VOCATIONAL NURSING PROGRAM

2013-2014 Application for admission to:

VOCATIONAL NURSING PROGRAM

PLEASE PRINT OR TYPE

Application Date _____/______/_____

Name: __________________________________________________________________________

PLEASE SPECIFY WHICH CAMPUS SITE(S) YOU WISH TO APPLY

BY RANKING EACH IN ORDER OF PREFERENCE:

______ Cuero ______ Gonzales ______ Hallettsville ______ Victoria

Last First Middle Maiden

Are there any other names which might appear on a transcript? If so, please list:

________________________________________________________________________________

Home Telephone #: _______________________ Work Telephone #: ________________________

Cell Telephone #: _________________________ E-mail Address: __________________________

Mailing Address:

________________________________________________________________________________________________

Permanent Address

(if different from above):

________________________________________________________________________________

Name, Address, and Telephone Number of person to be notified in case of an emergency:

P.O. Box or Number & Street City State Zip Code County

Number & Street City State Zip Code County

________________________________________________________________________________

It is the student’s responsibility to keep mailing address and contact information

current with the program office and the Admissions office.

Have you taken the DET exam? _____Yes _____No If yes, date of exam: _____/_____/_____

If you have taken the DET prior to September 1, 2011, you will need to re-test.

Have you obtained a clear criminal background check from the Board of Nursing? ____Yes ____No

*Social Security No.: ___ ___ ___ - ___ ___ - ___ ___ ___ ___ *Date of Birth: ______/______/______

*This information is required to complete the BON criminal background check.

Please give information concerning high school graduation or G.E.D. completion:

_______________________________________________________________________________________

Name of High School or GED Institution City/State

Please list any licenses or certificates held (e.g., EMT, CNA, etc.): __________________________________

_______________________________________________________________________________________

I certify that the above statements are true and correct.

__________________________________________________________

Type:

___Diploma ___GED

Please give information concerning college, university, vocational or allied health schools attended:

______________________________________________________________________________________

______________________________________________________________________________________

Name of Institution City/State Number of Credits Earned

To receive credit, students must provide course descriptions of any courses on the VN program of study taken outside of VC to the program coordinator. An official transcript must be provided to the Vocational Nursing Program Office and the Admissions Office by June 3rd.

Signature of Applicant

It is the applicant’s responsibility to:

Return this application by mail or in person to the

first choice

VN Program Secretary’s Office: Cuero

VN Program (2550 Esplanade, Cuero TX 77954), Gonzales VN Program (424 E. Sarah DeWitt, Gonzales

TX 78629), Hallettsville VN Program (1410 N. Texana, Hallettsville TX 77964) or Victoria VN Program

(2200 E. Red River St., Victoria TX 77901).

Additional information on the web: http://www.victoriacollege.edu/vocationalnursing

Statement of Nondiscrimination

Victoria College does not discriminate on the basis of race, color, religion, national origin, gender, pregnancy, age, disability, genetic information, marital status, amnesty, veteran’s status, or limited English proficiency. It is our policy to comply, fully, with the nondiscrimination provision of all state and federal rules and regulations.

 

 

LICENSURE ELIGIBILITY REQUIREMENTS

Applicant’s Name (Print):______________________________________________

Address: ___________________________________________________________

PO Box or Number & Street City, State Zip Code

Home Telephone #:____________________

Cell #: ____________________

*Social Security #:___________________ *Date of Birth: ____/____/_____

*This information is required to complete the Texas Board of Nursing criminal

background check (CBC).

To be considered an eligible applicant, Victoria College Nursing Programs

require proof of a clear Texas Board of Nursing (BON) criminal background.

All licensure eligibility issues must be resolved.

This form must be returned to your first choice Nursing Program Office to

initiate the Texas Board of Nursing criminal background check. Completion of

this process can take 4 months or longer.

