CRUSOE-HOLIFIELD
PRACTICAL NURSING
PROGRAM
Lively Technical Center
Health Education Department
500 North Appleyard Dr.
Tallahassee, FL 32304
Phone (850)487-7449
Fax (850)487-7478
Website: www.livelytech.com
APPLICATION DEADLINE FOR AUGUST 2013 ADMISSION: April 12, 2013
Crusoe-Holifield Practical Nursing Program Application Packet
PROGRAM DESCRIPTION:
The Crusoe-Holifield Practical Nursing Program is designed to prepare students for successful passage of the NCLEX-PN and future employment as a Licensed Practical Nurse. Clinical experiences are included as an integral part of this program. The program is approved by the Florida State Board of Nursing.
PROGRAM BEGINS: August 19, 2013 (Day and Evening Programs) January 2014 (Day Program)
PROGRAM LENGTH: Day program: Three semesters Evening program: Four semesters
PROGRAM HOURS: Day program (30 hrs/wk):
M-Th, 8am-4pm (classroom); 6:45am-2:45pm (clinical) Evening program (24 hrs/wk):
Basic Healthcare Worker: M-Th, 6pm-10pm Remainder of program:
M-W, 6pm-10pm (classroom/clinical) F, 6-10; Sat., 6:45am-3:15pm (clinical)
PROGRAM LOCATION: Lively Technical Center
Health Education Department, Building 15 500 North Appleyard Drive
Tallahassee, FL 32304
Externship Locations - Various
REQUIREMENTS
Applicants seeking admission to the Practical Nursing Program must: • Be at least 18 years of age
• Make application to the Lively Health Education Department • Have a high school diploma or equivalent; provide three references • Attend a General Information Program Session.
• Students' immunizations must be up to date, including the Hepatitis B series, MMRx2, Varicella, and Tetanus. An annual PPD (tuberculin skin test) is required.
• Students must keep their CPR for Healthcare Providers (BLS) certification current for the duration of the program.
• Successful completion of the program is dependent on meeting all the requirements of the program. • Two random drug screenings are required. Students with positive drug screen results may not continue
• A Level 2 criminal background screening is also required, which is done prior to enrollment, at the student’s expense. In order to participate in the mandatory clinical practicum, as well as to obtain licensure, students must have a clear background.
Applicants must successfully complete all of the required criteria and have all relevant documentation on file with the Lively Technical Center (LTC) Health Education Department, by (the specific date on the application). Meeting the criteria for selection does not guarantee admission to the Crusoe-Holifield Practical Nursing program. Final selection will be based on the qualified applicant pool and space available.
Note: #1 through #6 below must be completed and submitted by the application deadline. Late and/or incomplete packets will not be considered.
1. PERSONAL INFORMATION FORM
Please complete the Personal Information Form that is included in this packet.
2. TESTING
A. All prospective students must take the Test of Adult Basic Education (TABE), Level A. TABE
exit requirements for the Practical Nursing Program are 11.0 in Reading, Language and Total Math. TABE scores are valid for two (2) years. Prospective students will go to the Registration window in Building 8 to pay for the exam then report to the Testing Center. Prospective students with an Associate Degree or higher, have successfully completed the College Level Academic Skills Test (CLAST), or have already met the minimum scores, within the past two years, on the CPT, ACT, MAPS, SAT or ASSET are exempt from the TABE exam with the appropriate official documentation.
B. ATI-TEAS (ASSESSMENT TECHNOLOGY INSTITUTE - TEST OF ESSENTIAL ACADEMIC SKILLS) All applicants must take the TEAS Nursing Entrance Exam.
ATI-TEAS scores are valid for two (2) years; however, only the most recent score will be considered for admission. Applicants are encouraged to test early. There is a *$55.00 fee for this exam. Applicants will go to the Registration window in Building 8 to pay for the exam then report to the Testing Center. Once accepted, students will also be required to take ATI Standardized NCLEX-PN Testing Preparation Exams throughout the Program. The current desired proficiency level for the PN program is 58.7.
For more information, please contact The Testing Center at: 850-487-7467.
3. HEALTH REQUIREMENTS
Applicants are required to be in good mental and physical health and must submit proof of a recent medical evaluation (not more than 6 months old; see attached form). If, after acceptance, a student’s health status changes, further documentation may be required stating the student is physically able to continue the Program. Applicants are also required to provide proof of the following current immunizations:
• Tetanus, within the past 10 years (Td or Tdap)
• MMR x2 (given on or after the applicant’s first birthday). Official documentation of immunity is also acceptable.
• Hepatitis B series
• Varivax x2. Official documentation of immunity (titer results) is also acceptable. • PPD/Tuberculin skin test within past 12 months.*
program. Students who test positive for tuberculosis must show proof of a negative chest x-ray to satisfy this requirement.
