual basis. If possible, reasonable accommodations will be made 11

Applicant Name (please print): 1. The applicant must sign and date the Clinical Agency Consent and Release statement 2. The applicant must sign and date the Health Insurance Agreement statement 3. The application will not be processed if the form is incomplete. Clinical Agency Consent and Release: (Select one option, sign and date) I hereby give my consent/permission to the ISU and its representatives to release my medical, immunization, TB screening, and criminal history information to any clinical agencies that require such information for course-related clinical placements during all the academic years I am enrolled as a nursing student. I do not give my consent/permission to the ISU to release my medical, immunization, TB screening, and criminal history information to any clinical agencies that require such information for course-related clinical placements. I understand that if I decline permission to release information to clinical agencies, I may be limited in clinical experience options and thus, it may result in my not fulfilling the clinical requirements. I hereby release and hold harmless the State of Idaho,, its employees and representatives from any liability as the result of releasing or not releasing my criminal history and/or medical information to any clinical agency for course-related clinical placements. By signing below, I confirm that I have read and agree to the terms above. Signature of Applicant: Date: Health Insurance Agreement: (Sign and date) I verify that I am covered by health insurance. I agree to maintain health insurance coverage throughout the nursing program which includes, but is not limited to, payment for treatment and follow-up procedures, including exposure to blood-borne pathogens as well as other potentially infectious materials. Signature of Applicant: Date: It is the ongoing responsibility of the applicant to inform the of any significant changes in his/her health status. Academic action, which may include removal from clinical assignments, may be incurred if there has been deliberate misrepresentation of information in any manner on this health care form. 12

This form is for applicant use only do not submit with admission materials IMMUNIZATION REQUIREMENTS See Healthcare Personnel Vaccination Recommendations Appendix B Documented immunizations and TB skin tests required for admission to the include: 1. Tetanus with Pertussis Booster Tdap Vaccination Required: One time dose of Tdap AND Current Td booster Tetanus vaccination must be done every 10 years, and one of the updates must include pertussis booster. After the Tdap is received once then further tetanus vaccinations are required to be only Td. 2. Measles, Mumps, Rubella Required: Documentation of 2 doses MMR vaccination OR A positive titer is required. 2 doses of MMR vaccination OR positive titer 3. Hepatitis B Vaccination 3 doses OR positive titer If able to provide documentation of two MMR doses, no titer is required. If unable to provide documentation of two MMR doses, a titer must be completed. If the titer is non-responsive, or equivocal, documentation of a repeat series, 2 doses of MMR vaccine, is required. Required: Students must complete the three vaccination series OR at minimum must have completed the first vaccination of the series before the immunization verification deadline. Series initiated but not completed by the verification deadline: Students must submit verification of initiation of series by deadline. Students are required to submit verification of subsequent doses of the vaccination series as they are received. AND Upon completion of the 3 vaccination series a titer must be drawn after 4 weeks, but not greater than 8 weeks following the third dose in the series. Series completed within 8 weeks of the verification deadline: Students who have completed the 3 vaccination series within 8 weeks of the immunization verification deadline must also submit a titer to document immunity. The titer must be drawn after 4 weeks, but not greater than 8 weeks following the third dose in the series. Documentation of the entire vaccination series and titer results must be completed and submitted to the within 7 months of the FIRST vaccination. If documentation of the progress of the vaccination series and/or titer results is not received by the last day of the student s first Fall semester in the nursing program, he/she will not be allowed to proceed in the program and may receive a Level II Infraction. Students with negative titer results are required to provide documentation of a second series of three re-vaccinations AND provide positive titer results drawn after 4 weeks, but not greater than 8 weeks following the third dose in the series. If the student has a negative titer after 6 doses of the vaccine, the student is considered a non-responder. Non-responders are considered susceptible to Hepatitis B. The student should take appropriate precautions to prevent exposure and infection to Hepatitis B. Testing for Hepatitis B surface antigen should be considered. Students found to be 13

