NURSING APPLICATION CHECKLIST
Before submitting your Nursing Program Application, make sure you have included
ALL
the following
documentation:
Application period is January 1 – March 1 for admission beginning in the fall
Submit an admission application to West Shore Community College available on line @
https://my.westshore.edu/ICS/Admissions/
Eligibility for Math 120 as evidenced by (one of the following)
MTH 051 with a C (2.0) or better
MTH 120 with a C (2.0) or higher, or transfer equivalent, or appropriate test score to bypass
requirement
Pre- Algebra COMPASS score of 40 or higher
ACT math score of at least 16 within the last 5 years
Eligibility for ENG 111 as evidenced by
English Comp I with a C (2.0) or better or equivalent transfer credit
One or a combination of the following within the past 5 years:
o
Successful completion of ENG 051 & ENG 052 must have a C (2.0) or better
o
COMPASS writing score of 74 and COMPASS reading score of 76 or higher
o
ACT English score of 18 and an ACT reading score of 17 or higher
Ensure all OFFICIAL high school and college Transcript/s are on file in the Student Records Office.
Address: West Shore Community College 3000 N. Stiles Road, Scottville, MI 49454
THEN
Submit the Nursing Application available in Student Services/ Nursing Program Office
Attach proof of Completed HESI test.
Attach, if pertinent, documentation of patient care contact (employment)within the past 3 years.
For example a letter from an employer on agency letterhead indicating employment dates and job
responsibilities.
Attach signed background check authorization form
Attach completed point sheet
Student services will accept only completed packets
. If any of the above items are missing,
the application may be considered incomplete and will not be considered for acceptance.
COMPASS scores can be retrieved in the testing center (ph 231.843.5528). Picture ID must be
presented.
West Shore Community College Nursing Program
Application and Point Sheet
NAME________________________________________________________
Section A- High School GPA or Calculated College GPA
(Applicant to provide transcript)Section B - HESI COMPOSITE SCORE
(Average of English Composite & Math scores)Section C – Bonus Points General Education College Coursework
(Coursework transferable for BSN)Section D- Work Experience
(Applicant to provide letter from employer verifying length of employment & duties)SECTION A + SECTION B
+
SECTION C
+ SECTION D
+ 2 POINTS
=
TOTAL POINTS
2 points awarded for In District students.
HIGH SCHOOL GPA (GED SCORE*) CALCULATED COLLEGE GPA
Use for less than 12 college credits USE FOR 12 COLLEGE CREDITS OR MORE 3.90 + (765 - 800) 38 POINTS 3.90+ 40 POINTS TOTAL
3.80 - 3.89 (730 - 764) 36 POINTS 3.80 - 3.89 38 POINTS POINTS
3.70 - 3.79 (695 - 729) 34 POINTS 3.70 - 3.79 36 POINTS _____________ 3.60 - 3.69 (660 - 694) 32 POINTS 3.60 - 3.69 34 POINTS (40 possible points) 3.50 - 3.59 (625 - 659) 30 POINTS 3.50 - 3.59 32 POINTS 3.40 - 3.49 (590 - 624) 28 POINTS 3.40 - 3.49 30 POINTS 3.30 - 3.39 (555 - 589) 26 POINTS 3.30 - 3.39 28 POINTS 3.20 - 3.29 (520 - 554) 24 POINTS 3.20 - 3.29 26 POINTS 3.10 - 3.19 (485 - 519) 22 POINTS 3.10 - 3.19 24 POINTS 3.00 - 3.09 (450 - 484) 20 POINTS 3.00 - 3.09 22 POINTS 2.50 - 2.99 18 POINTS 2.50 - 2.99 20 POINTS OR
HESI ADMISSIONS TEST SCORE
99 - 95 10 POINTS 94 - 90 8 POINTS 89 - 85 6 POINTS
84 - 80 4 POINTS 79 - 75 2 POINTS TOTAL POINTS_________ (10 points possible)
All courses in SECTION C are awarded 1 point for B- or B. An A or A- is awarded 2 points
ANP 230 _______ ENG 111_______ CHM 107 ____ PSY 161______
ANP 231________ BIO 232 ________ TOTAL POINTS ___________ (12 points possible)
Health Care Work Experience Letter must be on Letterhead and experience in past 3 years
6 months – 1 year work experience ________(2 points) 1- 2 years work experience____ ___(4 points) 2+ years work experience________(6 points) CENA certification__________(4 points)
TOTAL POINTS________(10 points possible) *GED Scores listed are 2002 Series GED. If your GED is Pre-2002 or is the 2014 Series please call Christy at 231.843.5834 for additional
West Shore Community College
Criminal Background Check Authorization Form
PLEASE PRINT CLEARLY
Name (Last, First, Middle):___________________________________________________________________ List all other names you have ever used or by which you have ever been known:
