APPLICANT INFORMATION AND APPLICANT PACKET by zu9Iq1

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									APPLICANT INFORMATION AND APPLICANT PACKET
    ASSOCIATE DEGREE NURSING PROGRAM

                        2009-2010
      Applications Must be Completed when submitted!!!!!
      Incomplete Applications WILL NOT be accepted!!!!!!
       Readmitting paperwork must be updated yearly!!!!




                 Health Science Department
                      Chipola College
                     Marianna, Florida
                       (850)718-2316



                              1
Please use the provided checklist to ensure that ALL information is submitted at ONE time.
It is the student’s responsibility to make sure program admission requirements are met and
information is on file in the Health Science Department office. All applicants are required to
submit a completed application each year. Satisfactory completion does not guarantee entry into
the nursing program.

Requirements                        Completed                            Notes
Application to the College
   Official Transcripts to
         Admissions
 ***Transcripts to Health
          Sciences
        HESI Score
       Physical Exam
          Notarized
Emergency/Medical Release
         Payment to
  www.chipolachecks.com
        Drug Screen
    Background Check
    Fingerprint Check
        PPD/TB test
         Hepatitis B
       MMR 2 Dates
          Varicella
             TD
     Health Insurance
LPN only-
        LPN License
      LPN Transcript
            CPR



Applications must be submitted with all the information included, partial applications will
not be accepted or reviewed until all materials are present.

The checklist is provided in order of importance:
Applying to the college and providing admissions with official transcripts is the first and
most important step.




                                               2
                                             RO04/09
                                   CHIPOLA COLLEGE
                                HEALTH SCIENCE PROGRAMS

               ASSOCIATE IN SCIENCE DEGREE PROGRAM IN NURSING

The Associate in Science Degree Program in Nursing prepares the student to take the National
Council Licensure Examination for Registered Nurses (NCLEX-RN.) The successful passing of
this exam enables the student to practice as a registered nurse. After successful completion of
the first three semesters in the program, an individual can be eligible to take the National Council
Licensure Examination for Practical Nurses (NCLEX PN.) Successful passing of this exam
enables the student to practice as a licensed Practical Nurse (LPN).

Progression in the program is sequential and contingent upon satisfactory completion ("C" grade
or above) of each course (nursing and academic) within the nursing curriculum and satisfactory
completion of nursing skills laboratory examination. Any score below 75% in a nursing course
will be considered unsatisfactory. A more detailed description of grading and retention policies
is provided in the Nursing Student Handbook. A student who does not achieve a passing grade
or withdraws from a nursing course may apply to repeat that course only once on a space
available basis. Reentry would be at the beginning of the failed course on a space available
basis. All re-admissions will be required to successfully complete a clinical skills examination, a
90% math test, and all other admission requirements.




                                                 3
                        LPN Articulation to College Credit

    The Licensed Practical Nurse (LPN) has the opportunity to become a
    professional nurse and meet the education criteria for the registered
    nursing license examination. Students entering the Associate Degree
    Nursing (A.D.N.) program licensed as a LPN must:

           Hold either a valid certificate of LPN Licensure or
            evidence of successful completion from an approved
            practical nursing program pending results of LPN
            licensure examination (as determined by Dean of
            Enrollment.)


    All students following this option for the A.D.N.Program must also
    successfully complete, with a grade of “C” or higher:
                   ENC 1101
                   MAT 1033 or MAC 1105
                   MAC 1105 College Algebra by 4th Semester
                   PSY 2012 General Psychology
                   BSC 2093 Anatomy and Physiology I
                   BSC 2093L
                   DEP 2004 Human Growth and Development
                   BSC 2094 Anatomy and Physiology II
                   BSC 2094L
                   MCB 2010 Summer Session I


    The following procedures will be followed:

   Student must enroll in, and successfully complete with a grade of “C” or
    higher, all courses listed above

   Student must successfully complete the first semester of the second year of
    the Chipola College Nursing Program, and be eligible to continue (both
    academically and by the standards of the AS/RN Program) for the final
    semester of the Nursing Program.

   Upon successful completion of the above - students will request the
    Articulation Analysis Form be completed by the Dean of Enrollment


                                        4
          Services indicating the course equivalencies for the LPN articulation and
          credits will be posted to the student transcript.

          Upon successful completion of all of the above criteria students will receive
          credits equivalent to first year Nursing courses at Chipola College, as
          determined by the Dean of Enrollment Services.

         A grade of “P” for passing will be assigned to all course equivalencies. No
          grade points will be assigned for “P” credits.




LPN Admittance to Health Sciences

LPNs are admitted with advanced standing upon meeting the following criteria:

(1)       Hold valid LPN license;
(2)       Meet admission requirements;
(3)       Complete prerequisite courses; and
(4)       Successfully complete a clinical skills examination.

LPN Transition students will then begin on a space available basis. In the event that there are
more eligible LPN Transition students than there is space available, selection for admission will
be based on the composite sum of selection criteria.
Students wishing to transfer from another school must meet all the criteria and will be evaluated
individually for advanced placement. In addition, challenge examinations and clinical skills may
be evaluated. Students wishing to transfer must provide a letter of good standing from the
previous nursing program to qualify for admission.

       A student may not earn more than two grades below “C” in nursing coursework to
        include grades earned at ALL institutions.




                                                  5
Admission Requirements
To be considered by the college for admission to the nursing program, applicants must satisfy the
general college-wide admission requirements and meet the program's entry requirements.