4. CPR
All applicants must be certified and maintain current certification in American Heart Association CPR
for Healthcare Provider for the duration of the program. Four classes at Lively Technical Center have
been scheduled for February 4, March 4, April 1, and April 8, from 5pm-9pm. Cost is $50.00. You may register for a class in Bldg. 8 (Registration).
5. REFERENCES
Applicants must submit three current reference letters: two professional references (recent employers, former teachers, counselors, etc.) and one personal reference (may not be family member).
6. TRANSCRIPTS
Prospective students are required to submit proof of an academic high school diploma, general equivalency diploma (GED), or a validated foreign transcript equivalent to the LTC Health Education Department. All transcripts proving graduation from high school or GED must be received by the Health Education Department before the end of the first semester. Students will not be allowed to register for the second semester without proper documentation.
7. GENERAL INFORMATION MEETING
After submitting a completed application to the LTC Health Education Department, applicants will be notified about attending a mandatory General Information meeting. At least two meetings will be scheduled prior to student selection; the date and time of these meetings will be given to all applicants when the application is submitted. This meeting provides potential students with an overview of the Crusoe-Holifield Practical Nursing Program, registration process, financial aid, and general LTC campus information. This is also an opportunity for applicants to ask questions about the program. Further information may be obtained by calling the LTC Health Education Dept. at 850-487-7449.
8. INTERVIEW
After the completed application has been submitted and the student has attended the general information meeting; the applicant must schedule an interview with the LTC Health Education Director or designated faculty member. All interviews must be completed before the application will be considered by the selection committee.
9. CRIMINAL BACKGROUND CHECK
If accepted into the program, students must undergo a Level 2 criminal background check prior to registration for the program. A student not cleared by the clinical facilities will not be able to enroll in the program. Instructions for obtaining the background screening will be included the Practical Nursing Program acceptance letter.
Please be aware that clearance by the clinical facility does not guarantee clearance to test by the Florida Board of Nursing (FBON). Applicants should visit the FBON website at http://www.doh.state.fl.us/mqa/nursing/ for information regarding licensure requirements prior to beginning the application process.
10. DRUG SCREENING
facilities in Florida. Students who do not pass a random drug screening will not be able to access the clinical facilities and therefore will not be able to continue in the program. The cost of the drug screening is *$40.00 and must be paid for at the time of registration.
*Fees subject to change.
DISABILITY SUPPORT SERVICES:
If you have question regarding a disability accommodations, please contact LTC Student Services in Building 9.
FINANCIAL AID:
Financial Aid is available for this program based on eligibility. Qualifying students will receive the Federal Pell Grant. Loans and other financial arrangements are a personal decision and not handled at Lively Technical Center. The Financial Aid Office is located in Student Services, Building 9.
ACCEPTANCE INTO PROGRAM:
Applicants who have met the requirements for placement will be placed into a selection pool and chosen based on the number of available slots. Should the number of eligible applicants exceed the number of openings offered; students will be admitted based on a defined point system. In the event of a tie, a lottery selection system will be used.
ACCEPTANCE/REGISTRATION:
Applicants who are selected will be notified approximately two weeks after the interview sessions are completed. If an applicant is selected and does not complete the registration process, the applicant must reapply and be considered based on the applicant pool at the time of reapplication.
All prices are approximate and subject to change without notice.
TABE 25.00
ATI-TEAS Nursing Exam 55.00
Level 2 Background Check 61.00
Additional Criminal Background Check (Done online via third-party entity; paid directly by student)
49.50
Registration Fee ($75.00/Semester for three semesters) 225.00
Tuition $2.92/hour X 1350 hours (minimum) 3942.00
Laboratory Fee (linen rental, dressings, syringes, gloves, catheters, skills kit, etc) $250.00 each Registration.
