NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION

NURSING ASSISTANT PROGRAM

REGISTRATION PACKET

AND INFORMATION

Classes are offered at the following locations:

Superstition Mountain Campus

Signal Peak Campus

Maricopa Campus

Overview - Nursing Assistant Program

The Nursing Assistant Program is designed to prepare students to be eligible for Nursing Assistant Certification through the Arizona State Board of Nursing and, upon certification, to practice in a health care agency as a Certified Nursing Assistant and to master skills required to enter into the CAC Nursing Program. The CAC Nursing Assistant Program Information and Application Packets are available at the college admission and/or advising offices on each campus or may be downloaded on the college website www.centralaz.edu (go to ‘Academics’ – ‘Divisions and Programs’ – ‘Nursing’ – ‘Nurse Assistant Application Packet’).

Applicants seeking to enroll in the Nursing Assistant course HPM 125 should read and print this packet and complete it quickly to ensure enrollment in the class. The completed packet must be uploaded to the certified background website. If you have questions or need assistance, contact the Nursing Office at 520.494.5330 for assistance. Only applicants that have submitted completed Nursing Assistant packets to the certified background website will be allowed to register for the Nursing Assistant Classes. Upon satisfactory completion of HPM 125 Nursing Assistant course, the student is eligible to receive a certificate of completion. Each student must submit a request for a certificate on the last day of the Nursing Assistant program. It should be given to them by the instructor during the last class. Certificates will then be made and placed in the mail to the address you have provided.

REGISTRATION INFORMATION

Those wishing to register for HPM 125 Nursing Assistant Course must submit a Request for Registration form and provide documents via Certified Background following the procedure described below: 1. Carefully read through the procedure for requesting registration into the Nursing Assistant course. 2. If you have questions about the process, you can contact one of the following contacts:

Laurette Smith, 520.494.5330, Nursing Department Secretary Janice Vermiglio-Smith, 520.494.5483, Nursing Assistant Director

3. Complete the following information: a. Request for Registration form

b. Documented proof of all immunizations

c. Copy of both sides of the CPR Health Care Provider Card d. Health Care Provider Signature Form

e. ASSET or COMPASS score, Passing Reading Grade or transcript w/9 credits f. D & S Required Information Form

g. Copy of both sides of a valid driver’s license h. Student Acknowledgement Form

i. Background Check j. Student Checklist

SUBMIT ALL INFORMATION / DOCUMENTS TO CERTIFIED BACKGROUND NO INFORMATION IS TURNED INTO THE NURSING DEPARTMENT

STUDENT INSTRUCTIONS FOR CENTRAL ARIZONA COLLEGE

NURSING ASSISTANT

CertifiedProfile is a secure platform that allows you to order your background check and

medical document manager online. Once you have placed your order, you may use your login

to access additional features of CertifiedProfile, including document storage, portfolio builders

and reference tools. CertifiedProfile also allows you to upload any additional documents

required by your school.

 Required Personal Information

o In addition to entering your full name and date of birth, you will be asked for your

Social Security Number, current address, phone number and e-mail address.

 Immunizations

o Document trackers provide secure online storage for all of your important

documents. At the end of the online order process you will be prompted to upload

specific documents required by your school for immunization, medical or

certification records.

 Payment Information

o At the end of the online order process, you will be prompted to enter your Visa or

Mastercard information. Money orders are also accepted but will result in a $10 fee

and an additional turn-around-time.

Place Your Order

Go to:

www.CertifiedBackground.com

and enter package code: CE37

You will then be directed to set up your CertifiedProfile account.

Results

About CertifiedProfile

Order Summary

Place Your Order

Your results will be posted directly to your CertifiedProfile account. You will be notified if there

is any missing information needed in order to process your order. Although 95% of background

check results are completed within 3-5 business days, some results may take longer. Your order

will show as “In Process” until it has been completed in its entirety. Your school's administrator

can also securely view your results online with their unique username and password.

Measles, Mumps & Rubella (MMR)

-There must be documentation of one of the following:



2 vaccinations



Positive antibody titers for all 3 components (lab reports required)

Varicella (Chicken Pox)

-There must be documentation of one of the following:



1 vaccination



Positive antibody titer (lab report required)

Hepatitis B

-There must be documentation of one of the following:



3 vaccinations



Positive antibody titer (lab report required)

TB Skin Test

-There must be documentation of one of the following:



1 Step TB Skin test



If positive results, provide a clear Chest X-Ray (lab report required)

-Documentation must be within the last year.

Tetanus, Diphtheria & Pertussis (Tdap)

-There must be documentation of a Tdap booster within the past 10 years.

CPR Certification

-Must be the American Heart Association Healthcare Provider course. Copy must be front and

back of the card & card must be signed.