Eligibility issues that must be resolved in order to be qualified for nursing

program admission include:

1) [ ] No [ ] Yes 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 have 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 judgment/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 BON 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. Nondisclosure 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 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) [ ] No [ ] Yes Are you currently the target or subject of a grand jury or governmental agency investigation?

3) [ ] No [ ] Yes 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) [ ] No [ ] Yes *Within the past five (5) years have you been addicted to and/or treated for the use of

alcohol or any other drug?

5) [ ] No [ ] Yes *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 “YES” indicate the condition: [ ] schizophrenia and/or psychotic disorders,

[ ] bipolar disorder, [ ] paranoid personality disorder, [ ] antisocial personality disorder, [ ] borderline personality disorder

*Pursuant to the Occupations Code §301.27, information regarding a person’s diagnosis or treatment for a physical condition, mental condition, or chemical dependency is confidential to the same extent that information collected as part of an investigation is confidential under the Occupations Code §304.466.

If you answered “YES” to any of the questions listed above, submit a letter of

explanation to the Texas Board of Nursing (333 Guadalupe, Ste. 3-460, Austin TX

78701-3944) that is dated and signed indicating the circumstance(s) you are

reporting before you will be eligible for program admission.

Telephone number: (512) 305-7400, website:

www.bon.state.tx.us

Applicant’s Signature:_________________________________ Date:__________

 

 

NAME: _______________________________

DATE: ______________

Vocational Nursing Program

Checklist

Dear Vocational Nursing Program Applicant,

Thank you for your interest in the Vocational Nursing Program. The program begins every

fall semester. It is the responsibility of the applicant to furnish all necessary

documentation (as stated below) by June 3rd of the current year. In order to be considered

for admission to the program you must complete the following checklist:

*Applicants need to bring this form into the office when submitting documents.*

(VC staff will initial, check box, and date when documents have been submitted)

1.

Criminal Background Check (CBC)

Complete the Licensure Eligibility Requirement form and submit it to the

nursing program office. This form will not be accepted after March 1

st

for fall

admission. It can take 4 months or longer for the Texas Board of Nursing

(BON) to complete this process. Without resolution of all licensure eligibility

issues including a clear criminal background check (CBC), you are not

eligible for admission to the Vocational Nursing Program. Once you have

received a completed, clear CBC result from the BON, it is your

responsibility to submit the original document to the program office by

June 3rd. For applicants with a declaratory issue, please submit the

letter indicating Board order. (Faxed or scanned copies will not be

accepted.)

2.

Vocational Nursing Program Application

Submit a completed Vocational Nursing Program Application for VN

Admission. Vocational Nursing Program Applications are not retained from

year to year so in order to be eligibile for admission, a new application must

be submitted each year (October 1 – June 1).

3.

TSI Complete (Texas Success Initiative)

Applicants must be TSI (Texas Success Initiative) complete to qualify for

admission. Please contact Advising and Counseling Services for more

information at (361) 582.2400. It is the applicant’s responsibility to

validate their TSI status with the Advising/Counseling and the

Admission/Records Office. Official transcript(s) from all colleges attended

(other than Victoria College) must be provided to the Victoria College

Admission/Records Office and Vocational Nursing Program by June 3rd to

be eligibile for program admission.

4.

Record of Immunization Form

Submit completed Victoria College Record of Immunization form. Hepatitis

B series must be completed or in progress on or before March 1

st

of the

 

 

current year or earlier OR proof of seroligic immunity. The two-step PPD

skin test for tuberculosis is required.

1. The first PPD must be within one year of second PPD. This is submitted

on the Record of Immunization form.

2. The date of the second PPD should be no earlier than July 22, 2013 and

no later than August 7, 2013. The 2

nd

PPD test results must be submitted

no later than August 12, 2013 and will be submitted separately.

5.

Diagnostic Entrance Test (DET)

A qualifying Diagnostic Entrance Test (DET) result of 45% or higher in

English AND 45% or higher in Math on the same test date are required to be

eligible for admission to the program. You may only take this test twice in a

testing year. If taking the DET more than one time in a testing year, the most

recent score will be used to meet the admission criteria. Contact the Victoria

College Testing Center at (361) 572.6480 for further information regarding

the DET.