750.00
Vital signs kit (Stethoscope and BP cuff) 50.00
Books 950.00
ATI Standardized NCLEX-PN Testing Preparation Exams 500.00
Drug Testing 80.00
Liability Insurance 60.00
Clinical ID 5.00
NFLPN Membership 25.00
Graduation Fee (Cap & Gown, Nursing Pin, Program Certificate in frame, Nightingale Lamp & 5 x 7 photo)
100.00
CPR (recertification prior to graduation) 50.00
Required Accessories:
Uniforms (Minimum: two scrub tops and pants and logos) 60.00
Lab coat (thigh length, long sleeves, white, button closure, with Lively patch on left upper sleeve)
25.00
Shoes (white clinical or all-white athletic; closed) 50.00
Watch with a sweeping second hand (no decorative watches) 35.00
Bandage scissors (about six inches long) 10.00
Stethoscope (provided) Blood pressure cuff (provided)
Penlight 10.00
Headphones or ear buds 10.00
Basic calculator (not on cell phone) 3.00
Post-Completion Licensure Requirements:
Pearson VUE Registration (www.vue.com/NCLEX) 200.00
Florida Board of Nursing Licensure Application Fee (http://www.doh.state.fl.us/mqa/nursing/) 204.00
PERSONAL INFORMATION
PLEASE PRINT—BLUE OR BLACK INK ONLY Date ______________________
Date of Birth _______________________________ Place of Birth _________________________________________
Name __________________________________________ SS# _________________________________________________
Address _______________________________________ City/State __________________________ Zip _______________
Home # ( ) _____________________ Work # ( ) _____________________ Cell # ( )____________________
Email Address ________________________________________________________________________________________ Emergency Contact ___________________________________________ Phone# ( )_________________________
EDUCATION
High School _______________________________________City/State __________________________________________
Highest grade completed ____________ Year _____________ Circle one: Diploma GED
Previous Nursing School ________________________________ City/State ___________________________________
College ________________________ Degree awarded _________ City/State ___________________________________
Military _____________________________________________________________________________________________
Education as Certified Nursing Assistant, Patient Care Assistant, Patient Care Technician or Medical Assistant
Name of School ___________________________________________________________________________________
Certification Awarded Yes No Years Attended __________________________________________
EMPLOYMENT RECORD
Present ____________________________________ Title/Position __________________________________________
Dates of Employment: From __________ to _________
Previous ___________________________________ Title/Position __________________________________________
Dates of Employment: From __________ to _________
Previous ___________________________________ Title/Position __________________________________________
Dates of Employment: From __________ to _________ The information on this application is true and factual.
Signature: _______________________________________________________ Date: ________________________
Crusoe-Holifield Practical Nursing Program
Medical Evaluation
APPLICANT NAME (please print): ________________________________________
ESSENTIAL TASKS
Health related occupations are demanding, both physically and emotionally. Before entering a program in the health field, it is important to review the following tasks which have been established. Their performance is essential for success in the program.
To be completed and signed by the Health Care Provider ONLY:
Physical Requirements:
Ability to perform repetitive tasks
Ability to walk the equivalent of five miles per day Ability to reach above shoulder level
Ability to project audible verbal communications at a distance of 4 feet Ability to demonstrate high degree of manual dexterity
Ability to work with chemicals and detergents Ability to tolerate exposure to dust and/or odors Ability to grip
Ability to distinguish colors
Ability to lift a minimum of 25 lbs & maximum of 100 lbs Ability to bend knees
Ability to sit or stand for long periods of time Ability to perform CPR
Vision within normal limits Hearing with normal limits
Mental and Emotional Requirements:
Ability to cope with a high level of stress
Ability to make fast decisions under high pressure
Ability to cope with the anger/fear/hostility of others in a calm manner Ability to interpret audible sounds of distress
Ability to manage altercations Ability to concentrate
Ability to cope with confrontation
Ability to handle multiple priorities in a stressful situation Ability to assist with problem resolution
Ability to work alone
Ability to demonstrate a high degree of patience Ability to adapt to shift work
Ability to work in areas that are close and crowded
The above-named applicant to the Crusoe-Holifield Practical Nursing Program has been found to meet the above requirements.
______________________________ ____________________
Signature and Title of Health Care Provider Date
Crusoe-Holifield Practical Nursing Program
Student Health Assessment Record
THIS FORM MUST BE COMPLETED BY YOUR HEALTH CARE PROVIDER. Any falsification of this record
will result in immediate dismissal from the program (if accepted).
NAME (please print):______________________________________________________________________________ Last First MI
DATE OF BIRTH: _____/_____/_____ Male ___ Female ___
VERIFICATION OF DOCUMENTATION
Verified by: ___________________________________ _______________ Name of Physician’s Office/Health Center Date
_________________________________________ __________________ Signature Title
___________________________________________________________________________________ Stamp
1. MMR (Need proof of two MMR vaccines or one mumps, two measles, and one rubella. Any person born before 1/1/57 will need proof of rubella immunization or positive titer.) Date of MMR #1: _______________ Date of MMR #2: _______________
OR
Antibody titers:
Mumps titer date: _______________ Results: Immunity/Not immune Rubeola titer date: ______________ Results: Immunity/Not immune Rubella titer date: _______________ Results: Immunity/Not immune If not immune, will require MMR x2.
2. Tetanus (Td or Tdap with the last ten years): Date: _______________ 3. Hepatitis B series:
_______________ _______________ _______________ Hepatitis B #1 date Hepatitis B #2 date Hepatitis B #3 date 4. Varicella:
Date of 1st dose: _______________ Date of 2nd dose: _______________ If no documentation of two (2) Varivax, or if history of chicken pox:
Varicella titer: __________ Results: ________(Lab value)
5. PPD (TB Skin Test): Date taken: _______________ Results: Positive Negative