I. General Requirements: (ALL APPLICANTS)
Entering freshmen or transfer students seeking admission to Chipola College must:

A. Request an Application for Admission Form from the Registrar's Office.

B. Complete and submit the signed Application for Admission Form to the Registrar's
   Office.

C. Send a copy of high school transcript and all college transcripts DIRECTLY to the
Registrar's Office and Health Science Office. Applicants with a GED or equivalency diploma
must submit a copy of the diploma to the Registrar's Office.

Transfer students must submit an official transcript(s) of all college work to the Registrar's
Office AND the Health Science Department at Chipola College. This transcript must be on file
in both offices two months prior to the beginning date of the entering semester. (See Transfer
Policies pg.8)

Students entering the Nursing Program must have fulfilled the general college admission
requirements regarding Entrance Testing (See CC catalog).

II. Program Requirements: (ALL APPLICANTS)

   A. All applicants must submit a completed application for the Nursing Program to the
      Health Science Department at the College. Application forms may be obtained in the
      Health Science Department or downloaded from Chipola College Website. Application
      deadlines are May 15 for fall admission and September 15 for spring admission.

   LPN application deadlines are April 15 for summer session I and May 15 for summer session
   II admission.

NOTE:
It is the student's responsibility to make sure program admission requirements are met and
information is on file in the office of the Health Science Department by the application
deadline. Transcripts must be on file in the Registrar's Office and in the Health Science
Department. IT IS THE STUDENT'S RESPONSIBILITY TO ENSURE STUDENT
TRANSCRIPT/S ARE ON FILE.




                                               6
   B. All applicants are required to take the Pre-Admission Examination published by the
      Health Education Systems, Inc. (HESI). Further information concerning cost, testing
      dates and time, etc., may be obtained from the Testing Center (850) 718-2284.

   C. Applications for all Health Science Programs must be free of offense that would
      disqualify one for employment as a Certified Nursing Assistant (CNA) in a nursing home
      (Florida Statutes s.400.211). This policy is the result of requirements by clinical agencies
      in compliance with states and federal regulations. If a facility refuses access to a student
      a student at any time in the program the student will not be able to meet the clinical
      requirement and therefore cannot progress and will receive a grade of “F” for the nursing
      class for which they are currently enrolled.

Each application must be screened through Federal Bureau Investigation (FBI).
Judgment of guilty or pleas of nolo contendere (no contest) to the following crimes will
disqualify applications from entering into any Health Occupations program: murder;
manslaughter; vehicle homicide; killing of an unborn child by injury to the mother; assault; if the
victim of the offense was a minor; aggravated battery; kidnapping; false imprisonment; sexual
battery; prohibited acts of persons in familiar of custody authority; prostitution; lewd and
lascivious behavior; lewdness and incident exposure; arson; theft, robbery, and related crimes, if
the offense is a felony; fraudulent sale of controlled substance, only if the offense was a felony;
incest; abuse or neglect of a disabled adult or elderly person;; exploitation of disable adult or
elderly person; aggravated child abuse; negligent treatment of children; sexual performance by a
child; obscene literature; drug offenses which were a felony or if the offense involved a minor;
has not been judicially determined to have committed abuse or neglect against a child as defined
in s.3901(2) and (47); does not have a confirmed report of abuse, neglect, or exploitation as
defined in s. 415.1075 or s.415.504; does not proposed confirmed report that remains unserved
and is maintained in the central abuse registry and tracking system pursuant to s.415.1065(2)(c);
and has not committed and act that constitutes domestic violence a defined in s.714.128.

Applicants must complete and submit the American
Data Bank Student Background Check that includes a
urine drugscreen and FBI fingerprint review.
Applicants must enroll online at
www.chipolachecks.com.
Exemptions from disqualification can be granted. The law states that a period of at least three
years must have passed without repeated offenses, in order to clear disqualification. In addition,
one must meet any other requirement to be eligible for licensure or certification by the State of
Florida.



                                                 7
While enrolled in a Chipola Health Science program, the student is also responsible for notifying
the program director of any arrests, regardless of adjudication, that occur after acceptance and
during enrollment in a given program. Failure to promptly notify the program director shall be
grounds for dismissal from the program.

After admission into the program of choice, the student must remain free of disqualifying
charges or may be subject to dismissal from the program.

All students enrolled in a health related program are required to be drug and/or alcohol free when
at the college and while at "affiliating agencies" (including parking lots and grounds).

For all "affiliating agencies” which require students to be subject to the agency’s Drug Testing
Policies when there is reasonable suspicion to believe a student may be impaired, or is using or
has used illegal drugs and/or alcohol, the student may be tested in accordance with the
"affiliating agency's" policies and will be responsible for expenses incurred. If tested by an
"affiliating agency" the student shall provide his/her program coordinator with a copy of any test
results. Failure to promptly do so shall be grounds for dismissal from the program.

Admitted students must remain drug-free throughout the tenure in their program at the college.
Failure to do so shall be grounds for dismissal from the program. Any student who has been
arrested for any offense other than a minor traffic violation should be aware that the Florida
Board of Nursing will require information about that arrest record before that student will be
permitted to take the licensure examination upon graduation from the program. A Federal
Bureau Investigation (FBI) background check will be completed on each applicant. The Board
will not consider any individual's record before that applicant graduates from a nursing program
and applies to take the licensure examination. Chipola College cannot guarantee that any
graduate will be allowed to take the licensure examination.

   D.     All applicants who are applying for the ADN program are required to complete the
        Chipola College admission, submit a completed Physical Examination form including
        immunization, complete required background screening, and submit current verification
        of CPR (Cardiac Pulmonary Resuscitation) Health Care Provider Level Certification to
        the Health Science Department. Classes can be scheduled through Chipola College's
        Continuing Education Department (850) 718-2297 or your local fire department.
        Therefore, please make your appointment for the physical examination well in
         advance so you can submit your examination form to the program.

