Nursing Application to begin programs Spring Semester 2016

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Division of Health

Nursing Department

Nursing Application

to begin programs Spring Semester 2016

includes

Career Mobility (RN Bridge) Program-Tracks 1 and 2

Paramedic to RN Bridge Program

Associate Degree Nursing Program

The nursing programs at Calhoun Community College are approved by the Alabama Board of Nursing P.O. Box 303900 Montgomery, Alabama 36130 (800) 656-5318 www.abn.state.al.us

and accredited by the Accreditation Commission for Education in Nursing (ACEN) 3343 Peachtree Road NE, Suite 850 Atlanta, Georgia 30326 (404) 975-5000 www.acenursing.org

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Nursing Application Minimum Requirements

Nursing programs applicants must first apply to Calhoun Community College and be accepted as a

student.

Nursing applicants must submit transcripts from every college ever attended and/or high school to the

CCC Department of Admissions and Records by a deadline of August 3, 2015

for transcripts to be

evaluated.

All applicants must submit an

unofficial

copy of a Calhoun Community College transcript in the

application envelope which includes all coursework taken at CCC and coursework taken at other

colleges or high school and accepted in transfer. The Admissions and Records Office should be

contacted with questions regarding the transfer of credit.

Do not submit transcripts from other colleges with the nursing application. Coursework taken at other

educational institutions must be evaluated and accepted by the CCC Department of Admissions and

Records to be considered.

It is the applicant’s responsibility to make certain all relevant coursework is listed on the CCC

transcript. Applicants must highlight courses and grades being claimed for points on the CCC

transcript. No points will be awarded if courses and grades are not listed on the CCC transcripts. A

copy of your transcript from MYCALHOUN is acceptable.

Applicants must submit a valid TEAS-V score from a test taken within the past three years = after

August 1, 2012.

All applicants must read and signify understanding of the Alabama Community College System

Nursing

Essential Functions

found on pp. 22-23 of this application.

Applicants must have a minimal grade point average (GPA) of 2.5 based on the most recent 24 hours of

undergraduate or graduate work. GPAs will be calculated

after

the application deadline.

Career Mobility applicants

must have completed (MTH 100) Intermediate College Algebra or a higher

math as determined by college policy, (BIO 201) Human Anatomy and Physiology I, (BIO 202) Human

Anatomy and Physiology II, and (ENG 101) English Composition I.

Paramedic to RN applicants

must have completed (MTH 100) Intermediate College Algebra or a higher

math as determined by college policy, (BIO 201) Human Anatomy and Physiology I, (BIO 202) Human

Anatomy and Physiology II, (BIO 220) Microbiology, (ENG 101) English Composition I, and (PSY 200)

General Psychology.

Associate degree nursing applicants

must be eligible to take (MTH 100) Intermediate College Algebra,

(ENG 101) English Composition I, and (BIO 201) Human Anatomy and Physiology I as determined by

college policy.

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APPLICATION PACKET CHECKLIST

All required application pages and supporting documents are to be enclosed in

ONE 9” X 12” ENVELOPE.

Application

packets must be

received

by the Nursing Department no later than

Monday, August 31, 2015.

Information cannot be

accepted via fax or by email and individual pages of required documentation will not be accepted with the exception of

letters of good standing from nursing directors at other colleges.

MAILING ADDRESS:

PHYSICAL LOCATION:

Calhoun Community College

CCC Decatur Campus

Nursing Department

Health Sciences Building – 3

rd

floor Administration

P.O. Box 2216

Hours: Monday – Thursday 8 am – 5 pm

Decatur, AL 35609

Friday 8-11:30 am

Do not fold and do not staple transcripts, application pages or other documentation.

Do not include health forms, financial aid records, or other information that is not specifically requested. The

nursing department will not be responsible for these items.

Each time an individual applies to a nursing program an application packet must be completed in its entirety;

copies of items submitted should be retained as information will not be released from previous application

packets.

Please check () if the following is enclosed:

A valid TEAS-V score (Test of Essential Academic Skills – V) taken with the last three years – August 1, 2012 or later.

An UNOFFICIAL Calhoun Community College transcript confirming all coursework taken at CCC and elsewhere

accepted in transfer.

COMPASS MATH score if you have not successfully completed the program math requirement (ADN program only).

Page 4 of the Application with your name and contact information.

ONE

of the following points worksheets:

CMB–Track 1 or Track 2 – college student (p. 8)

Paramedic to RN – college student (p. 13)

ADN– college student (p. 17)

ADN– high school student (p. 19)

Pages 9-10 if

Career Mobility program

is your FIRST CHOICE.

Pages 14-15 if the

Paramedic to RN program

is your FIRST CHOICE.

Pages 20-21 if the

associate degree/RN program

is your FIRST CHOICE.

Incomplete application packets will not be returned.

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Nursing Programs Application

Spring Semester 2016

PRINT CLEARLY

INCLUDE THIS PAGE IN THE APPLICATION ENVELOPE

First Name:________________________ Initial:_____

Last Name:_____________________________________

Maiden Name (if applicable): ______________________

Calhoun Student ID (C#):__________________________

Mailing Address:________________________________

______________________________________________

Valid Email: ______________________@ ____________

This email address will be used for official

communication.

City:__________________________________________

State:________________________ Zip:______________

Telephone: (________)___________________________

Choice

of nursing program: (Select ONE)

______ Career Mobility Track 1: Grad. before 8/31/13

______ Career Mobility Track 2: Grad. after 8/31/13

______ Paramedic to RN

______ Associate Degree Nursing

Office Use ONLY:

Date Received by Department:_____________

Dept. Rep. Initials:__________

TURN TO THE APPROPRIATE PAGE AND COMPLETE ONE APPLICATION –

Career Mobility Application-p. 5-10

Paramedic to RN Application-p. 11-15

RN Application-p. 16-21

NO INFORMATION ABOUT ACCEPTANCE WILL BE GIVEN OVER THE PHONE OR IN PERSON.