Influenza

Physical Examination

-Provide your physical exam form completed and signed by a medical professional. Exam must

include date.

D&S Required Information Form

-Download, print & complete the D&S Required Information for Certification form and upload

to this requirement.

Placement Score / Transferable Credits

-Placement Scoring showing a passing score of 41 on the ASSET or 81 on the COMPASS Reading

Test



or documented proof of a passing grade in Reading 094



or documented proof of an Official Transcript sent to CAC with 9 or more transferrable

credits.

Drivers License

-Provide a copy of your current Drivers License

Student Acknowledgement Form

-Download, print & complete the Student Acknowledgment form and upload to this

requirement

High School Diploma or GED

I NEED HELP!!!

If you need assistance please contact CertifiedProfile at 888-666-7788 or

[email protected]

and a Student Support Representative will be available Monday-Thursday 8am-8pm, Friday

Process for Notification of Permission for Registration

Completed requests received during registration will be dated and placed in order of receipt. Our Program is based on a first come first serve process.

Once Request for Registration forms and documents are checked for requirements and deemed complete by the Director of the Nursing Assistant program, the student is eligible for registration. The number of available positions in the Nursing Assistant course is limited; students are registered only as space is available. The student will receive permission to register by email via only CAC email accounts. They must take that email to the registrar at the college to register for the class. Once students are notified, students must register within 24 hours. Payment is due at the time of registration.

If the student fails to register within the 24 hours’ time frame his or her slot will be given to the next student on the waiting list.

You may call the office 520.494.5330 to check on placement status if you have not received an email from us by 7 days after you uploaded all required information to the Certified background website.

Additional Information about the Nursing Assistant Program

If you are registered for the Nursing Assistant classes and decide not to attend the program for any reason, you must come to the Admissions office and withdraw in advance of the start date.

Any student not attending class or clinical on the first day will be withdrawn from the course. The Nursing Assistant course has a strict attendance policy and students are expected to attend each class session

Nursing Assistant Uniforms: Students must wear a forest green or hunter green scrub top, forest green or hunter green scrub pants and white shoes. You will be expected to wear your uniform and shoes starting with the second day of class.

Books: Students may purchase course materials prior to the first day of class in campus bookstores. The bookstore staff will tell you which textbooks and classroom materials are required for the Nursing Assistant courses.

COST ESTIMATE FOR THE NURSING ASSISTANT PROGRAM *

HPM125* Nursing Assistant Courses (6 credits x $77.00 Arizona Resident) $462.00 Liability Insurance Included with tuition and fees

Textbooks Approximate $100.00

Background check $76.00

Gait/Transfer Belt (May be required in specific agencies) Cost will Vary $12.00 Stethoscope (optional) Cost will Vary $20.00 Watch with a Second Hand Cost will Vary $10.00 Uniform and Shoes Cost will Vary $70.00 Physical Exam and Immunizations Cost will Vary $100.00 Total Estimated Cost of Nursing Assistant Program $850.00 Upon completion of HPM 125 students are eligible to take the examination for certification as Nursing Assistants administered under the guidelines of the Arizona State Board of Nursing. The cost for obtaining certification is approximately $108.00. Contact the ASBON at

http://www.azbn.gov or 602-771-7800.

REQUIRED DOCUMENTATION INFORMATION

No exemptions to the immunizations or physical assessment requirements are

granted because of the requirements of the clinical sites.

HEALTH RECORDS

Required Immunizations Documentation Submitted to Magnus as follows:

 Documentation of the following vaccinations or having had the disease

 If you have no proof of the vaccinations or having had the disease, you must get a blood Titer Test

 Measles, Mumps, Rubella (MMR)

 To be considered immune (if you were born during 1957 or later): Documentation of having had the disease or vaccinations consisting of 2 doses of live measles and mumps vaccine and at least 1 dose of live rubella vaccine or lab evidence of immunity on a Titer Test is needed.

 To be considered immune (if you were born before 1957) it is recommended that you have 2 doses of MMR vaccine if you are unvaccinated and Titer tests are negative.

 If you do not have any of the above, you will have to have the vaccinations consisting of 2 doses of MMR 4 weeks apart.

 MMR vaccination may be given at the same time as other vaccines.

 Varicella (Chickenpox)

 To be considered immune, you need documentation of 2 doses of Varicella vaccine given at least 28 days apart or history of Varicella or herpes zoster based on physician diagnosis or lab evidence of immunity on a Titer Test.

 If you do not have any of the above, you will need to have the vaccinations consisting of 2 doses of Varicella vaccine 4 weeks apart.

 Varicella vaccination may be given at the same time as other vaccines.