6.

Victoria College Application

Complete an online application for admission to Victoria College. More

information is located at http://www.victoriacollege.edu/admissionschecklist.

It is the applicant’s responsibility to validate with the Admission and

Records Office that their Victoria College application has been

processed by calling (361) 573-3291 or (877) 843-4369.

7.

EDUC 1300 or SDEV 0301

Applicants who have earned less than 13 hours of college credit must

complete EDUC 1300 or SDEV 0301 with a “C” or better prior to June 3rd to

be eligible for admission.

8.

BIOL 2404 OR BIOL 2401 and BIOL 2402

Submit

official

transcript which includes completion within the past 5 years

of BIOL 2404 OR BIOL 2401 and 2402 (Anatomy & Physiology) with a “C”

or better. Applicants are responsible for submitting college transcripts to the

Admissions/Records Office and Vocational Nursing Program by June 3rd.

PRIOR TO ENROLLMENT: Qualified applicants who have been ACCEPTED into

the Vocational Nursing Program must submit a current and completed:

1. CPR Health Care Provider card (American Heart Association only)

2. Victoria College Allied Health Physical Examination form (completed no

more than 6 months prior to program enrollment).

Please call or email our office if you have any questions regarding the Vocational Nursing

Program. We look forward to assisting you in becoming a Licensed Vocational Nurse.

Most sincerely,

Vocational Nursing Program Coordinators

http://www.victoriacollege.edu/vocationalnursing

Victoria College Vocational Nursing Programs

Cuero Campus

2550 Esplanade, Cuero TX 77954

•

(361) 277-6760

Rebecca

Barfield, Program Coordinator

[email protected]

Sheryl Mueller, Program Secretary

[email protected]

Gonzales Campus

424 E. Sarah DeWitt,

Gonzales TX 78629

•

(830) 672-6251

Karen Bauer Smith, Program Coordinator

[email protected]

Helen Hahn, Program Secretary

[email protected]

Hallettsville Campus

1410 N. Texana, Hallettsville TX 77964

•

(361) 798-2289

Joyce Harper, Program Coordinator

[email protected]

Tricia Grahmann, Program Secretary

[email protected]

Victoria Campus

2200 E. Red River St., Victoria TX 77901

Rebecca Barfield, Program Coordinator

[email protected]

(361) 582-2503

Sheryl Mueller, Program Secretary

[email protected]

Arnett Development Corporation

Diagnostic Entrance Test

DET

The Arnett Development Corporation, Diagnostic Entrance Test is a 148 multiple choice item content test,

divided into four major parts which consist of English, Reading/Comprehension, Critical Thinking and Math.

The DET test was designed to be a diagnostic instrument to evaluate your knowledge level in specific areas and

pinpoint strengths and weaknesses. This test is designed to assess your ability to incorporate material learned

throughout your education and use principles, rules, concepts and facts that have been built on throughout

your educational life.

Categorization of Major Areas of Coverage

English



Spelling



Grammar



Contextual Words



Sentence Structure

Reading



Paragraph & Passage comprehension



Drawing inferences & conclusions



Graph & Chart interpretation

Math



Integers, -, +,

x

, / whole number



Fractions



Decimals



Percents



Pattern Recognition



Word Problem

Critical Thinking

(core competency)



Analysis



Explanation



Inference



Interpretation



Evaluation

(This section is based on your ability to solve problems.)

There are 88 questions in the English category and 60 questions in the Math category for a

total of 148 questions. The time allotted to take this test is two hours and 30 minutes.

Study Materials

Test Taking Tips

Recommended study

material (study guide)

for the DET is

provided. Purchasing

of this study material is

not required. It is

optional. The study

guide can be purchased

at the Victoria College

Bookstore or on-line at

www.arnettce.com

.