All applicants will receive a letter notifying them whether or not they were accepted into the Spring 2016 Nursing

programs. Letters are scheduled to be mailed the week of September 18, 2015. Please allow 3-5 business days for

delivery. The Nursing department will not call applicants if letters are returned as “undeliverable” as it is the

responsibility of the applicant to provide a correct mailing address. Keep a copy of your application and transcripts. Once

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CAREER MOBILITY TRACK 1 NURSING PROGRAM OF STUDY

The career mobility-track 1 nursing program begins in the spring and is four semesters in length with a total of 57 credit hours; 30 hours in general education and 27 hours in nursing. All courses must be taken and successfully completed in the order delineated, though any or all of the general education requirements may be fulfilled prior to enrollment in the CMT1 program. Graduates are awarded an Associate of Applied Science Degree in Nursing (A.D.N.) and are eligible to apply to write the National Council Licensure

Examination for Registered Nurses (NCLEX-RN®) and apply to a state board of nursing for licensure as a registered nurse.

Career Mobility Track 1 Curriculum Plan First Term - Spring

Course Theory Lab Clinical Credit Contact

Nursing Career Mobility Assessment NUR 200

3 1 1 5 9

Term total 3 1 1 5 9 Second Term - Summer

Course Theory Lab Clinical Credit Contact

Psychology PSY 200 3 - - 3 3 Microbiology BIO 220 2 2 - 4 6

Nursing Through the Lifespan I NUR 201

3 - 2 5 9

Term total 8 2 2 12 18 Third Term - Fall

Course Theory Lab Clinical Credit Contact

Speech SPH 106 or SPH 107

3 - - 3 3

Human Growth and Development PSY 210

3 - - 3 3

Nursing Through the Lifespan II NUR 202

3 - 3 6 12

Term total 9 - 3 12 18 Fourth Term - Spring

Course Theory Lab Clinical Credit Contact

Humanities Elective 3 - - 3 3

Nursing Through the Lifespan III NUR 203

4 - 2 6 10

Role Transition for the Registered Nurse NUR 204 (Preceptor 3:1)

2 - 2 4 8

Term Total 9 - 4 13 21

Program total

General education credit hours = 30

Nursing credit hours = 27 Total credit hours = 57

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CAREER MOBILITY TRACK 2 NURSING PROGRAM OF STUDY

The career mobility-track 2 nursing program begins in the spring and is three semesters in length with a total of 54 credit hours; 30 hours in general education and 24 hours in nursing. All courses must be taken and successfully completed in the order delineated,

though any or all of the general education requirements may be fulfilled prior to enrollment in the CMT2 program. Graduates are awarded an Associate of Applied Science Degree in Nursing (A.D.N.) and are eligible to apply to write the National Council Licensure

Examination for Registered Nurses (NCLEX-RN®) and apply to a state board of nursing for licensure as a registered nurse.

Career Mobility Track 2 Curriculum Plan First Term - Spring

Course Theory Lab Clinical Credit Contact

Psychology PSY 200 3 - - 3 3 Microbiology BIO 220 2 2 - 4 6

Nursing Through the Lifespan I NUR 201

3 - 2 5 9

Term total 8 2 2 12 18 Second Term - Summer

Course Theory Lab Clinical Credit Contact

Speech SPH 106 or SPH 107

3 - - 3 3

Human Growth and Development PSY 210

3 - - 3 3

Nursing Through the Lifespan II NUR 202

3 - 3 6 12

Term total 9 - 3 12 18 Third Term - Fall

Humanities Elective 3 - - 3 3

Nursing Through the Lifespan III NUR 203

4 - 2 6 10

Role Transition for the Registered Nurse NUR 204 (Preceptor 3:1)

2 - 2 4 8

Term Total 9 - 4 13 21

Program total

General education credit hours = 30

Nursing credit hours = 24 Total credit hours = 54

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Nursing Application Point System

Career Mobility Program

FOR COLLEGE STUDENTS

The number of students selected for enrollment in nursing programs is limited. After meeting all minimum admission

requirements, applicants are rank-ordered using the following point system:

Career Mobility Nursing Application Points System

TEAS-V Score: Max 200

TEAS-V Science Sub-Score 0-100

TEAS-V Math Sub-Score 0-100

Course Grades: A=30, B=20, C=0 Max 90 College Courses

BIO 201 – Anatomy & Physiology I 0-30 BIO 202 – Anatomy & Physiology II 0-30 BIO 220 - Microbiology 0-30

Additional Points: Max 12

All General Education Courses Completed 7

First Time RN Student 3

Attendance at a Nursing Programs Information Session 2

Total Possible Points Max 302

1. Application points are earned based on the submitted TEAS-V (Test of Essential Academic Skills)

Science

Sub-score

and the

Math Sub-score

from a test taken in the past three years (August 1, 2012 or later). The combined

TEAS-V Science and Math Sub-Scores represent approximately

two-thirds of the possible application point total.

2. Application points are earned based on grades received in designated college science courses: Anatomy &

Physiology I (BIO 201), Anatomy & Physiology II (BIO 202), and Microbiology (BIO 220).

Up to 90 points can be

accrued for grades of A or B.

3

. Seven (7)

application points are earned for successful completion (letter grade of C or >) of all designated general

education courses required for ADN program completion. (See p. 13-14)

4

. Three (3)

points are awarded to applicants who have never been enrolled in an RN program at CCC or another

college.

5. Up to

two points (2)

can be earned by

applicants for attending a nursing programs and application information

session. Dates and times of information sessions are noted on the CCC Nursing Department website.

You are strongly encouraged to carefully read all application instructions

and Frequently Asked Questions available on the

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Nursing Application Point System Worksheet

Career Mobility Nursing Program

FOR COLLEGE STUDENTS

Complete & include in application envelope

Name of Applicant: ______________________________________ Calhoun Student ID (C#):_________________________________ Record the college and grade for all general education courses you have completed. POINTS WILL NOT BE AWARDED UNLESS THE COURSE AND GRADE EARNED IS NOTED ON THE UNOFFICIAL CALHOUN COMMUNITY COLLEGE TRANSCRIPT SUBMITTED WITH THIS APPLICATION. HIGHLIGHT EACH COURSE AND THE GRADE RECEIVED. A COPY OF A TEAS-V TEST TAKEN WITHIN THE PAST 3 YEARS MUST BE INCLUDED IN THE APPLICATION ENVELOPE FOR POINTS TO BE AWARDED.