 Tetanus, Diphtheria, Pertussis (Tdap)

 If you have not completed a primary series of 3 doses of tetanus and diphtheria toxoid-containing vaccine, you will need to have the first dose and then the 2nd dose 4 weeks later and the 3rd dose 6-12 months after the second. Tdap (Tetanus, Diphtheria, Pertussis) can substitute for any one of the doses in the 3-dose series.

 If you are under 65 years old, you will need a one-time dose of tdap (Tetanus,

Diphtheria, Pertussis) if you have NOT received Tdap previously. Then you will need Td (Tetanus, Diphtheria) booster every 10 years thereafter.

 Tdap or Td vaccination may be given at the same time as other vaccines.

 Hepatitis B

 To be considered immune, you need documentation of a 3-dose series of hepatitis B vaccine at 0, 1 and 6 month intervals or a positive Hepatitis B Titer Test.

 Turberculosis(Tb) skin test (PPD or Mantoux) and the results within the past 6 months

 You will need a PPD skin test for Tb.

 If the skin test is positive, you will need documentation of a negative chest x-ray within the past 6 months.

 PPD skin test can be given either on the same day as vaccination with live-virus vaccines or 4 to 6 weeks after the vaccination

IMPORTANT:

 Students are responsible for maintaining their own health records including current CPR

certification and proof of negative TB skin tests until completion of the program. Copies of proof of these updates must be submitted to the Magnus website.

 Some places that offer immunizations would be your private physician, the Pinal County Health Department, the Maricopa County Health Department and EVVAX (East Valley Vaccination and Examination Center) in Mesa. Your private physician and EVVAX may offer Titer tests.

 Students are responsible for their medical expenses. CPR CERTIFICATION

You must take a American Heart Association HEALTH CARE PROVIDER CPR Class. CPR certification must include infant, child, and adult, 1 and 2 man rescuer, evidence of the Heimlich maneuver and evidence of a land-based demonstration component. CPR certification must have been completed within the last 12 months. Include a copy of both sides of the CPR card in your Nursing Assistant Packet. You must take the CPR class in person; online class certification is not acceptable.

CPR class dates and locations are available online. Some of the organizations that offer these are CPR instruction.com; American Safety & Health Institute; The Heart Association, local fire departments and the first week of the semester at the CAC campus.

HEALTH CARE PROVIDER SIGNATURE FORM

A health care provider must sign Health Care Provider Signature Form (page 8 of this packet) and indicate whether the applicant will be able to function as a Nursing Assistant student. Health care providers who qualify to sign this declaration include a licensed physician (M.D., D.O.), a nurse practitioner (NP) or physician’s assistant (PA).

If any medical condition exists which may interfere with your becoming a NA, then you may be sent to an independent practitioner for a second opinion. (The student is responsible for the cost).

emotional stress as they undertake responsibilities and duties impacting patients’ lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program prior to making

application.

ASSET OR COMPASS READING TEST

Obtain a copy of the ASSET or COMPASS Reading Test from the Registrar at the college where you took the test. If your score was less than 41 on the ASSET Reading test or 81 on the COMPASS Reading Test, you will need to take and pass Reading 094 prior to enrolling in the Nursing Assistant Class. If you have completed 9 or more transferrable credits at another college, you will need to have those credits transferred by having an official transcript sent to Central Arizona College and including an unofficial transcript showing these credits with your Nursing Assistant Packet.

BACKGROUND CHECK

All students registered for the Nursing Assistant course will be responsible for obtaining a background check from CertifiedBackground. The website address is www.CertifiedBackground.com

WAIVER OF LICENSURE/CERTIFICATION GUARANTEE: Admission or graduation from the CAC Nursing Program does not guarantee obtaining a license or certificate to practice nursing. Licensure and certification requirements and the subsequent procedures are the exclusive right and responsibility of the Arizona State Board of Nursing. Students must satisfy the requirements of the Nurse Practice Act: Statutes, Rules and Regulations, independently of any college or school requirements for graduation. Pursuant to A.R.S. § 32-1606(B)(17), an applicant for professional or practical nurse license by examination is not eligible for licensure if the applicant has any felony convictions and has not received an absolute discharge from the sentences for all felony convictions. The absolute discharge must be received five or more years before submitting this application. If you cannot prove that the absolute discharge date is five or more years, the Board cannot consider your application.

After finishing the Nurse Assistant program, as a part of the certification process, all nursing assistant applicants for certification and licensure must be fingerprinted to permit the Department of Public Safety to obtain state and federal criminal history information. All applicants with a positive history are investigated. If there is any question about eligibility for licensure or certification, contact the nursing education consultant at the Arizona State Board of Nursing (602-771-7800).

Students may be removed from the program based on the following criteria. This criterion is

not all inclusive and may need administrative approval.