E. CORE PERFORMANCE STANDARDS FOR PROGRESSION IN THE PROGRAM

All students admitted into the program will be required to submit a physical examination form
indicating that they are capable of meeting the "core" performance standards. Every effort will
be made to accommodate special needs of students with disabilities who are otherwise capable of
meeting those standards.


                                                8
These Core Performance Standards are:
1. Critical thinking ability sufficient for clinical judgment.
2. Interpersonal abilities sufficient to interact with individuals, families, and groups from a
   variety of social, emotional, cultural, and intellectual backgrounds.
3. Communication abilities sufficient for interaction with others in verbal and written form.
4. Physical abilities sufficient to move from room to room and maneuver in small spaces.
5. Gross and fine motor abilities sufficient to provide safe and effective nursing care.
6. Auditory ability sufficient to monitor and assess health needs.
7. Visual ability sufficient for observation and assessment necessary in nursing care.
8. Tactile ability sufficient for physical assessment.

   F. All applicants must provide proof of current enrollment in a healthcare insurance
      program.
   G. Prior to admission, students must provide verification of current immunization for
      measles, mumps, rubella, chickenpox, hepatitis B, and tetanus, as well as evidence of
      a recent tuberculin skin test.
   H. Applicants must complete and submit the American Data Bank Student
      Background Check including a urine drug screen and FBI fingerprint review.
      (www.chipolachecks.com)
   I. Students accepted into the program must be eligible to enroll in Anatomy &
      Physiology I (BSC 2093) either by successfully completing BSC 1005 or receive
      departmental approval.

III. Selection Criteria
The total number of enrollees in the nursing program is regulated by the Board of Nursing and
limited to faculty and clinical availability. Objective criteria are utilized to assess each
applicant's academic ability for matriculation through each level of the program. Points are
awarded for achievement in each of the areas assessed. Selection for admission into the nursing
program will be determined by a composite score derived from these points.

Students must apply to the college through admissions AND the nursing program at the same
time, in order to allow for all transcripts to be posted on NWRDC.

For selection into the Nursing Program:
   All academic transcripts will be reviewed according to the following factors: Breadth,
       depth, and rigor of course content as evidenced by course description, prerequisites,
       writing or oral communication requirements, and cumulative GPA. A minimum grade
       point average of 2.5 MUST be maintained in ALL courses required in the nursing
       curriculum. A cumulative GPA must be at least 2.0.
   The HESI composite score ( must be at least 75% to qualify for admission)
   No admission holds or sanctions.
   Application file complete


                                                 9
Student scores will be ranked from the highest to lowest. Acceptance into the Nursing Program will be
determined by selecting students with the highest number of points and progressing until all available
slots are filled. In the event of applicants with identical selection scores, students who have completed
the most academic course work toward the degree will be chosen.

Students selected for the class will be notified by letter. An alternate list will be formed including
applicants given the next highest consideration. If vacancies occur those applicants on the alternate list
will be accepted and notified in the same manner. Acceptance will be tentative until such time as all
requirements are met, the student file is complete, and registration fees are paid.

IV. Grading Policies:

Students will be graded on a pass (75% or higher) /fail (below 75%) basis for the clinical portion of each
Nursing course including skills laboratory examinations. A failing grade in clinical or skills laboratory
automatically results in a "F" for the course regardless of the theory grade. If the clinical grade is
satisfactory, the student will receive the grade he/she earned in theory.

Grading Scale for Nursing Courses:

        A 93-100
        B 83-92
        C 75-82

Below "C" is unsatisfactory for progression in the Nursing Program
Students who do not successfully complete a nursing course with at least a 75% will not be allowed to
progress in the nursing program. Students who do not complete in the designated semester a required
academic course with at least a “C” will not be allowed to progress in the nursing program.

Re-admission to the nursing curriculum will be on a space available basis. If the class is not full (40) and
if more than one person is applying to re-enter the program, re-admission will be based on the highest
numerical grade average achieved by the persons involved or the program selection score.

If you are enrolled in non-nursing academic courses, you are encouraged to complete those courses,
which will give you a lighter course load upon re-admission to the nursing courses.
All associate of science nursing students must complete the required academic courses with a grade of
“C” or higher.


 Transfer Policies:
Any student wishing to transfer college credit from another institution to Chipola College's Nursing
program must submit an official transcript to the Registrar's office and to the Health Science Department.
Applications of transfer students will be evaluated on an individual basis by the Nursing faculty and the
Registrar's Office prior to admission to CC's Nursing program. Each transferred course will be evaluated
as to its ability to meet the requirements of the CC Nursing program. All transfers are required to pass a
clinical skills examination, a 90% math exam, and meet all other delineated requirements. Admission is
on a space available basis.



                                                     10
Student Expenses:

      Tuition and Fees are due on the designated date on student’s registration receipt. Dates
       for tuition/fees may vary from student to student. Please pay attention to your own
       receipt date. Failure to pay by the designated date will result in the student being
       dropped from the Peoplesoft system and therefore loss of the class/clinical site will result.
       The student will be required to re-register. Note: The student is responsible for seeing
       that agency/financial aid meets the fee deadline as loss of the class/clinical site is the
       result. Failure to follow-up will result in the inability to attend class/clinical resulting in
       an absence.
      Designated nursing courses have laboratory fees as indicated in the catalogue. These fees
       are added to each session’s registration fees. It is your responsibility to see that the
       Financial Aid office is aware of this when paying fees.