Course Name & Number Academic Institution

(example: CCC, WSCC, UNA)

Letter Grade

(A, B, C)

Earned Application Points: Circle One

Office Use Only

BIO 201 – Human Anatomy & Physiology I

A=30 B=20 C=0 Not Completed

BIO 202 – Human Anatomy & Physiology II

A=30 B=20 C=0 Not Completed

BIO 220 – General Microbiology

A=30 B=20 C=0 Not Completed

MTH 100 – Intermediate College Algebra Completed Not Completed

ENG 101 – English Composition Completed Not Completed

PSY 200 – General Psychology Completed Not Completed

PSY 210 – Human Growth & Development Completed Not Completed

Speech Elective – SPH 106, 107, 116 Completed Not Completed

Humanities Elective: Art, Music, Foreign Language, Literature, Philosophy, Religion, Theatre

Completed Not Completed

All 9 general education course requirements listed above have been completed with a grade of C or >

YES=7 NO=0 TEAS-V ScienceSub-score from a test taken

in past 3 years. Enter score in points column, do not round. A copy of the TEAS-V must be included in application packet.

_______.____

TEAS-V Math Sub-score from a test taken in past 3 years. Enter score in points column, do not round. A copy of the TEAS-V must be included in application packet.

_______.____

I am a “first time RN student” as I have not been previously enrolled in a RN program at CCC or another college in or out of the state of Alabama.

YES=3 NO=0

I attended a Nursing Dept. Info. Session in 2015 & signed an attendance roster.

Date Attended: YES=2

NO=0

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Career Mobility Program Nursing Application

Circle

the correct response:

MINIMUM APPLICATION REQUIREMENTS

Yes or No 1. I have submitted an application and been accepted as a student by Calhoun Community College.

Yes or No 2. I have submitted transcripts from every college I have attended, and high school transcripts if requested, to the

CCC Office of Admissions and Records by Monday, August 3, 2015.

Yes or No 3. I have a current cumulative grade point average (GPA) of at least 2.5 based on my most recent 24 hours of undergraduate or graduate work.

Yes or No 4. I have completed MTH 100 Intermediate College Algebra with a grade of C or higher.

Yes or No 5. I have completed ENG 101 English Composition I with a grade of C or higher.

Yes or No 6. I have completed BIO 201 Anatomy & Physiology I with a grade of C or higher.

Yes or No 7. I have completed BIO 202 Anatomy & Physiology II with a grade of C or higher.

Yes or No I understand that the above items 1-7 are the MINIMUM APPLICATION REQUIREMENTS for the Career Mobility Nursing Program and, because program enrollment is limited, meeting minimal requirements does not guarantee acceptance.

Yes or No I have included a copy of a valid TEAS-V score taken within the last three years.

Yes or No I have included a copy of a Calhoun Community College UNOFFICIAL transcript which shows all coursework taken at CCC and other colleges accepted in transfer. I understand it is my responsibility to make certain the CCC transcript is correct. I have highlighted the courses and grades noted on page 8 (Points Worksheet) of the application.

Yes or No I have included a copy of my unencumbered Alabama Practical Nurse license with my application. I further understand that if a copy of my current license is not included, my application cannot be considered.

MINIMUM ENROLLMENT REQUIREMENTS

Yes or No 1. I have read the ACCS Essential Functions for Nursing (page 22-23) and understand I must meet these

requirements with or without reasonable accommodations. I understand that if accommodations are required to meet the Essential Functions it is my responsibility to request reasonable accommodation through the CCC Office of Special Populations, Dawn Hale 256-306-2630.

Yes or No 2. I understand that students in healthcare programs are required to submit to a background check and drug screening by a vendor designated by the College to comply with clinical affiliate contracts. I understand that the background check and/or a confirmed positive drug screen may render me ineligible to participate in required learning experiences at clinical affiliates because I will be denied access. In this event, I understand that I will be dismissed from the program and a grade of “F” will be recorded for course(s) if I do not officially withdraw.

Yes or No 3. I understand that students in healthcare programs are required to submit to a health examination by a licensed physician or CRNP, to provide documentation of immunization to certain communicable diseases, and to undergo tuberculosis screening.

Yes or No 4. I understand that during my nursing education I will come in contact with infectious diseases. I further understand that my health and accident insurance and/or expenses are my responsibility.

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Yes or No 5. I understand that I will be required to submit evidence of current cardiopulmonary resuscitation certification. (AHA Health Care Provider, ARC CPR for the Professional Rescuer, or American Health and Safety Institute CPR Pro)

Yes or No 6. I understand I must purchase professional liability insurance through the College.

Yes or No 7. I understand that it is my responsibility to read and abide by all policies noted in the CCC Catalog, Nursing Student Policy Manual, and nursing course syllabi.

Yes or No I understand that the above items 1-7 are the MINIMUM ENROLLMENT REQUIREMENTS for the Career Mobility Nursing Programs. I understand that all clinical requirements (background check, drug screen, health form, proof of immunization, TB testing, CPR certification) must be completed by a published deadline once I am accepted into a nursing program and prior to registration. If I fail to submit all required documentation by the deadline I will forfeit enrollment in the program.

Yes or No I understand nursing students shall comply with the standards that determine acceptable behavior of a nurse in accordance with the Alabama Board of Nursing Administrative Code. Legal requirements for licensure as a nurse include being of good moral character. Individuals who have been found guilty of certain offenses may be denied licensure. State boards of nursing have the power to deny licensure to those found guilty of fraud or deceit, convicted of a felony, those guilty of a crime involving moral turpitude or gross immorality, those unfit or incompetent due to the use of alcohol or addiction to the use of habit-forming drugs; persons convicted of any violation of a federal or state law relating to controlled substances; those mentally incompetent; and individuals guilty of unprofessional conduct of a character likely to deceive, defraud or injure the public in matters pertaining to

health. For additional information or a copy of the complete Code visit www.abn.state.al.us .