(Last, First, Middle):________________________________________________________________________ _________________________________________________________________________________________ Date of Birth (Month, Day, Year):_____/ _____/ _____ Gender: Male _____ Female _____
Race: __________________ (White, Black, Asian or Pacific Islander, American Indian, Alaskan Native, Unknown/Other)
Social Security #:__________________ Michigan Driver's Lic. #_______________________
I CERTIFY THAT I HAVE RESIDED IN THE STATE OF MICHIGAN FOR 3 YEARS OR MORE. I authorize the Michigan State Police, its authorized agent(s), and/or West Shore Community College to conduct a criminal background check, as set forth in Michigan Public Health Code Section 20173 and to release those results to West Shore Community College. I understand and agree that if I am arrested for or convicted of any criminal offenses covered by Michigan Public Health Code Section 20173, I will immediately inform the Director of Nursing and Allied Health. I also understand that if I refuse to authorize a criminal background check, do not pass a criminal background check or am subsequently arrested for or convicted of any criminal offenses covered by Michigan Public Health Code Section 20173, I will not be placed into the clinical component or rotation of any course which requires such clinical components or rotations, and will be removed from any such clinical component or rotation if already placed.
I authorize West Shore Community College to release the results of my criminal background check to any hospital, facility, or other partner healthcare agency which requests the results as a part of fulfilling my education/training requirements, or assessing my qualifications for a clinical component or rotation. I understand that completion of all clinical components or rotations is a graduation requirement, and that a degree will not be granted me if I do not successfully complete all clinical components or rotations.
_____________________________________ ____________________________________
Signature Date
Student Criminal Background Disclosure Statement To be Retained by the Educational Institution
Student Name: ________________________________________ Date of Birth: ________________ Educational Institution Name: ________________________________________________________ Training Program: _________________________________________________________________ 1. I certify that I have not been convicted of a crime or offense that prohibits me from being granted
clinical privileges in a long-term care setting as required by P.A. 27, 28 and 29 of 2006 within the applicable time period prescribed by each crime.
______________________________________ _ _________________________
Signature of Student Date
2. I certify that I have not been the subject of an order or disposition under the Code of Criminal Procedure dealing with findings of “not guilty by reason of insanity” for any crime.
______________________________________ _ _________________________
Signature of Student Date
3. I certify that I have not been the subject of a state or federal agency substantiated finding of patient or resident neglect, abuse or misappropriation of property or any activity that caused my nurse aide certification to be “flagged.”
______________________________________ _ _________________________
Signature of Student Date
4. I have listed below all offenses for which I have been convicted, including all terms and conditions of sentencing, parole and probation and any substantiated finding of patient or resident neglect, abuse or misappropriation of property.
______________________________________ _ _________________________
Signature of Student Date
Conviction/Offense Date of
Conviction/Finding
City State Sentence Date of
Discharge
5. I certify that I have reviewed the list of prohibited offenses as defined in P.A. 27, 28 and 29, and that the above list of my convictions and/or substantiated findings of patient or resident neglect, abuse or misappropriation of property (if any) is true, correct and complete to the best of my knowledge. I also understand that if the information is not accurate or complete, my clinical privileges will be withdrawn immediately. I understand that the facility or educational program denying my privileges based on information retained through a background check is provided immunity from any action brought by a Student due to the decision to remove clinical privileges.
______________________________________ _ _________________________