    SCHOLORSHIPS/FINANCIAL AID/SPECIAL TUTION SUPPORT PROGRAMS

IT IS THE STUDENT’S RESPONSIBILITY TO MAKE SURE THETUITION/FEES
ARE PAID BY THE AGENCY OR COLLEGE FINANCIAL AID DEPARTMENT BY
THE DUE DATE ON THE REGISTRATION FORM. Students cannot attend clinical if
dropped from the college system. Loss of a clinical slot is the result and students will have
to re-register.

Students who obtain a Pell Grant, Stafford Loan, and/or Federal Supplemental Educational
Opportunity Grant may be required to refund to the Department of Education a portion or all of
their financial aid if they withdraw completely from classes before the 60% of the semester has
been completed (see College Catalogue or contact Financial Aid on campus for details).

There are many scholarship opportunities offered for Nursing Students after completion of the
first semester of Nursing.




                                                 11
Diagnostic Testing:
A pharmacology calculation test designed to evaluate a student’s ability to accurately determine
drug dosages will be administered each semester. If 90% accuracy is not attained after the third
attempt, the student will be given the option of withdrawing or receiving a “F” in the course.

90% Calculation exam will be given each semester in the following courses:

Semester One: Fundamentals
Semester Two: Basic Med Surg
Semester Three: Mental Health
Semester Four: Advanced Concepts Med Surg
Semester Five: Med Surg Critical Concepts

Students will be required to take Health Education Systems, Inc., (HESI) nationally normed tests
throughout the curriculum. Required remediation must be completed. In the last semester of the
curriculum, students will be required to take a comprehensive exit exam and make a benchmark
level score on such exam prior to graduation. Please refer to handbook for comprehensive
explain under the section titled Standardized Testing.




                                               12
                                               Fall Semester Admission
Prerequisites
SLS   1101                                 1
ENC 1101                                   4
MAT 1033/MAC 1105                          3
PSY 2012                                   3
BSC 1005                                   3
BSC 1005 3cr hrs-required by Science Dept or permission to progress (see Bldg C, Room 6 for more details)


1ST Semester –Fall
NUR 1020C Fundamentals                     6
NUR 1141 Pharmacology 1                    1
BSC 2093C A&P1/LAB                         4
DEP 2004    Human Growth & Dev            3
                            Total:        14



2nd Semester-Spring
NUR 1211C Basic Med Surg                         7
NUR 1422C     Basic OB                          2
NUR 1312C     Basic Peds                        2
BSC 2094C     A&P II/Lab                        4
                                 Total:         15

3rd Semester-SSI                                                                      3rd Semester-SSII
NUR 2522C Mental Health               3                                  NUR 1280C     Geriatrics             1

MCB 2010      Microbiology Lab        4                                  NUR 1010    Professional Seminar I   1

                            Total:                   7                                           Total:       2

4th Semester- Fall
NUR 2212C Advanced Concepts Med Surg     6
NUR 2142 Pharmacology II                 2
Humanities Elective*                     3
MAC 1105 College Alg*                   3
                                  Total: 14


5th Semester Spring
NUR 2291C Med Surg Critical Concepts 7
NUR 2450C Advanced Concepts OB        2
NUR 2350C Advanced Concepts Peds      2
NUR 2810 Professional Seminar II      1
                               Total: 12
                    Total Nursing Completion=72 hours
                                                            Grand Total Credits Required: 72-Any college
preparatory or other prerequisite courses for placement must be satisfied prior to enrollment in these courses. This
also applies to students entering LPN/RN tract. *Students may choose a course from any of MUL 2010, MUE 2290,
THE 2014, or any arts class. See catalog regarding English 1101 requirements.




                                                                    13
                                                    Spring Semester Admission
Prerequisites
SLS   1101                                  1
ENC 1101                                    4
MAT 1033/MAC 1105                           3
PSY 2012                                    3
BSC 1005                                        3
BSC 1005 3cr hrs-required by Science Dept or permission to progress (see Bldg C, Room 6 for more details)
                                 Total: 14


1ST Semester –Spring
NUR 1020C Fundamentals                      6
NUR 1141     Pharmacology 1                 1
BSC 2093C       A&P1/LAB                    4
DEP 2004     Human Growth & Dev             3
                                Total:                      14

2nd Semester-SSI                                                 2nd Semester-SSII
NUR 1280C Geriatrics                   1                         NUR 2522C     Mental Health          3
NUR 1010 Professional Seminar I        1                                              Total:          3
BSC 2094C A&P II                       4
                      Total:           6

3rd Semester-Fall
NUR 1211C     Basic Med Surg           7
NUR 1422C     Basic OB                 2
NUR 1312C     Basic Peds               2
MCB 2010 Microbiology/Lab              4
                       Total:          15

4th Semester-Spring
NUR 2212C Advanced Concepts Med Surg                    6
NUR 2142     Pharmacology II                            2
Humanities Elective*                                    3
MAC 1105 College Alg*                                   3
                                           Total: 14

5th Semester SSI                                                      5th Semester SSII
NUR 2291C Med Surg Critical Concepts 7                                     Continues
NUR 2450C Advanced Concepts OB                      1
NUR 2350C Advanced Concepts Peds                    3
NUR 2810     Professional Seminar II            1
                                                Total: 12                       Total Nursing Completion=72 hours
                                                               (Not including BSC 1005=required by Science Dept)
Grand Total Credits Required: 72-Any college preparatory or other prerequisite courses for placement must be
satisfied prior to enrollment in these courses. This also applies to students entering LPN/RN tract. *Students may
choose a course from any of MUL 2010, MUE 2290, THE 2014, or any arts class. See catalog regarding English
1101 requirements.