Yes or No I understand that any falsification and/or omission of information on this application will remove my name from consideration for enrollment or may be grounds for dismissal from the program in accordance with College policies.

___________________________________________________________ ___________________

Signature

Date

Completed application packets must be

received

by the Nursing Department no later than

Monday, August 31, 2015.

The Nursing Programs Admission Committee will meet in September. All applicants will be notified of decisions by mail

at the address supplied on the application. Please do not call the department as no information will be available by

telephone.

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PARAMEDIC TO RN (PMRN) NURSING PROGRAM OF STUDY

The paramedic to RN nursing program begins in the spring and is three semesters in length with a total of 72 credit hours; 30 hours in general education and 42 hours in nursing. All courses must be taken and successfully completed in the order delineated, though any or all of the general education requirements may be fulfilled prior to enrollment in the PMRN program. Graduates are awarded

an Associate of Applied Science Degree in Nursing (A.D.N.) and are eligible to apply to write the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) and apply to a state board of nursing for licensure as a registered nurse.

Paramedic to RN Curriculum Plan First Term - Spring

Course Theory Lab Clinical Credit Contact

Paramedic to RN Mobility NUR 111

8 1 3 12 20

Term total 8 1 3 12 20 Second Term - Summer

Course Theory Lab Clinical Credit Contact

Speech SPH 106 or SPH 107

3 - - 3 3

Human Growth and Development PSY 210

3 - - 3 3

Nursing Through the Lifespan II NUR 202

3 - 3 6 12

Term total 9 - 3 12 18 Third Term - Fall

Humanities Elective 3 - - 3 3

Nursing Through the Lifespan III NUR 203

4 - 2 6 10

Role Transition for the Registered Nurse NUR 204 (Preceptor 3:1)

2 - 2 4 8

Term Total 9 - 4 13 21

Program total

General education credit hours = 30

Nursing credit hours = 42 Total credit hours = 72

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Nursing Application Point System

Paramedic to RN Nursing Program

FOR COLLEGE STUDENTS

The number of students selected for enrollment in nursing programs is limited. After meeting all minimum admission

requirements, applicants are rank-ordered using the following point system:

Paramedic to RN Nursing Application Points System

TEAS-V Score: Max 200

TEAS-V Science Sub-Score 0-100

TEAS-V Math Sub-Score 0-100

Course Grades: A=30, B=20, C=0 Max 90 College Courses

BIO 201 – Anatomy & Physiology I 0-30 BIO 202 – Anatomy & Physiology II 0-30 BIO 220 - Microbiology 0-30

Additional Points: Max 12

All General Education Courses Completed 7

First Time Nursing Student 3

Attendance at a Nursing Programs Information Session 2

Total Possible Points Max 302

1. Application points are earned based on the submitted TEAS-V (Test of Essential Academic Skills)

Science

Sub-score

and the

Math Sub-score

from a test taken in the past three years (August 1, 2012 or later). The combined

TEAS-V Science and Math Sub-Scores represent approximately

two-thirds of the possible application point total.

2. Application points are earned based on grades received in designated college science courses: Anatomy &

Physiology I (BIO 201), Anatomy & Physiology II (BIO 202), and Microbiology (BIO 220).

Up to 90 points can be

accrued for grades of A or B.

3

. Seven (7)

application points are earned for successful completion (letter grade of C or >) of all designated general

education courses required for ADN program completion. (See p. 13-14)

4

. Three (3)

points are awarded to applicants who have never been enrolled in a nursing program at CCC or another

college.

5. Up to

two points (2)

can be earned by

applicants for attending a nursing programs and application information

session. Dates and times of information sessions are noted on the CCC Nursing Department website.

You are strongly encouraged to carefully read all application instructions

and Frequently Asked Questions available on the

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13

Nursing Application Point System Worksheet

Paramedic to RN Nursing Program

FOR COLLEGE STUDENTS

Complete & include in application envelope

Name of Applicant: ______________________________________ Calhoun Student ID (C#):_________________________________ Record the college and grade for all general education courses you have completed. POINTS WILL NOT BE AWARDED UNLESS THE COURSE AND GRADE EARNED IS NOTED ON THE UNOFFICIAL CALHOUN COMMUNITY COLLEGE TRANSCRIPT SUBMITTED WITH THIS APPLICATION. HIGHLIGHT EACH COURSE AND THE GRADE RECEIVED. A COPY OF A TEAS-V TEST TAKEN WITHIN THE PAST 3 YEARS MUST BE INCLUDED IN THE APPLICATION ENVELOPE FOR POINTS TO BE AWARDED.

Course Name & Number Academic Institution

(example: CCC, WSCC, UNA)

Letter Grade

(A, B, C)

Earned Application Points: Circle One

Office Use Only

BIO 201 – Human Anatomy & Physiology I

A=30 B=20 C=0 Not Completed

BIO 202 – Human Anatomy & Physiology II

A=30 B=20 C=0 Not Completed

BIO 220 – General Microbiology

A=30 B=20 C=0 Not Completed

MTH 100 – Intermediate College Algebra Completed Not Completed

ENG 101 – English Composition Completed Not Completed

PSY 200 – General Psychology Completed Not Completed

PSY 210 – Human Growth & Development Completed Not Completed

Speech Elective – SPH 106, 107, 116 Completed Not Completed

Humanities Elective: Art, Music, Foreign Language, Literature, Philosophy, Religion, Theatre

Completed Not Completed

All 9 general education course requirements listed above have been completed with a grade of C or >

YES=7 NO=0 TEAS-V ScienceSub-score from a test taken

in past 3 years. Enter score in points column, do not round. A copy of the TEAS-V must be included in application packet.

_______.____

TEAS-V Math Sub-score from a test taken in past 3 years. Enter score in points column, do not round. A copy of the TEAS-V must be included in application packet.

_______.____

I am a “first time nursing student” as I have not been previously enrolled in a nursing program at CCC or another college in or out of the state of Alabama.

YES=3 NO=0

I attended a Nursing Dept. Info. Session in 2015 & signed an attendance roster.

Date Attended: YES=2

NO=0

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14

Paramedic to RN Program Nursing Application

Circle

the correct response:

MINIMUM APPLICATION REQUIRMENTS

Yes or No 1. I have submitted an application and been accepted as a student by Calhoun Community College.