Hepatitis B surface positive should be medically evaluated 4. Varicella (Chicken Pox) 2 doses of Varicella vaccination OR positive titer 5. Influenza 1 dose of Influenza vaccine annually unless a Declination Statement is signed by student, approved by faculty, and submitted to the SON 6. Tuberculosis (TB) skin test 1 skin test after May 15 of the application year. In addition, TB screening must be performed annually while in the SON. Series completed greater than 8 weeks prior to the student s application acceptance verification deadline of June 1: Prior to application, if a student who previously completed the 3 vaccination series and did not obtain a titer within 8 weeks following the third vaccination, he/she will have the discretion of having a titer drawn. The student is subsequently responsible to have the required titer drawn in the event of clinical exposure to blood or other potentially infectious body fluids as stated in the SON Blood Borne Pathogen Policy. Required: Documentation of 2 doses of Varicella vaccination OR A positive titer is required. If able to provide documentation of two Varicella doses, no titer is required. If unable to provide documentation of two Varicella doses, a titer must be completed. If the titer is non-responsive, or equivocal, documentation of a repeat series, 2 doses of Varicella vaccine, is required. If the student has had chicken pox, a Varicella titer is required to verify immunity. If the titer is non-responsive, or equivocal, documentation of a repeat series, 2 doses of Varicella vaccine, is required. Required: Documentation of annual influenza vaccines OR a signed Declination Statement is due by October 31 st each year. The student who declines may be required to wear a face mask at facilities that require influenza vaccination or may not be able to complete clinical hours at such facilities. All students enrolled in ISU s must be free of active signs and symptoms of Tuberculosis. Students with a previously positive skin test OR have had the BCG immunization: It is not recommended that the student receive another TB skin test. Student must submit negative chest x-ray interpretation, letter from physician stating completion of antibiotic therapy, and/or letter from physician stating student does not have active TB. These instances will be handled on a case by case basis. Please contact the for further instructions. Students with a baseline positive or a newly recognized positive skin test: It is not recommended that the student receive another TB skin test. Student must complete the following steps: 1. Evaluation by healthcare professional a. Symptom screen b. Chest x-ray i. Serial follow-up chest x-rays are not recommended for students with a previous positive skin test who have documentation of a previous clear chest x-ray unless they present with symptoms of TB or a clinician recommends it. 14

c. If applicable, QuantiFERON TB Gold QTF-G test, i. If healthcare provider recommends test to be done please submit the results to the SON. ii. Positive QuantiFERON TB Gold QTF-G test: please contact the SON for further instructions. iii. Negative QuantiFERON TB Gold QTF-G test: no further action required, please contact the SON. d. If applicable, collection of sputum specimens. 2. If TB disease is diagnosed a. Begin anti-tuberculosis treatment and provide documentation to the SON. Please contact the SON for further instructions. 3. If Latent TB Infection (LTBI) is diagnosed a. Treatment for LTBI then annual symptom screens, please contact the SON for further instructions. b. If treatment has already been completed submit documentation and contact the SON for further instructions. Note: All immunization and vaccination records are due June 1, 2016 EXCEPT the influenza vaccination. Influenza vaccination is due by October 31, 2016. Maintaining current status with all immunizations listed above is the sole responsibility of the student throughout the duration of their time in the Accelerated nursing program. Failure to maintain current immunizations status according to the guidelines above will result in uncompleted clinical hours and may result in expulsion from the nursing program. This form is for applicant use only do not submit with admission materials 15

This form is for applicant use only do not submit with admission materials IMMUNIZATION REQUIREMENTS CHECKLIST See Healthcare Personnel Vaccination Recommendations Appendix B 1. Tetanus with Pertussis Booster Tdap received date (1 dose of Tdap required) AND/OR Td received date (if Tdap > 10 years ago) 2. Measles, Mumps, Rubella Vaccination Documentation of 2 doses of MMR Vaccine #1 date #2 date OR MMR Titer completed date 3. Hepatitis B Vaccination Series Documentation of 3 doses of Hepatitis B Vaccine # 1 date # 2 date # 3 date OR Documentation of positive titer date If titer NEGATIVE dates of re-vaccination # 1 Re-vaccination date # 2 Re-vaccination date # 3 Re-vaccination date OR Documentation of at least the first dose in the series date 4. Varicella (Chicken Pox) Vaccination Documentation of 2 doses of Varicella vaccine #1 date #2 date OR Documentation of positive titer date 5. Tuberculosis (TB): Documentation that student does not have active TB disease: Negative (0 mm induration) TB skin test (TST) OR Negative TB blood tests (QuantiFERON TB Gold OR T-SPOT ) OR Negative TB blood test if student has received the TB vaccine, bacille Calmette Guérin (BCG) OR Negative TB blood test for anyone not wanting to receive a TST or is at risk of not returning for the second appointment to 'read' the TST. For all other situations and questions please contact the as soon as possible to address individual circumstances. 6. Influenza Vaccination Vaccination date 16

Healthcare Personnel Vaccination Recommendations: Appendix B 17

APPLICATION FOR ADMISSION 18

APPLICATION FOR ADMISSION 19