BRIDGING APPLICATION FOR CONSIDERATION FOR SUMMER 2016 Print out this entire document. All pre‐requisites must be completed prior to applying. Sciences must be less than 10 years old at the time you apply. Use the first page “check off sheet” to keep track of your application requirements and deadlines. If you applied for consideration for Summer 2015, we should still have your transcripts on file. You will only need to provide us with updated transcripts if additional courses have been taken. Be sure to check “yes” on the application area that asks if you applied last year. If you applied for consideration for Summer 2014, 2013, 2012 or prior, you will need to re‐ submit all official transcripts with your application.
You will note that you are to submit a “complete” application packet: Application Curriculum work sheet ‐ if your VN/PN transcript does not show the VNSG course numbers for the pre‐requisites listed, you may leave that area blank. Please note that we may have to contact you for course descriptions or syllabi. Sealed official transcripts. Official transcripts should be obtained from your college either in person or have the transcripts sent to you at your home address. If you are a graduate of an out of state PN program you must also include documentation of ACEN accreditation. Contact ACEN via their website
TEMPLE COLLEGE LVN BRIDGING APPLICATION PROCESS
Summer 2016
Instructions/Check Off Sheet Part 1 A 1. Temple College Application Official Transcripts to Admissions & Records
If not already done, submit a completed application for admission or re-admission to TC Admissions & Records Office in One College Centre. This should be done
immediately. You must meet all Temple College requirements for testing, transcripts,
etc. You must be TSI complete. Arrange to have official transcripts (from each program/college/university) sent to TC Admissions & Records Office. Their address is on the bottom of this page. Transcripts must be received by February 8, 2016. If you
transferred credits from one college to another, submit an official transcript from the original college. Failure to meet this requirement by the time your nursing application
is received could jeopardize the processing of your nursing application.
2. Application Curriculum Worksheet Official Transcripts from all colleges attended
Print out this entire document. Complete all of the information requested on the
application and curriculum worksheet. Return all of the forms to the Associate Degree Nursing (ADN) office by February 8, 2016. Include(with your application) official transcripts (keep them in their sealed envelopes) from all colleges attended, including Temple College. The address is at the bottom of this page. If you do not see the VNSG courses that are listed on the curriculum worksheet on your transcript, please leave it blank. We will find the appropriate courses. All pre-requisite courses must
be complete before you apply. Be sure to read the Licensure page from the Texas
Board of Nursing. Documentation of nursing practice experience may be required. Your Texas VN license must be in good standing, unrestricted, and not solely a compact license.
3. Out of state VN school ACEN/NLNAC Accreditation
If you graduated from a VN/PN program outside of Texas, you must provide
documentation that your nursing school was accredited by Accreditation Commission for Education in Nursing (formerly known as NLNAC) for your enrolled time period. We recommend contacting ACEN at http://www.acenursing.org/ Contact the webmaster; provide them with name, city and state of your nursing program and the year you entered the program. If they affirm accreditation by NLNAC/ACEN, print the email received from ACEN and include with the application. If your VN/PN program was not accredited as required, please do not submit an application.
MATERIALS NOT RECEIVED BY A SPECIFIED DEADLINE MAY JEOPARDIZE YOUR APPLICATION.
You may drop off your application packet (including transcripts) to the ADN office or you may mail them to:
Temple College ADN Office 2600 S. First Street Temple, TX 76504
KEEP THIS PAGE FOR FUTURE REFERENCE
Official transcripts for all courses taken at another college must also be submitted to:
Temple College
Admissions & Records Office 2600 S. First Street
Temple, TX 76504
TEMPLE COLLEGE LVN BRIDGING APPLICATION PROCESS Summer 2016 Additional Information Part 1 B 4. Acceptance Status:
After satisfactory completion of the application process, applicants will be notified by
letter or email during the latter part of March regarding your application status.
Please do not call regarding this notification process before the end of March. During the application process, keep an eye on your email account and also check your “junk email”. Please print all of your contact information on your application legibly.
5. Financial Aid:
It often takes 6-8 weeks or longer to complete the financial aid process, so get started now. The Financial Aid Office is in One College Centre.