Yes or No 2. I have submitted transcripts from every college I have attended, and high school transcripts if requested, to the

CCC Office of Admissions and Records by Monday, August 3, 2015.

Yes or No 3. I have a current cumulative grade point average (GPA) of at least 2.5 based on my most recent 24 hours of undergraduate or graduate work.

Yes or No 4. I have completed MTH 100 Intermediate College Algebra with a grade of C or higher.

Yes or No 5. I have completed ENG 101 English Composition I with a grade of C or higher.

Yes or No 6. I have completed BIO 201 Anatomy & Physiology I with a grade of C or higher.

Yes or No 7. I have completed BIO 202 Anatomy & Physiology II with a grade of C or higher.

Yes or No 8. I have completed BIO 220 Microbiology with a grade of C or higher.

Yes or No 9. I have completed PSY 200 General Psychology with a grade of C or higher.

Yes or No I understand that the above items 1-9 are the MINIMUM APPLICATION REQUIREMENTS for the Paramedic to RN Nursing Program and, because program enrollment is limited, meeting minimal requirements does not guarantee acceptance.

Yes or No I have included a copy of a valid TEAS-V score taken within the last three years.

Yes or No I have included a copy of a Calhoun Community College UNOFFICIAL transcript which shows all coursework taken at CCC and other colleges accepted in transfer. I understand it is my responsibility to make certain the CCC transcript is correct. I have highlighted the courses and grades noted on page 13 (Points Worksheet) of the application.

Yes or No I have included a copy of my unencumbered Alabama Paramedic license with my application. I further understand that if a copy of my current license is not included, my application cannot be considered.

Yes or No I have included employer documentation of at least one (1) year of experience, within the last two years, as a Paramedic with my application. I further understand that if my documentation is not included, my application cannot be considered.

MINIMUM ENROLLMENT REQUIREMENTS

Yes or No 1. I have read the ACCS Essential Functions for Nursing (page 22-23) and understand I must meet these

requirements with or without reasonable accommodations. I understand that if accommodations are required to meet the Essential Functions it is my responsibility to request reasonable accommodation through the CCC Office of Special Populations, Dawn Hale 256-306-2630.

Yes or No 2. I understand that students in healthcare programs are required to submit to a background check and drug screening by a vendor designated by the College to comply with clinical affiliate contracts. I understand that the background check and/or a confirmed positive drug screen may render me ineligible to participate in required learning experiences at clinical affiliates because I will be denied access. In this event, I understand that I will be dismissed from the program and a grade of “F” will be recorded for course(s) if I do not officially withdraw.

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15

Yes or No 3. I understand that students in healthcare programs are required to submit to a health examination by a licensed physician or CRNP, to provide documentation of immunization to certain communicable diseases, and to undergo tuberculosis screening.

Yes or No 4. I understand that during my nursing education I will come in contact with infectious diseases. I further understand that my health and accident insurance and/or expenses are my responsibility.

Yes or No 5. I understand that I will be required to submit evidence of current cardiopulmonary resuscitation certification. (AHA Health Care Provider, ARC CPR for the Professional Rescuer, or American Health and Safety Institute CPR Pro)

Yes or No 6. I understand I must purchase professional liability insurance through the College.

Yes or No 7. I understand that it is my responsibility to read and abide by all policies noted in the CCC Catalog, Nursing Student Policy Manual, and nursing course syllabi.

Yes or No I understand that the above items 1-7 are the MINIMUM ENROLLMENT REQUIREMENTS for the Paramedic to RN Nursing Program. I understand that all clinical requirements (background check, drug screen, health form, proof of immunization, TB testing, CPR certification) must be completed by a published deadline once I am accepted into a nursing program and prior to registration. If I fail to submit all required documentation by the deadline I will forfeit enrollment in the program.

Yes or No I understand nursing students shall comply with the standards that determine acceptable behavior of a nurse in accordance with the Alabama Board of Nursing Administrative Code. Legal requirements for licensure as a nurse include being of good moral character. Individuals who have been found guilty of certain offenses may be denied licensure. State boards of nursing have the power to deny licensure to those found guilty of fraud or deceit, convicted of a felony, those guilty of a crime involving moral turpitude or gross immorality, those unfit or incompetent due to the use of alcohol or addiction to the use of habit-forming drugs; persons convicted of any violation of a federal or state law relating to controlled substances; those mentally incompetent; and individuals guilty of unprofessional conduct of a character likely to deceive, defraud or injure the public in matters pertaining to

health. For additional information or a copy of the complete Code visit www.abn.state.al.us .

Yes or No I understand that any falsification and/or omission of information on this application will remove my name from consideration for enrollment or may be grounds for dismissal from the program in accordance with College policies.

___________________________________________________________ ___________________

Signature

Date

Completed application packets must be

received

by the Nursing Department no later than

Monday, August 31, 2015.

The Nursing Programs Admission Committee will meet in September. All applicants will be notified of decisions by mail

at the address supplied on the application. Please do not call the department as no information will be available by

telephone.

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16

Nursing Application Point System

Associate Degree Nursing Program

FOR COLLEGE STUDENTS

The number of students who can be enrolled in nursing programs is limited. After meeting all minimum admission

requirements, applicants are rank-ordered using the following point system:

Associate Degree Nursing Application Points System

TEAS-V Score: Max 200

TEAS-V Science Sub-Score 0-100

TEAS-V Math Sub-Score 0-100

Course Grades: A=30, B=20, C=0 Max 90 College Courses

BIO 201 – Anatomy & Physiology I 0-30 BIO 202 – Anatomy & Physiology II 0-30 BIO 220 - Microbiology 0-30

Additional Points: Max 12

All General Education Courses Completed 7

First Time Nursing Student 3

Attendance at a Nursing Programs Information Session 2

Total Possible Points Max 302

1. Application points are earned based on the submitted TEAS-V (Test of Essential Academic Skills)

Science

Sub-score

and the

Math Sub-score

from a test taken in the past three years (August 1, 2012 or later). The combined

TEAS-V Science and Math Sub-Scores represent approximately

two-thirds of the possible application point total.