1. Stealing

2. Drug Use

3. Certified Background Falsification

4. Breach of Confidentiality

REQUEST FOR REGISTRATION

(PRINT) Name _________________________________________Student ID Number______________________ (PRINT) E-Mail Address (will be used to notify you of your acceptance, Acceptance email will ONLY be sent to your

CAC Email) ___________________________________________________________________________________ Phone: Cell ________________________Day________________________ Evening _____________________ Mailing Address _______________________________________________________________________________ City________________________________________State________________________Zip Code___________ COURSE ID: HPM125 NURSING ASSISTANT

I am requesting (Check one): ____ Signal Peak Campus in Coolidge

____ Superstition Mountain Campus in Apache Junction ____ Maricopa Campus in Maricopa

____ Aravaipa Campus in Winkelman (Spring Semesters ONLY)

1st Choice CRN #_______________

Health Care Provider Signature Form

Applicant Name_______________________________ Student ID Number_________________

(Please Print)

It is essential that Nursing Assistant students be able to perform a number of physical activities in

the clinical portion of the program. At a minimum, students will be required to lift patients (50

pounds or more),, stand for several hours at a time and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement direct patient care. The clinical nursing experience also places students under

considerable mental and emotional stress as they undertake responsibilities and duties impacting patients’ lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program prior to making application.

I believe the applicant _______ WILL OR _______ WILL NOT be able to function as a nursing student as described above.

If not, explain: _____________________________________________________________________________

____________________________________________________________________________________________ ____________________________________________________________________________________________

Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.)

I have read and understand the following requirements for my Certified Nursing

Assistant Course:

(Please initial each line and sign at the bottom)

_____ I understand that I must read my assignments before the start of the first class to be

prepared for my first day of testing.

_____ I understand that I must log on to Blackboard before the first class and read the course

syllabus and curriculum.

_____ I understand that the clinical start time can / will be different than the class start time

based on which clinical facility you may attend.

_____ I understand that I will need to know and remember where my clinical site is after the

Instructor has given out the information.

_____ I understand that due to campus being closed for Holidays (students cannot attend class

or clinicals when the campus is closed) that my end completion date may fall after the semester

has ended.

_____ I understand that there is no guarantees of make-up classes for clinical or classroom

time.

_____ I understand that there are a physical requirements when attending clinical such as

lifting 50 pounds or more, bending, reaching and standing for long periods of time. A doctor’s

note cannot change this requirement. CAC nor the clinical facility will not accept this liability.

____ I understand that if an Influenza vaccination is not available at the time of uploading your

completed packet, that my completed packet will be accepted. I understand that I will be

responsible for fulfilling this requirement before I can attend my clinical site.

D & S Required Information for Certification

Social Security Number: ( - - )

Name:

(Last) (First) (Maiden)

Date of Birth:

(Month) (Day) (Year)

Address:

(Street Address) (Apt. #)

(City) (State) (Zip)

Phone Number: ( )

( )

( )

(Home) (Work) (Cell)

STUDENT CHECKLIST

TO DETERMINE COMPLETENESS OF

NURSING ASSISTANT PACKET

(PRINT) Name _____________________________________Student ID Number___________________

(PRINT) E-Mail Address (will be used to notify you of your acceptance) ______________________________ (CAC Student Email ONLY)

Nurse Assisting rev. 9/15/08

FACULTY CHECKLIST

The following items have been enclosed in this packet:

All immunization records must include:

 your name

 signature of the healthcare provider giving the immunization

 date of immunization

_____ Documented proof of MMR (Measles/Rubeola, Mumps, Rubella) vaccinations or 3 positive titer tests.

_____ Documented proof of Varicella (Chickenpox) vaccination or positive titer test.

_____ Documented proof of a Tetanus/Diphtheria (Td) immunization within the past 10 years.

_____ Documented proof of a TB skin test (PPD) and negative results within the last 6 months or documented proof of a tuberculosis-free status on an x-ray within the last 6 months.

_____ Documented proof of 3 Hepatitis B vaccinations or positive titer test.

Documentation of the first vaccination must be submitted with the packet;

documentation of the second one must be submitted one month after the first vaccination and the third one 4 months after the second vaccination.

_____ Documented proof of a Influenza Vaccination from the current season

_____ Documented proof of CPR Health Care Provider Certification within the last 12 months.  A copy of both sides of the CPR certification card.

_____ Health Care Provider Signature Form signed by Physician or Physician’s Assistant or a Nurse Practitioner _____ Placement Scoring showing a passing score of 41 on the ASSET or 81 on the COMPASS Reading Test

or documented proof of a passing grade in Reading 094

or documented proof of an Official Transcript sent to CAC with 9 or more transferrable credits. _____ D & S Required Information for Certification Sheet

_____ Student Acknowledgement form Signed _____ High School Diploma or GED

_____ Front and back copy of your valid Driver’s License

_____ Printed receipt for online background check from www.certifiedbackground.com