1. Do not cram.

2. Get a good night’s sleep the night before the test.

3. Eat breakfast.

4. Dress comfortably.

DET-LVN Program Exam

Schedule 2012-2013

Test Fee-- Cost $30

Reschedule Fee-- $15 (must be paid

in-person at Payment Center by 4PM

the day of the test)



No refunds on testing

Please Note:



You may only take this exam

TWICE

between

September 1

2012and June 1, 2013

.

 Walk-In testing is NOT available.

 Registration fee can be paid in person at the VC-Payment Office or online at www.victoriacollege.edu/

testingcenter. Payment guarantees your seat.

 Retain your payment receipt for your records. Photo ID and Paid Receipt are required to sign-in on test day.

 Be familiar with the computer.

Computer knowledge is needed to take this exam.

 Tests will not be administered during Final Exam testing, spring & Christmas breaks, and government holidays.

 Because of the difficulty of the exam and the limited number of attempts allowed, students are strongly encour-aged to study for the exam. If you wish to purchase a Study Guide, please go to the Victoria College Bookstore web-site: www.victoriacollege.edu/ bookstore

Test will be administered at:

Main Campus

Continuing Education Center

2200 E. Red River, Room 201

Victoria, TX 77901

(unless otherwise noted)

361-582-2589

www.victoriacollege.edu/testingcenter Www.victoriacollege.edu/maincampus

(driving directions)

Gonzales Center

424 E. Sarah DeWitt Drive

Gonzales, TX 78629

830-672-6251

Www.victoriacollege.edu/gonzalescenter (driving directions)

 Please call in advance to check test date availability if you are traveling from outside Victoria County.

 Scheduled dates are subject to change as needed.

 Please bring your Paid Receipt and

PHOTO ID to testing session.

 Please arrive at least 15 MIN BEFORE

test is scheduled to start

 Students who are late WILL NOT be allowed to test and will have to reschedule. All fees apply.

VC Testing Center-Main Campus

Exams scheduled will start promptly at

8:30 a.m.

on the following test dates:

 October 3, 2012  October 17, 2012  November 7, 2012  January 15, 2013  January 23, 2013  January 30, 2013  February 6, 2013  February 20, 2013  February 27, 2013  March 6, 2013  March 20, 2013  March 27, 2013  April 3, 2013  April 17, 2013  April 24, 2013  May 15, 2013  May 17, 2013  May 31, 2013

VC Gonzales Center

Exams scheduled on

FRIDAYS

on the following test dates:

 October 19, 2012 12:30 PM  November 9, 2012 9:00 AM  February 8, 2013 12:30 PM  February 22, 2013 9:00 AM  March 22, 2013 12:30 PM  April 12, 2013 12:30 PM  April 26, 2013 9:00 AM Revised 5-22-12

Please turn to other side of page to complete form.

Revised 4/20/11

***READ THIS FIRST***

INSTRUCTIONS TO

RECORD OF IMMUNIZATIONS

Submit “Record of Immunizations”

by June 3, 2013

, regardless of

whether or not the Hepatitis B series is completed. The 2

nd

PPD test will

not have been given.

The complete Hepatitis B series (or confirmation of serologic immunity test) must be submitted

no later than September 1, 2013.

Immunizations must be current. This includes the DT (diphtheria, tetanus) booster within the

last 10 years, and MMR (measles, mumps, rubella).

The two-step PPD skin test for tuberculosis is required.

1. The first PPD must be within one year of second PPD. This is submitted on this form.

2. The date of the second PPD should be no earlier than July 22, 2013 and no later than

August 7, 2013. The 2

nd

PPD test results must submitted no later than August 12, 2013

and will be submitted separately.

EXCEPTIONS TO IMMUNIZATION REQUIREMENT

(Verification of Immunity/History of Illness)

(a)

Serologic

confirmation

of immunity to measles, rubella, mumps, Hepatitis A,

Hepatitis B, or varicella, is acceptable. This confirmation of immunity must be

validated by a qualified healthcare provider and must include the laboratory report that

confirms

immunity.