2. Application points are earned based on grades received in designated college science courses: Anatomy &

Physiology I (BIO 201), Anatomy & Physiology II (BIO 202), and Microbiology (BIO 220).

Up to 90 points can be

accrued for grades of A or B.

3.

Alternately, high school graduates with no college work

receive up to 90 application points for A or B grades in

their highest level biology class, Algebra II or higher HS math course and chemistry. See HS Points System p. 17.

4

. Seven (7)

application points are earned for successful completion (letter grade of C or >) of all designated general

education courses required for ADN program completion. (See p. 13-14)

5

. Three (3)

points are awarded to applicants who have never been enrolled in a nursing program at CCC or another

college.

6. Up to

two points (2)

can be earned by

applicants for attending a nursing programs and application information

session. Dates and times of information sessions are noted on the CCC Advising Department website.

You are strongly encouraged to carefully read all application instructions

and Frequently Asked Questions available on the

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Nursing Application Point System Worksheet

Associate Degree Nursing Program

FOR COLLEGE STUDENTS

Complete & include in application envelope

Name of Applicant: ______________________________________ Calhoun Student ID (C#):_________________________________ Record the college and grade for all general education courses you have completed. POINTS WILL NOT BE AWARDED UNLESS THE COURSE AND GRADE EARNED IS NOTED ON THE UNOFFICIAL CALHOUN COMMUNITY COLLEGE TRANSCRIPT SUBMITTED WITH THIS APPLICATION. HIGHLIGHT EACH COURSE AND THE GRADE RECEIVED. A COPY OF A TEAS-V TEST TAKEN WITHIN THE PAST 3 YEARS MUST BE INCLUDED IN THE APPLICATION ENVELOPE FOR POINTS TO BE AWARDED.

Course Name & Number Academic Institution

(example: CCC, WSCC, UNA)

Letter Grade

(A, B, C)

Earned Application Points: Circle One

Office Use Only

BIO 201 – Human Anatomy & Physiology I

A=30 B=20 C=0 Not Completed

BIO 202 – Human Anatomy & Physiology II

A=30 B=20 C=0 Not Completed

BIO 220 – General Microbiology

A=30 B=20 C=0 Not Completed

MTH 100 – Intermediate College Algebra Completed Not Completed

ENG 101 – English Composition Completed Not Completed

PSY 200 – General Psychology Completed Not Completed

PSY 210 – Human Growth & Development Completed Not Completed

Speech Elective – SPH 106, 107, 116 Completed Not Completed

Humanities Elective: Art, Music, Foreign Language, Literature, Philosophy, Religion, Theatre

Completed Not Completed

All 9 general education course requirements listed above have been completed with a grade of C or >

YES=7 NO=0 TEAS-V ScienceSub-score from a test taken

in past 3 years. Enter score in points column, do not round. A copy of the TEAS-V must be included in application packet.

_______.____

TEAS-V Math Sub-score from a test taken in past 3 years. Enter score in points column, do not round. A copy of the TEAS-V must be included in application packet.

_______.____

I am a “first time nursing student” as I have not been previously enrolled in a nursing program at CCC or another college in or out of the state of Alabama.

YES=3 NO=0

I attended a Nursing Dept. Info. Session in 2015 & signed an attendance roster.

Date Attended: YES=2

NO=0

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Nursing Application Point System

Associate Degree Nursing Programs

FOR HIGH SCHOOL/DUAL ENROLLMENT STUDENTS

The number of students who can be enrolled in nursing programs is limited. After meeting all minimum admission

requirements, applicants are rank-ordered using the following point system:

Associate Degree Nursing Application Points System

TEAS-V Score: Max 200

TEAS-V Science Sub-Score 0-100

TEAS-V Math Sub-Score 0-100

High School Course Grades: A=30, B=20, C=0 Max 90 Highest level biology, incl. anatomy and physiology 0-30

Algebra II or higher math 0-30

Chemistry 0-30

Additional Points: Max 5

First Time Nursing Student 3

Attendance at a Nursing Programs Information Session 2

Total Possible Points Max 295

1. Application points are earned based on the submitted TEAS-V (Test of Essential Academic Skills)

Science

Sub-score

and the

Math Sub-score

from a test taken in the past three years (August 1, 2012 or later). The combined

TEAS-V Science and Math Sub-Scores represent approximately

two-thirds of the possible application point total.

2. Application points are earned based on the grades received in the highest level biology course taken in high

school, Algebra II or a higher math class, and Chemistry.

Up to 90 points can be accrued for grades of A, B, C.

3

. Three (3)

points are awarded to applicants who have never been enrolled in a nursing program at CCC or another

college.

4. Up to

Two points (2)

can be earned by

applicants for attending a nursing programs and application information

session. Dates and times of information sessions are noted on the CCC Advising Department website.

You are strongly encouraged to carefully read all application instructions

and Frequently Asked Questions available on the

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Nursing Application Point System Worksheet

Associate Degree Nursing Programs

FOR HIGH SCHOOL/DUAL ENROLLMENT STUDENTS

Complete worksheet & include in application envelope

Name of Applicant: ______________________________________ Calhoun Student ID (C#):_________________________________ Record the high school and course name for designated courses you have completed. POINTS WILL NOT BE AWARDED UNLESS THE COURSE AND GRADE EARNED IS NOTED ON THE UNOFFICIAL HIGH SCHOOL TRANSCRIPT SUBMITTED WITH THIS APPLICATION. HIGHLIGHT EACH COURSE AND THE GRADE RECEIVED. A COPY OF A TEAS-V TEST TAKEN WITHIN THE PAST 3 YEARS MUST BE INCLUDED IN THE APPLICATION ENVELOPE FOR POINTS TO BE AWARDED.

Course Name & Number Name of High School / Name of Course Letter Grade (A, B, C) Earned Application Points: Circle One Office Use Only

Highest level high school biology course

A=30 B=20 C=0 Not Completed

Algebra II or higher high school math course

A=30 B=20 C=0 Not Completed

High school chemistry course

A=30 B=20 C=0 Not Completed

TEAS-V ScienceSub-score from a test taken in past 3 years. Enter score in points column, do not round. A copy of the TEAS-V must be included in application packet.