6. Meningitis:
According to state law, some students will be required to show proof of the bacterial meningitis immunization to Temple College A & R prior to registration. If you are under the age of 30, check with A & R regarding this requirement.
If conditionally accepted into the program, you will receive instructions on completing the following
requirements, do not submit any of these items with your application.
7. Physical: You will be required to submit a physical examination by April 11, 2016. Anticipate this expense. A form will be mailed with acceptance letters.
8. Hepatitis B/ TB & Immunizatio ns:
The series of 3 Hepatitis B vaccines must be completed by July 13, 2016. Required TB screenings/immunizations (including flu vaccine) are detailed on the physical examination form.
9. CPR: You must show proof of successful completion of the CPR course: American Heart
Association Basic Cardiac Life Support for Health Care Providers, by the first day
of classes. This requirement remains in effect throughout your entire Bridging program.
10. Orientation: You need to attend an orientation day. It is typically in April. The date will be provided
in the letter of acceptance. This is mandatory.
11. Background Check:
YOU MUST HAVE TEXAS BOARD OF NURSING CLEARANCE BY MAY 16, 2016. Specific instructions will be given.
12. Drug Screen:
You must pass a drug screen. Specific instructions will be given.
TEMPLE COLLEGE LVN BRIDGING
STUDENT APPLICATION FOR ADMISSION
SUMMER 2016
PLEASE TYPE OR PRINT CLEARLY IN INK
Date: _______________ TC Student ID # _______________ Social Security # : _________________ Date of Birth: ______________
Name: ____________________________________________________________________________________________________________________
(Last) (First) (Middle) (Maiden) Home Ph #: (_____) _______________ Cell Ph #: (_____) ___________________Work Ph #: (_____) _______________________
Personal E-Mail Address: __________________________________ TC E-Mail Address: [email protected] Physical Address: ______________________________________________________________________________________________
(Number, Street, Apt. #) (City) (County) ( State) ( Zip) (School District)
Mailing Address: _______________________________________________________________________________________________
(Number, Street, Apt. #) (City) (County) ( State) (Zip)
Did you apply to the TC Bridging program for Summer 2015?
No
YesVN Nursing License #: ____________________________ State: _________________________________________________
Schools/Colleges Attended
What VN program did you graduate from? _______________________________________________ When: __________________ (Name of school, city, and state*)
*Graduates of out of state VN/PN programs must provide documentation of NLNAC/ACEN accreditation Name, city, & state of other nursing schools attended: ______________________________________________________________
Only list LVN work experiences starting with the most recent. Letters of verification may be requested. Year
Started
Year Ended
Agency Name City/State Full Time/Part Time (Circle One) Type of Service* ________ ________ _________________________ _________________ FT/PT ________________ ________ ________ _________________________ _________________ FT/PT ________________ ________ ________ _________________________ _________________ FT/PT ________________
*Type of service = med surg, long term care, ob, etc.
I have reviewed the Texas Board of Nursing (BON) Licensure questions. I am aware that I must report to the BON and be cleared of any issues or conditions addressed in these licensure questions. If I am not cleared in all of the areas addressed, I understand that I will not be allowed to register for nursing courses.
__________________________________________________ __________________________________________
(Signature of applicant) (Date)
I certify that all given information is correct & complete. I understand that failure to provide correct & complete
information could result in being removed from the application process or immediate dismissal, should I be accepted into the program.
I understand that I must have background check clearance by the Texas Board of Nursing by May 16, 2016, should I be accepted into the program.
I understand that by signing below, I give permission for the TC ADN Department to contact me at the email address(es) provided.
__________________________________________________ __________________________________________
(Signature of applicant) (Date)
It is the policy of Temple College that all persons shall receive equal opportunities in admission or access to its programs and activities without regard to race, religion, color, handicap, sex, age, national origin or veteran status
For Office Use Only: FINAL: _______ GPA: _______ LTR TYPE: _______ DATE SENT: _______ DOB: _______ TEMPLE COLLEGE LVN BRIDGING SUMMER 2016 CURRICULUM WORKSHEET
For Office Use Only: AR APP: AR TRANS: NF SA: TCVN: TX VN PROGRAM: YES NO YES NO YES NO YES NO YES NO YES NO ACEN? Please print clearly and provide all information. Incomplete applications will not be processed.