                                                                           14
                                         CHIPOLA COLLEGE


                              NURSING PROGRAM
                                 Student Application

Please Indicate:
Beginning Student ____
Transfer Student ____
LPN Transition    SSI___ SSII___



                                                                             Date:

1. Name:
      Last                  First               Middle               Maiden

2. Completed CC Application for Admission         yes  no
3. Social Security Number ___________________________

4. *Florida Resident   yes     no             County _________________

5. Permanent Home Address__________________________________________________
                            Street                  City        State       Zip
6. Present Mailing Address ___________________________________________________
                            Street/P.O. Box #       City        State       Zip
7. Permanent Phone No.   (         )-      -          Local No.(   )-    -

8. Email Address ______________________________________

9. Name and location of secondary (high) school from which you
   graduated or will graduate:




                                                  15
10. List below all colleges or post-secondary schools you have attended:




NAME OF SCHOOL                DATES                  DEGREES EARNED     CREDITS
AND ADDRESS                   ATTENDED               REASON FOR LEAVING EARNED




11. Have you ever attended another Nursing Program? yes                    no
    If yes:
    Where: __________________________________________



12. Do you possess current licensure as a practical nurse?   yes    no

13. If employed, state briefly your area of work assignment:




14. Previous work experience:



ORGANIZATION                  TYPE OF WORK                   DATES




                                               16
I understand and agree that I will be bound by the College's regulations as published in the
college catalog and the nursing student handbook.

I understand that by completing this application, I am not guaranteed admission into the
program.

I understand that a FBI Report and Drug Screen are required as part of the application process. I
further understand that if the drug comes back positive or if there is a problem with the FBI
Report, I may not be accepted into Nursing program.

I certify that the information given in this application is complete and accurate and understand
that any misrepresentation of facts may result in immediate dismissal from the Nursing Program.




______________________________________________
Applicant's Signature         Date




                                                17
                                          CHIPOLA COLLEGE
                                       HEALTH SCIENCE PROGRAMS

                                         HEALTH RECORD NOTICE

PLEASE READ CAREFULLY!!
Attached is the health form that must be completed by ALL students applying to the nursing
programs. Clinical agencies used by the program you have selected require that students be free
from physical, mental, and communicable diseases. Students must see a medical doctor (MD or
DO), Nurse Practitioner (ARNP) or Physician Assistant (PA) who will conduct a physical
examination and complete/sign the attached forms. Students are responsible for cost of the
physical exam and immunizations.

You must submit your health form with your application. Failure to submit the health
form will prevent you from being considered as a candidate for admission.

The Health Record Form (History, Physical, TB Skin Test, and Record of Immunization namely)
are to be completed with your application. Students in two-year programs must submit a TB
Skin Test each year.

All students must provide evidence of current enrollment in a healthcare insurance program.

Read the Health Record Form carefully. You must have:
1. Documentation of ALL immunizations:
       a. Take documentation of past immunization to your physician; without
       documentation, the physician will not be able to complete the form.
       b. If your immunization record is incomplete, consult the Health Department or your
       practitioner BEFORE scheduling your physical. Many of the tests or immunizations
       must be completed before you get your physical. Evidence of current immunity is
       required.

2. Verification that you perform the following necessary occupational activities: walking,
standing, sitting for long periods; stooping, lifting patients; squatting, reaching, twisted, bending,
pushing/pulling/dragging, climbing, and manual dexterity. This health information will NOT be
used to prevent your entrance into the program.

DO NOT WAIT UNTIL THE LAST MINUTE TO MAKE AN APPOINTMENT FOR A
PHYSICAL.



                                                 18
                                    Health Science Programs
                                        Chipola College
                                       Marianna, Florida


                                   HEALTH CERTIFICATE


NAME OF APPLICANT:

Last                              First                    Middle                Maiden

Social Security # ________________________ Telephone No. ____________________

PRESENT ADDRESS:

Number                Street              City            State/Zip              County

EQUAL OPPORTUNITY DATA/OPTIONAL                           (This information is gathered for
statistical and reporting purposes only and does not in any way affect your candidacy for
program admission.)




Number of Children:            Ages:         ,        ,

Name of person to be notified in case of Emergency:

Address:                           Phone#:                      Relation:




                                                 19
MEDICAL HISTORY: The following section should be completed by the student and
reviewed by a physician or advanced registered nurse practitioner (ARNP). Please list
conditions or diseases which you have had or have now. Include the year beside each one and
any additional information as needed below the list.

Drug Allergies


Routine Medications


                           HOSPITALIZATION OR SURGERY
Reason/Date
______________________________________________________________________________
______________________________________________________________________________


                                PAST MEDICAL HISTORY

   Rheumatic Fever                     Allergies/Hay Fever                 Gout
   Venereal disease                    Asthma                              Thyroid Disease
   Tuberculosis (TB)                   Chronic Rashes                      Bleeding Disorder
   Bronchitis                          Ulcer                               Lung Disease
   Hepatitis                           GI Disorder                         Cancer
   Anemia                              Gall Bladder Disease                Seizures
   Scarlet Fever                       Prostate Disease                    Varicose veins
   Heart Disease                       Bowel Irregularity                  Back Problems
   High Blood Pressure                 Sexual/Menstrual Dysfunction        Arthritis
   Complicated Pregnancy               Nervousness                         Stroke
   Depression                          Mental Illness                      Glaucoma
   Diabetes                            Kidney Disease                      Tobacco Use
   Frequent Infections                 Shortness of Breath                 HIV
   Heart Palpitations                  Heart Murmur                        Chest Pain
   Dizziness/Fainting                  Peripheral vascular disease      Other

The above statements are true to the best of my knowledge.