X

_______.____

TEAS-V Math Sub-score from a test taken in past 3 years. Enter score in points column, do not round. A copy of the TEAS-V must be included in application packet.

X

_______.____

I am a “first time nursing student” as I have not been previously enrolled in a nursing program at CCC or another college in or out of the state of Alabama.

X

YES=3 NO=0

I attended a Nursing Dept. Info. Session in 2015 & signed an attendance roster.

Date Attended:

YES=2 NO=0

TOTAL POINTS =

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Traditional Associate Degree Nursing Application

Circle

the correct response:

MINIMUM APPLICATION REQUIREMENTS

Yes or No 1. I have submitted an application and been accepted as a student by Calhoun Community College.

Yes or No 2. I have submitted transcripts from every college I have attended, and high school transcripts if requested, to the

CCC Office of Admissions and Records by Monday, August 3, 2015.

Yes or No 3. I have a current cumulative grade point average (GPA) of at least 2.5 based on my most recent 24 hours of undergraduate or graduate work.

Yes or No OR

4A. I have completed MTH 100 Intermediate College Algebra with a grade of C or higher.

Yes or No 4B. I have not completed MTH 100 Intermediate College Algebra but am eligible to take MTH 100 during the first

term of the associate degree nursing program AND MY COMPASS MATH SCORE IS INCLUDED IN

THIS APPLICATION PACKET.

Yes or No OR

5A. I have completed ENG 101 English Composition I with a grade of C or higher.

Yes or No 5B. I have not completed ENG 101 English Composition I but am eligible to take ENG 101 during the second term of the associate degree nursing program. (Consult the Advising Office with questions about course eligibility)

Yes or No OR

6A. I have completed BIO 201 Anatomy & Physiology I with a grade of C or higher.

Yes or No 6B. I have not completed BIO 201 Anatomy & Physiology I but am eligible to take BIO 201 during the first term of the associate degree nursing program. (Consult the Advising Office with questions about course eligibility.)

Yes or No I understand that the above items 1-6 are the MINIMUM APPLICATION REQUIREMENTS for the Traditional

Associate Degree Nursing Program and, because program enrollment is limited, meeting minimal requirements does not guarantee acceptance.

Yes or No I have included a copy of a valid TEAS-V score taken within the last three years.

Yes or No I have included a copy of a Calhoun Community College UNOFFICIAL transcript which shows all coursework taken at CCC and other colleges accepted in transfer. I understand it is my responsibility to make certain the CCC transcript is correct. I have highlighted the courses and grades noted on page 17 or 19 (Points Worksheet) of the application.

Yes or No I was previously enrolled in a nursing program(s) which I did not complete. I understand that if this nursing program was at a college other than Calhoun Community College, it is my responsibility to contact that nursing program and

have a Letter of Good Standing sent to the CCC Nursing Department NO LATER THAN August 31, 2015. I further

understand that if a letter of good standing is not received by the deadline, my application cannot be considered.

MINIMUM ENROLLMENT REQUIREMENTS

Yes or No 1. I have read the ACCS Essential Functions for Nursing (page 22-23) and understand I must meet these

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meet the Essential Functions it is my responsibility to request reasonable accommodation through the CCC Office of Special Populations, Dawn Hale 256-306-2630.

Yes or No 2. I understand that students in healthcare programs are required to submit to a background check and drug screening by a vendor designated by the College to comply with clinical affiliate contracts. I understand that the background check and/or a confirmed positive drug screen may render me ineligible to participate in required learning experiences at clinical affiliates because I will be denied access. In this event, I understand that I will be dismissed from the program and a grade of “F” will be recorded for course(s) if I do not officially withdraw.

Yes or No 3. I understand that students in healthcare programs are required to submit to a health examination by a licensed physician or CRNP, to provide documentation of immunization to certain communicable diseases, and to undergo tuberculosis screening.

Yes or No 4. I understand that during my nursing education I will come in contact with infectious diseases. I further understand that my health and accident insurance and/or expenses are my responsibility.

Yes or No 5. I understand that I will be required to submit evidence of current cardiopulmonary resuscitation certification. (AHA Health Care Provider, ARC CPR for the Professional Rescuer, or American Health and Safety Institute CPR Pro)

Yes or No 6. I understand I must purchase professional liability insurance through the College.

Yes or No 7. I understand that it is my responsibility to read and abide by all policies noted in the CCC Catalog, Nursing Student Policy Manual, and nursing course syllabi.

Yes or No I understand that the above items 1-7 are the MINIMUM ENROLLMENT REQUIREMENTS for the Traditional Associate Degree Nursing Programs. I understand that all clinical requirements (background check, drug screen, health form, proof of immunization, TB testing, CPR certification) must be completed by a published deadline once I am accepted into a nursing program and prior to registration. If I fail to submit all required documentation by the deadline I will forfeit enrollment in the program.

Yes or No I understand nursing students shall comply with the standards that determine acceptable behavior of a nurse in accordance with the Alabama Board of Nursing Administrative Code. Legal requirements for licensure as a nurse include being of good moral character. Individuals who have been found guilty of certain offenses may be denied licensure. State boards of nursing have the power to deny licensure to those found guilty of fraud or deceit, convicted of a felony, those guilty of a crime involving moral turpitude or gross immorality, those unfit or incompetent due to the use of alcohol or addiction to the use of habit-forming drugs; persons convicted of any violation of a federal or state law relating to controlled substances; those mentally incompetent; and individuals guilty of unprofessional conduct of a character likely to deceive, defraud or injure the public in matters pertaining to

health. For additional information or a copy of the complete Code visit www.abn.state.al.us .

Yes or No I understand that any falsification and/or omission of information on this application will remove my name from consideration for enrollment or may be grounds for dismissal from the program in accordance with College policies.

___________________________________________________________ ___________________

Signature

Date

Completed application packets must be

received

by the Nursing Department no later than

Monday, August 31, 2015.

The Nursing Programs Admission Committee will meet in September. All applicants will be notified of decisions by mail

at the address supplied on the application. Please do not call the department as no information will be available by

telephone.