Last Name First Name MI Maiden Name SSN TC Student ID
__________________________ _____________________ _____________@ ______________ ___________________@ stu.templejc.edu City that you live in School District that you live in Personal Email Address TC Email Address
Fill in the following information. All prerequisites must be completed prior to applying. If you are currently enrolled in any listed corequisite courses, indicate “IP” (In Progress) in the grade area. In Progress courses will not be counted in your calculation of admission points. *BIOL prerequisite courses cannot be more than 10 years old at the time you apply and must be 4 credits.
For Office Use Only
Prerequisite Course College Course No. & Name Sem. Hrs. Sem/year Taken (i.e. Fall 2009) Grade / / / T EQ/SUB Composition I / / Human Anatomy &
Physiology I*
/ / /
Human Anatomy & Physiology II* / / / General Psychology / / VNSG 1160 Clinical I (1 credit) / / VNSG 1423
Basic Nursing Skills (4 credits) / / / VNSG 1231 Pharmacology (2 credits) / / / VNSG 1509 Nursing in Health & Illness II
(5 credits)
/ / /
Corequisite Course College Course No. & Name Sem. Hrs. Sem/year Taken (i.e. Fall 2009) Grade / / / T EQ/SUB Lifespan Growth & Development / / / Elective See list of options below
/ / /
Elective options: ENGL 2322, 2323, 2327, 2328, HIST 2311, 2312, HUMA 1301, SPAN 1411, 1412, ARTS 1301, 1303, 1304, 2356, DRAM 1310, MUSI 1301, 1306, 1308, 1309, 1310
Spring 2016
Texas Board of Nursing Licensure Questions:
All students seeking licensure as a registered nurse must pass the NCLEX-RN administered by the Texas Board of Nursing. The Board may delay or refuse to admit persons to their examination or refuse to issue a license or certificate of registration for any of the following reasons:
1) For any criminal offense, including those pending appeal, have you: a. Been convicted of a misdemeanor?
b. Been convicted of a felony?
c. Pled nolo contendere, no contest, or guilty? d. Received deferred adjudication?
e. Been placed on community supervision or court-ordered probation, whether or not adjudicated guilty? f. Been sentenced to serve jail or prison time? Court-ordered confinement?
g. Been granted pre-trial diversion?
h. Been arrested or any pending criminal charges? i. Been cited or charged with any violation of the law?
j. Been subject of a court-martial; Article 15 violation; or received any form of military judgement/punishment/action?
(You may only exclude Class C misdemeanor traffic violations.)
NOTE: Expunged and Sealed Offenses: While expunged or sealed offenses, arrests, tickets, or citations need not
be disclosed, it is your responsibility to ensure the offense, arrest, ticket or citation has, in fact, been expunged or sealed. It is recommended that you submit a copy of the Court Order expunging or sealing the record in question to the BON office with your application. Failure to reveal an offense, arrest, ticket, or citation that is not in fact expunged or sealed, will at a minimum, subject your license to a disciplinary fine. Non-disclosure of relevant offenses raises questions related to truthfulness and character.
NOTE: Orders of Non-Disclosure: Pursuant to Tex.Gov’t Code § 552.142(b), if you have criminal matters that are
the subject of an order of non-disclosure you are not required to reveal those criminal matters on this form. However, a criminal matter that is the subject of an order of non-disclosure may become a character and fitness issue. Pursuant to other sections of the Gov’t Code chapter 411, the Texas Nursing Board is entitled to access criminal history record information that is the subject of an order of non-disclosure. If the Board discovers a criminal matter that is the subject of an order of non-disclosure, even if you properly did not reveal that matter, the Board may require you to provide information about that criminal matter.
2) Are you currently the target or subject of a grand jury or governmental agency investigation?
3) Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted
surrender of, suspended, placed on probation, refused to renew a professional license, certificate, or multi-state privilege held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you? 4) Within the past five (5) years have you been addicted to and/or treated for the use of alcohol or any other drug? 5) Within the past five (5) years have you been diagnosed with, treated, or hospitalized for schizophrenia and/or
psychotic disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder?
If you answered yes or if you are not certain of the answer, then you MUST start the declaratory order process immediately! Instructions and forms can be obtained at