_______________________________________________
Signature/Date




                                             20
                               CHIPOLA COLLEGE
                           HEALTH SCIENCE PROGRAMS

                       ~STUDENT HEALTH INFORMATION~

THIS FORM MUST BE SIGNED BY A PRACTICING, LICENSED MD, DO OR ARNP

STUDENT NAME:______________________________SS#:_____________________
PROGRAM:___PN ___RN                                         DOB_____/_____/______
ALLERGIES (FOOD, MEDICINES, OTHER):_________________________________
_______________________________________________________________________
PERSONAL MEDICAL HISTORY: Do you have current or past problems in the following
areas? (If the answer is Current or Past, please explain in the space below.)

PROBLEM          CURRENT   PAST    NONE        PROBLEM            CURRENT   PAST    NONE

Emphysema                                     Loss of Extremity
Bronchitis                                    Prosthesis
Asthma                                        Skin Lesions
Tuberculosis                                  Shingles/whitlow
Diabetes                                      Back problems
Hypertension                                  Surgeries
Epilepsy                                      Varicose Veins
Syncope                                       Substance Abuse
Arthritis                                     Emotional
                                              Disorder
**Chicken pox                                 Psychiatric
                                              Disorder
Tumors/growths                                Immunosuppres-
                                              sion
Blood Disorder                                Hear condition
STD                                           Heart murmur
Hepatitis                                     Pacemaker
Vision                                        Valve Prolapsed
Hernia                                        Hearing




                                         21
PHYSICAL EXAM:

To be completed by student's physician or ARNP.

Height         Weight          B/P     /    Pulse Rate          Rhythm

Eyes ____________________________________________

Ears __________________________________________

Nose, Throat, Mouth, Neck ______________________________________

Chest ________________________________________________________

Lungs _______________________________________________________

Heart ________________________________________________________

Abdomen ____________________________________________________

Back/Spine ___________________________________________________

Extremities ___________________________________________________

Does the student have any active disease or is any treatment being followed which should be
periodically checked? If so, explain:

Is he/she taking any routine medications? Y N _
If so, please list type and amount: ________________________________

Other Conditions (please list):
______________________________________________________________________________
__________________________________________________________________
EXPLANATION (of the above conditions please attach additional sheet if necessary)
________________________________________________________________________

SPECIFIC PHYSICAL
LIMITATIONS:__________________________________________________________
________________________________________________________________________

CHRONIC THERAPY: (ex: Physical therapy, Hemodialysis, Chemotherapy)
____________________________________________________________



                                              22
IMMUNIZATION STATUS:

Provide a copy of personal immunization record. Required immunizations include MMRx2,
Varicella, Hep B, Tetanus (within 10 years), and a TB skin test (PPD-annual).

**Hepatitis B vaccination is NOT required if student signs waiver releasing CC and hospitals
from liability.



TEST RESULTS:
                      N/A DATE                    OTHER
TB Skin Test         ___ ______         Within Normal Limits  YES  NO
(or Chest X-ray)     ___ ______         Within Normal Limits YES NO

GENERAL HEALTH:

In my opinion, this applicant is free form from communicable disease and will not compromise
the immunosuppressed patients with who they will come in contact. The applicant’s physical and
mental health is compatible with that required for the nursing program. The applicant is able to
perform the following occupational activities: walking, standing, and sitting for long periods;
stooping, lifting patients, squatting, reaching, twisting, bending, and pushing / pulling/dragging,
climbing, and manual dexterity skills.

__________________________________           _____________________________
Printed Name of MD, DO, PA or ARNP           Date of Exam

__________________________________           ____________________________
Signature of MD, DO, PA or ARNP              Professional License Number




                                                23
                                     MEDICAL RELEASE

To be completed by ALL students. This MUST BE notarized!

I grant permission to the Health Department or the local hospital or medical doctor to render
emergency treatment to me that might be deemed necessary.

I understand that I am responsible for any costs incurred and the College is not financially
obligated.


                                      Signature of student, parent, or guardian
                                      (In ink in the presence of Notary Public)

                                      Sworn to and subscribed to me this ______
                                      day of          , 20 ______

                                      ____________________________________
                                      Signature of Notary Public




                                                24
                               Chipola College Testing Schedule
                                      Nursing Program

Chipola College Testing Center will host the Health Education Systems, Inc. (HESI) test (the
English and Math sections) Tuesday and Thursday from 8-1:00 p.m. in the Student
Services/Administration Building. No appointment is necessary. Photo ID required. This test is
part of the pre-admission criteria and must be taken prior to filing for admission to the program.
There is a $30.00 fee for the test.

If you have any questions, contact the Testing Center (850) 718-2284.




                                                25
                                    ACADEMIC COURSES


ENC 1101 Communication Skills I (4 credit hours)
Prerequisite: Acceptable placement scores in writing (or a grade of “C” in ENC 0004 or ENC
0005) and/or score of 17 on the English Enhanced ACT and 18 on the reading Enhanced ACT.

English composition, a course designed to prepare a student to write successfully throughout his
four-year college career. The assignments deal with narrative, descriptive, expository, and
argumentative writing. A documented essay is required, and the total amount of writing required
fulfills the requirements of the Communication Skills Law. A "C" grade or higher must be
earned to advance to a higher-level English course or to use this course as part of the general
education requirements in English.

PSY 2012 General Psychology (3 credit hours)

This course is designed to give the student an adequate foundation in the field of psychology; to
provide an understanding of human behavior and to enable the student to adapt himself to his
physical and social environment. This is the prerequisite course for all advanced courses in
psychology. It is recommended that this course be pursued only after completion of one
semester in college study.