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THE ALABAMA COMMUNITY COLLEGE SYSTEM NURSING PROGRAMS

ESSENTIAL FUNCTIONS

The Alabama Community College System endorses the Americans' with Disabilities Act. In accordance with College policy, when requested, reasonable accommodations may be provided for individuals with disabilities. Physical, cognitive, psychomotor, affective and social abilities are required in unique combinations to provide safe and effective nursing care. The applicant/student must be able to meet the essential functions with or without reasonable accommodations throughout the program of learning. Admission, progression and graduation are contingent upon one's ability to demonstrate the essential functions delineated for the nursing programs with or without reasonable accommodations. The nursing programs and/or its affiliated clinical agencies may identify additional essential functions. The nursing programs reserve the right to amend the essential functions as deemed necessary. In order to be admitted and to progress in the nursing program one must possess a functional level of ability to perform the duties required of a nurse. Admission or progression may be denied if a student is unable to demonstrate the essential functions with or without reasonable accommodations. The essential functions delineated are those deemed necessary the ACCS nursing programs. No representation regarding industrial standards is implied. Similarly, any reasonable accommodations made will be determined and applied to the respective nursing program and may vary from reasonable accommodations made by healthcare employers. The essential functions delineated below are necessary for nursing program admission, progression and graduation and for the provision of safe and effective nursing care. The essential functions include but are not limited to the ability to:

1) Sensory Perception

a) Visual

i) Observe and discern subtle changes in physical conditions and the environment ii) Visualize different color spectrums and color changes

iii) Read fine print in varying levels of light iv) Read for prolonged periods of time v) Read cursive writing

vi) Read at varying distances

vii) Read data/information displayed on monitors/equipment b) Auditory

i) Interpret monitoring devices

ii) Distinguish muffled sounds heard through a stethoscope

iii) Hear and discriminate high and low frequency sounds produced by the body and the environment iv) Effectively hear to communicate with others

c) Tactile

i) Discern tremors, vibrations, pulses, textures, temperature, shapes, size, location and other physical characteristics d) Olfactory

i) Detect body odors and odors in the environment

2) Communication/ Interpersonal Relationships

a) Verbally and in writing, engage in a two-way communication and interact effectively with others, from a variety of social, emotional, cultural and intellectual backgrounds

b) Work effectively in groups c) Work effectively independently

d) Discern and interpret nonverbal communication e) Express one's ideas and feelings clearly

f) Communicate with others accurately in a timely manner g) Obtain communications from a computer

3) Cognitive/Critical Thinking

a) Effectively read, write and comprehend the English language

b) Consistently and dependably engage in the process of critical thinking in order to formulate and implement safe and ethical nursing decisions in a variety of health care settings

c) Demonstrate satisfactory performance on written examinations including mathematical computations without a calculator d) Satisfactorily achieve the program objectives

4) Motor Function

a) Handle small delicate equipment/objects without extraneous movement, contamination or destruction b) Move, position, turn, transfer, assist with lifting or lift and carry clients without injury to clients, self or others c) Maintain balance from any position

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d) Stand on both legs

e) Coordinate hand/eye movements

f) Push/pull heavy objects without injury to client, self or others

g) Stand, bend, walk and/or sit for 6-12 hours in a clinical setting performing physical activities requiring energy without jeopardizing the safety of the client, self or others

h) Walk without a cane, walker or crutches

i) Function with hands free for nursing care and transporting items

j) Handle small delicate equipment/objects without extraneous movement, contamination or destruction k) Move, position, turn, transfer, assist with lifting or lift and carry clients without injury to clients, self or others l) Maintain balance from any position

m) Stand on both legs

n) Coordinate hand/eye movements

o) Push/pull heavy objects without injury to client, self or others

p) Stand, bend, walk and/or sit for 6-12 hours in a clinical setting performing physical activities requiring energy without jeopardizing the safety of the client, self or others

q) Walk without a cane, walker or crutches

r) Function with hands free for nursing care and transporting items s) Transport self and client without the use of electrical devices t) Flex, abduct and rotate all joints freely

u) Respond rapidly to emergency situations v) Maneuver in small areas

w) Perform daily care functions for the client

x) Coordinate fine and gross motor hand movements to provide safe effective nursing care y) Calibrate/use equipment

z) Execute movement required to provide nursing care in all health care settings aa) Perform CPR and physical assessment

bb) Operate a computer

5) Professional Behavior

a) Convey caring, respect, sensitivity, tact, compassion, empathy, tolerance and a healthy attitude toward others b) Demonstrate a mentally healthy attitude that is age appropriate in relationship to the client

c) Handle multiple tasks concurrently

d) Perform safe, effective nursing care for clients in a caring context

e) Understand and follow the policies and procedures of the College and clinical agencies f) Understand the consequences of violating the student code of conduct

g) Understand that posing a direct threat to others is unacceptable and subjects one to discipline h) Meet qualifications for licensure by examination as stipulated by the Alabama Board of Nursing i) Not to pose a threat to self or others

j) Function effectively in situations of uncertainty and stress inherent in providing nursing care k) Adapt to changing environments and situations

l) Remain free of chemical dependency

m) Report promptly to clinicals and remain for 6-12 hours on the clinical unit n) Provide nursing care in an appropriate time frame

o) Accepts responsibility, accountability, and ownership of one's actions p) Seek supervision/consultation in a timely manner

q) Examine and modify one's own behavior when it interferes with nursing care or learning

Upon admission, an individual who discloses a disability can request reasonable accommodations. Individuals will be asked to provide documentation of the disability in order to assist with the provision of appropriate reasonable accommodations. The respective College will provide reasonable accommodations but is not required to substantially alter the requirements or nature of the program or provide accommodations that inflict an undue burden on the respective College. In order to be admitted one must be able to perform all of the essential functions with or without reasonable accommodations. If an individual's health changes during the program of learning, so that the essential functions cannot be met with or without reasonable accommodations, the student will be withdrawn from the nursing program. The nursing faculty reserves the right at any time to require an additional medical examination at the student's expense in order to assist with the evaluation of the student's ability to perform the essential functions.

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