To begin the application process, please fill out the application form and return by mail with a $40 nonrefundable



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Nancy D. Luce, Ph.D., Superintendent Michael Shellabarger, Director, Adult Division School of Practical Nursing Stouder Center - Suite 1472 1100 Wayne Troy, Ohio 45373 P 937.440.0550 F 937.440.0544 www.uppervalleycc.org Dear Prospective Practical Nursing Student: Thank you for your interest in the Practical Nursing Program. The purpose of this letter is to inform you of class start dates and steps of the application process. The next available program will begin in October of 2011. We are accepting applications at this time and you will be notified by phone when the first testing date becomes available. begin the application process, please fill out the application form and return by mail with a $40 nonrefundable fee to: Sonja Worley, Adult Education Upper Valley Career Center Applied Technology Center 8901 Looney Road Piqua, OH 45356 These items must be on file at the school before we can schedule you to take the pre-entrance exam. When this paperwork has been received in our office, you will be contacted regarding our next available testing date. Once we have scheduled your exam, if you must change the date, it is imperative to call and reschedule as quickly as possible so we may offer your testing spot to another applicant. You may reschedule one time. If you do not call or show up for your scheduled exam you will automatically forfeit the $40.00 test fee. Application Process: Pre-entrance examination The Pre-Entrance Exam is given at our Stouder Campus located at 1100 Wayne, Suite 1472 in Troy. The Exam is a scholastic aptitude test that consists of four content areas: Math - covers whole numbers, metric conversion, fractions and decimals, percentages and ratio / proportion. Reading - covers paragraph comprehension, passage comprehension and inferences / conclusions. English - measures knowledge of punctuation, grammar, sentence structure, contextual words and spelling. Science - covers science reasoning, science knowledge, basic physical principles and general science.

All tests contain multiple-choice items with one correct answer. The test is administered via computerized method which allows us to provide you with instant results at the close of the test session. In addition to the computerized assessment, a paper/pencil math exam will be administered. Calculators are not permitted during the exam. This test consists of 66 questions and covers the following topics: roman numerals, improper fractions, mixed numbers, decimals (addition, subtraction, multiplication and division), fractions (addition, subtraction, multiplication and division), rounding decimals and solving ratios. A practice worksheet and answer key is available to be picked up or emailed to you. For additional math practice worksheets you may visit the following online sites: www.math-drills.com or www.helpingwithmath.com/resources/worksheets.htm There is an optional study guide available for you to purchase for the computerized portion of the exam. The cost of the guide is $45.00 and may be purchased by completing the enclosed order form and mailing with your application and registration card. Scheduling of Interview At the conclusion of your exam, results will be analyzed and you will be given appropriate directions for scheduling an interview. Required Information Reference letters, transcripts and medical forms will be given to you during the interview process. Forms must be filled out and returned to our office as instructed. Admissions Committee Upon our receiving the above items your completed file will be reviewed for acceptance by the Practical Nursing Admissions Committee. You will be informed of their decision by phone. It is important to keep the LPN department current with phone numbers/contact information. If you have any questions concerning the application process, please call Sue Colbert at 937-440-0550, ext. 0. Thank you for your interest in our program. I wish you success on your pre-entrance exam. Sincerely, Pam Hill RN, MS Pam Hill RN, MS Program Administrator Upper Valley Career Center School of Practical Nursing

UPPER VALLEY CAREER CENTER SCHOOL OF PRACTICAL NURSING Stouder Center, Suite 1472 1100 Wayne Troy, OH 45373 937/440-0550 Name Last First Middle Maiden Address Social Security Number Date of Birth Number and City State Zip County Telephone Numbers Home# Cell# Email Address In Case of Emergency Contact: Name Relationship Telephone Number EDUCATION High School Name Address Major Dates Attended Degree/ Diploma Date of Departure College Other WORK EXPERIENCE (begin with most recent employment) Employer Complete Address Employment Dates Position Reason for Leaving

1. 2. 3. City State Zip City State Zip City State Zip REFERENCES Please list four references and give complete addresses. Do not list relatives or employers 1. 2. 3. 4. Why do you wish to seek a career in Practical Nursing? Have you ever applied to this PN Program? Yes Year No

Have you ever applied to any PN/RN Program? Yes No Name of School Year I certify that all information provided in this application is correct to the best of my knowledge. Applicant s Signature Date PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO: UPPER VALLEY CAREER CENTER Mail the completed application, registration card and $40 check or money order to: Sonja Worley, Adult Education Upper Valley Career Center Applied Technology Center 8901 Looney Rd Piqua, OH 45356 After we receive your completed application, registration card, and testing fee you will then be contacted by us to schedule your pre-entrance exam. ** YOU MUST BRING A PHOTO ID WITH YOU ON TEST DATE AND ALLOW 4 HOURS FORTESTING** Updated 7-6-2011

UPPER VALLEY CAREER CENTER SCHOOL OF PRACTICAL NURSING POLICY: Mental and Physical Abilities required of the Practical Nursing Education Program by the Ohio Organization of Practical Nurse Educators Minimal acceptable mental and physical qualifications of an applicant for the Program of Practical Nurse Education include the following abilities: 1. Frequently work in a standing position and do frequent walking. 2. Lift and transfer patients up to 6 inches from a stooped position, then push or pull the weight up to 3 feet. 3. Lift and transfer patients from a stooped to an upright position to accomplish bed-to-chair and chair-to-bed transfers. 4. Physically apply up to 10 pounds of pressure to bleeding sites, or in performing CPR. 5. Respond and react immediately to auditory instruction/request/monitor equipment, and perform auditory auscultation without auditory impediment. 6. Perform close and distance visual activities involving objective, person, and paperwork, as well as discriminate depth and color. 7. Discriminate between sharp/dull and hot/cold when using hands. 8. Manual dexterity required for preparing and administering medications. 9. Ability to read medication labels and patient records. 10. Perform mathematical calculation for medication preparation and administration. 11. Speak English clearly enough for most patients to understand and understand the verbal communication of English-speaking clients. 12. Communicate effectively in writing, using appropriate grammar, vocabulary and word usage. 13. Make quick decisions under stressful situations. 14. Carry out procedures that prevent the spread of infection, e.g., frequent hand washing, using mask and gloves, etc. Applicants are responsible to determine their own eligibility in light of these qualifications to identify to the school any particular accommodation they may need. Students with a disability who enter the program do so with the understanding they will be expected to meet course requirements, with any reasonable accommodation that may be provided by the school. Request for reasonable accommodation will be evaluated by the nursing faculty, Director of the PN Program, and the Director of Upper Valley Career Center Adult Division.

UPPER VALLEY CAREER CENTER SCHOOL OF PRACTICAL NURSING PRE-ENTRANCE EXAM OPTIONAL STUDY GUIDE ORDER FORM Yes, I would like to order a copy of the Pre-Entrance Exam Study Guide. Name: Address: City: State: Zip: Phone: Please enclose check or money order in the amount of $45.00 made payable to: UPPER VALLEY CAREER CENTER *Your study guide will be mailed to you at the above address.