MAC 1105 (3 credit hours)
Prerequisite: At least one year of high school algebra and an acceptable score on a state
approved mathematics placement test, or a “C” or higher in MAT 1033.

This course is primarily a conceptual study of functions and graphs, their applications, and of
systems of equations and inequalities. Linear, quadratic, rational, absolute value, radical,
exponential and logarithmic functions will be investigated. A graphing calculator is required for
this course.

MAT 1033 (3 credit hours)
Prerequisite: An acceptable score on a state approved mathematics placement test and successful
completion of the equivalent of one year of Algebra I, or a “C” or higher in MAT 0024. A “C”
grade or higher must be made in this course to advance to a higher level mathematics course.

This course includes the study of real numbers, linear and quadratic equations, linear
inequalities, systems of linear equations, exponents, polynomials, factoring, rational expressions
and related equations, radicals, quadratic formula, completing the square, complex numbers,
absolute value, graphing, and applications.

BSC 1005 (3credit hours)
Prerequisite: Acceptable placement scores in reading or a grade of “C” or higher in REA 0004.


                                                26
This is a basic general education course to give the student an understanding of the major
biological concepts of anatomy, reproduction, development, genetics, ecology and evolution in
plant, animal and human life. This course cannot be used to satisfy degree requirements for
students who already have credit in BSC 2010 and or BSC 2011.

BSC 2093C Anatomy & Physiology I(3credit hours)
Prerequisite: BSC 1005, BSC 2010, or equivalent; a pretest can be taken in the Chipola Testing
Center to determine preparation for this course. Three hour lecture, 3 semester hour’s credit.
Introduction to the study of the functions of the human body. Scope: basic organization and
structure with histology, integumentary system, skeletal system, muscular system, and nervous
system.

BSC 2094 Anatomy & Physioloy II (3credit hours)
Prerequisites: BSC 2093 or BSC 2010 and BSC 2011 or consent of department.
Introduction to the study of the functions of the human body. Scope: special senses, endocrine,
circulatory, respiratory, digestive, urinary, and reproductive systems; and metabolic regulation.



                            NURSING PROGRAM COURSES
Prerequisites for the following courses: SLS 1101; ENC 1101; MATH 1033/ MAC 1105; PSY
2012; BSC 1005: and,
Application and approval to the Nursing Program for any of the following courses.


                               FUNDAMENTALS - NUR 1020C

Course Description:
This course is designed to provide students with a basic understanding of certain key concepts
and principles fundamental to the practice of nursing. Emphasis on the wellness-illness
continuum will lay the foundation for future study. The student is introduced to the nursing
process as a systematic method of problem solving in which effective communication and
interpersonal relationships are central components. Basic needs relative to hygiene, activity, rest
and sleep, comfort, safety, nutrition, and fluid and electrolytes, urinary and bowel elimination,
and oxygenation are necessary to meet the needs of the moderately ill, hospitalized patient. The
content includes socio-economic, ethno-cultural, spiritual needs, community health concepts,
nutrition, and HIV/AIDS education. Instruction includes the development of critical thinking
skills. The student will be introduced to medication administration. The clinical application of
drugs is also emphasized to insure rational and optimal patient care. Serious attention is given to
the skills that are essential to safe nursing practice. Supervised practice and planned hospital
experience will provide the student opportunities to assist patients to an optimal level of
wellness. Theoretical instruction and clinical experience in geriatric nursing are incorporated


                                                27
throughout the course. This course will also present HIPPA regulations and the implications
related to the provision of healthcare.

                             GERIATRIC NURSING - NUR 1280C
Course Description:
This unit of study is designed to help the student understand the health related needs that result
from the normal aging process. The focus is on factors that promote a healthy aging process.
Discussions will include the demographics and characteristics of the aging population. Special
concerns of the elderly such as poly pharmacy, safety/falls, depression, and environments of care
will be discussed. End of Life Care is included in the course content.

                          PROFESSIONAL SEMINAR I - NUR 1010

Course Description:
This course is designed as an introduction to the healthcare career of nursing. Information will
be provided to give the student nurse an overall view of the nursing profession. Included in the
information will be such issues as the historical events that influenced nursing. The legal,
ethical, political and on-the-job issues that today’s nurse must be aware of are presented.
Workplace communication, time management, and self-care strategies are among the career
advancement tools provided. Information related to effective resume’ writing, interviewing tips,
and employee benefits is also provided.


                                PHARMACOLOGY I - NUR 1141
Course Description:
This course introduces the study of drugs, drug standards and legislation, and is designed to
provide the nursing students with a basic background of drug classifications, actions, dosages,
and side effects. This course includes basic drugs and reviews the mathematical computations
that are necessary for safe administration in the clinical setting. Drug therapy will be integrated
throughout the curriculum. Students will demonstrate safe techniques of medication
administration in the skills laboratory prior to administering medications in the clinical area.


                                    BASIC OB - NUR 1422C

Course Description:
This course is designed to present the nursing student with basic knowledge and skills related to
care of a client from conception, concentrating on the stages of normal pregnancy, labor and
delivery through postpartum. The course will present an introduction of high risk factors in these
areas.

The nursing process provides a framework for planning care for clients on the wellness-illness
continuum with inclusion of human growth and development, culture diversity,


                                                 28
pharmacology, and administration of medications, nutrition, legal aspects of practice,
interpersonal relationships, , and current issues in nursing. Concepts related to pre, intra, and
postoperative care are discussed.

Clinical experiences are provided in both clinic and acute care settings. Observational time may
be scheduled to enhance learning experiences.