(b) A parent or physician validated history of varicella disease (chickenpox) or varicella

immunity is acceptable in lieu of vaccine. A written statement from a physician, or

the student’s parent or guardian, or school nurse, must support history of varicella

Print Name: _____________________________________________ DOB: ______________________

RECORD OF IMMUNIZATIONS

Note: Please provide dates for each requested blank unless otherwise specified and proof of immunity, if applicable.

TETANUS/DIPHTHERIA

: Booster date: ____________________

(One dose of tetanus-diphtheria toxoid (Td) is required within the last ten years.)

MEASLES/MUMPS/RUBELLA:

Two doses of MMR are required:

Dose #1 ___________________ (Immunization received as infant may be used as first dose.) Dose #2 ___________________

OR

Proof of immunity to Rubella by Rubella titer: Immune Status/Date: _________________________ Proof of immunity to Measles by Measles titer: Immune Status/Date: ________________________ Proof of immunity to Mumps by Mumps titer: Immune Status/Date: __________________________

2 STEP PPD TB TEST Note:

TINE TESTS ARE NOT ACCEPTABLE

1. Date of “first” skin test: (NOTE: must be within one year of second test) ________ Reaction: _____mm induration 2. Students must provide evidence of second TB skin test results to program secretary prior to enrollment. If candidate has a positive PPD, has he/she been evaluated for/received INH chemoprophylaxsis? ________________ If previous positive PPD, date of chest x-ray within 6 months of admission date: ________ Chest x-ray report: ________

HEPATITIS B SERIES:

Date of First Dose: _______________________

Date of Second Dose (One (1) month after 1st dose): ________________________ Date of Third Dose (Six (6) months after 1st dose): __________________________

OR Serologic confirmation of immunity to hepatitis B virus: Date: __________________________ Immune Status: __________________

VARICELLA:

Date of 1st dose: ______________________

Date of 2nd dose: _____________________ (Required if 1st dose was given after 13 years of age.)

OR Serologic confirmation of immunity to Varicella virus: Date: _________________________ Immune Status: _________________

OR Complete form “Documenting History of Illness: Varicella (Chickenpox)” Date of Illness: ______________ By signing this document, you, the Healthcare Provider, are validating immune status on any titers reported above. Please attach laboratory results of all titers completed. ***Healthcare Provider signature required.***

___________________________________________________ ____________________________________

Signature of Healthcare Provider Date

A – X Studen

t, Emplo

yee, and Visit

or P arking Studen t and Visit or parking is allo w ed in an y unmark ed space. No permit is r equir ed. Reser ved spaces (Y ello w curb) r equir e emplo yee

permit ($25 fine per viola

tion) Studen ts and visit or s ma y use r eser ved spaces aft er 5:00 p.m. Handic

ap spaces (Blue curb) r

equir

e s

tat

e-issued

permit. ($50 fine per viola

tion)

Parking

E - En

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Museum of the Coas

tal Bend

Ac

ademic Building (AB)

Johnson Hall (JH)

Fine Arts (F

A)

Allied Health (AH)

Johnson S ymposium (JS) Libr ar y (LIB) W elc ome Cen ter/ Studen t Ser vices Building A

Health Sciences Cen

ter (HSC)

Languag

e Building (L)

Sports & Fitness Cen

ter (SPC TR) Studen t Cen ter/Book stor e Con tinuing E duc ation Cen ter (CE C TR) Technology Cen ter (T C) William W ood V oc ational Building (WB) Colleg e Ser vices & T raining Building (CS T) 18 19 UHV W es t UHV Ce nter

Vict

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Univ

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sity of Hous

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CAMPUS MAP

Vict

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and the Univ

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Main En tr ance Exi t Only 1 2 3 4 5 6 7 9 8 10 11 12 13 A B F 17 18 19 C D E1 E2 E3 E4 E5 E6 E9 E G H I I J K L P Q M O S T R 14 15 16

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Red R

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