                              BASIC PEDIATRICS - NUR 1312C

Course Description:
This course is designed to present the nursing student with basic knowledge and skills related to
care of a client from birth through childhood and adolescence. The course will present an
introduction to the nursing role in supporting the health of ill children and their families.

The nursing process provides a framework for planning care for clients on the wellness-illness
continuum with inclusion of human growth and development, cultural diversity,
community health concepts, pharmacology and administration of medications, nutrition, legal
aspects of practice, interpersonal relationships, and current issues in nursing.

Clinical experience is provided in both clinic and acute care settings. Observational time may be
scheduled to enhance learning experiences. One hour of lecture and two hours of clinical per
week (two credit hours).



                         BASIC MEDICAL SURGICAL - NUR 1211C

Course Description:
This introductory course is designed to provide students with the opportunity to acquire the
knowledge and skills to provide safe and effective care for clients with simple medical and/or
surgical problems. This course builds upon foundation material from previous courses. The
nursing process provides a framework for the students to utilize critical thinking skills to
promote or restore the health of clients within a holistic framework. Clinical experience is
provided in acute care settings. Observational time will be scheduled to enhance learning
experiences and will be scheduled in addition to clinical days. There will also be outside
assignments such as virtual experiences on the computer that will be included in the clinical
experience. A physical assessment review will occur during the first full week of class with a
clinical check-off that must be evaluated as satisfactory, as well as, outside clinical assignments.

Prerequisites: all course identified above: NUR 1020C; NUR 1141, BSC 2093C; DEP
2004;NUR 1211C; NUR 1422C; NUR 1312C; BSC 2093C AND BSC 2094C.



                                                 29
                               MENTAL HEALTH - NUR 2522C

Course Description:
This course provides the student with the opportunity to acquire knowledge and skills needed to
care for patients with maladaptive coping disorders. Therapeutic nurse/patient interaction skills
are stressed. Clinical experiences are selected to help students increase their understanding of
the interdisciplinary health team and the nurse’s role as a member of the team. Clinical practice
is provided in a psychiatric setting.


                      ADVANCED CONCEPTS MEDICAL SURGICAL
                                  NUR 2212C

Course Description:
This course is designed to provide information to assist the student in acquiring the knowledge
and skills to provide safe and effective care for clients with complex medical and/or surgical
problems. This course builds upon material from basic medical surgical concepts. The nursing
process will be a guide for the student to utilize critical thinking skills to promote or restore the
health of clients within a holistic framework. Clinical experience is provided in acute care
settings and specialty care areas. Observational time may be scheduled to enhance learning
experiences.

                               PHARMACOLOGY II - NUR 2142

Course Description:
This course builds on the acquired knowledge of basic pharmacology and is designed to enhance
comprehension and integrate application of knowledge into safe and effective medication
administration. Emphasis is provided in areas such as: specific pharmacologic effects and
category, cellular or mechanism of action, therapeutic response, major side effects and adverse
effects, patient assessment needed prior to medication administration, patient education, and
other special nursing implications. The course content is developed to increase the learners’
degree of understanding related to medications and to decrease the errors associated with the
administration of medications. The learners have previously demonstrated competency in
preparing and administering medications via all routes. The administration of medication is
integrated throughout the curriculum with the study of disorders of specific body systems.


                MEDICAL SURGICAL NURSING CRITICAL CONCEPTS
                                 NUR 2291C

Course Description:
This course is designed to provide information to assist the student in acquiring the knowledge
and skills to provide safe and effective care for clients with critical medical and/or surgical


                                                  30
problems. This course builds upon material from basic and advanced medical concepts. The
nursing process will be a guide for the student to utilize critical thinking skills to promote or
restore the health of clients within a holistic framework. Clinical experience is provided in acute
care setting and specialty care areas. Observational time may be scheduled to enhance learning
experiences.


                   ADVANCED CONCEPTS PEDIATRICS – NUR 2350C

Course Description:
This course is designed to present the nursing student with advanced concepts of knowledge and
skills related to care of a client from birth through childhood and adolescence.

The nursing process is utilized in caring for the high-risk pediatric client on the wellness-illness
continuum with inclusion of human growth and development, culture diversity, community
health concepts, pharmacology and administration of medications, nutrition, legal aspects of
practice, interpersonal relationships, health teaching and counseling, and current issues in
nursing.

Clinical experience is provided in both clinic and acute care settings. Observational time may be
scheduled to enhance learning experiences. Three hours lecture and six hours of clinical per
week.


                         ADVANCED CONCEPTS OB – NUR 2450C

Course Description:
This course is designed to present the nursing student with advanced concepts of knowledge and
skills related care of a client from conception, labor and delivery, and through postpartum.

The nursing process is utilized in caring for the high-risk obstetric client on the wellness-illness
continuum with inclusion of human growth and development, culture diversity, community
health concepts, pharmacology and administration of medications, nutrition, legal aspects of
practice, interpersonal relationships, health teaching and counseling, and current issues in
nursing.

Clinical experience is provided in both clinic and acute care settings. Observational time may be
scheduled to enhance learning experiences. Concepts related to pre, intra, and post-operative
care are discussed.




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                          PROFESSIONAL SEMINAR II - NUR 2810

Course Description:
This course is designed to assist the student in the transition from the role of student to that of
graduate enabling effective practice at entry level. It is also designed to assist the graduate nurse
to anticipate the challenges of a rapidly changing work environment. Information will be
provided on such issues as dealing effectively with social and economic factors that impact the
profession, the role of professional organizations and licensure requirements. Tools for
developing leadership-management roles, delegating appropriately, thinking critically and
creatively will be presented.




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