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									Class: 1/15/09

                                       St. Petersburg Campus
                                  PRACTICAL NURSING PROGRAM
                              General Information and Admissions Packet
                                           January 15, 2009

The purpose of the Practical Nursing Program is to provide training for employment in the health care industry. Graduates
complete courses in caring for medical and surgical patients. Included in the program are courses designed to instruct
students in the care of pediatric, obstetric, and geriatric patients, as well as convalescent, physically challenged, and
rehabilitative physical and/or mental patients. Graduates are prepared to function within the rules and regulations as
defined by the Florida State Board of Nursing.

The program length is 1350 hours. The first 450 hours of the program include classroom theory, laboratory experiences,
and selected clinical experiences. A more detailed explanation of essential job functions is included in this packet. Upon
successful completion of the program, graduates are eligible to sit for the national examination, which qualifies them as a
Licensed Practical Nurse.

The January 2009 class does not offer advanced standing for previously completed coursework. Applicants are
required to complete the full 1350 hours.
The Practical Nursing Program is supervised by the Pinellas County School Board and the Department of Education. It is
governed by the Standards established by the Florida State Board of Nursing, which include the number of program
hours, the curriculum, and the types of clinical learning experiences that the student will successfully complete.

Contact the school counselor for specific start dates. Individuals interested in enrolling in the Practical Nursing Program
must complete the enrollment process as outlined in this packet. This admissions packet is valid only for the January 15,
2009 class.

Please follow these steps to download and complete the application:

      Step 1:    Under the “File” Menu select “Save As” and save the document to your computer.

      Step 2:    Complete the application on page 4 electronically and print a hard copy to include in your completed
                 admissions packet.

      Step 3:    Print out all 11 pages and read through the packet, making note of any questions you have. Review
                 the FAQs for the PN admissions process.

      Step 4:    Complete as much of the packet as you feel comfortable doing at this time

      Step 5:    Bring the packet and your questions to the Admissions Seminar on Wednesday, November 19, 2008
                 at 1:00 PM

      Step 6:    Submit completed packet by noon on December 5, 2008. Incomplete packets will not be considered
                 for admission.

Class: 1/15/09

                                              ESSENTIAL JOB FUNCTIONS
                                                         Practical Nursing
                                                         January 15, 2009

                                                     Basic Skills
                         Math - Grade 11           Language - Grade 11                Reading - Grade 11
Mental/Cognitive Factors
          Ability to visually read calibrated equipment in increments of one hundredth of an inch
          Ability to visually discriminate, describe and interpret depth and color perceptions
          Ability visually identify contours, sizes, and movements
          Ability to view, read, and physically manipulate health record information and pertinent data in a variety of formats,
          including paper-based records, handwritten documentation, computerizes data bases, typed reports and other
          institutional sources
          Ability to use tactile sensory contact to assess size, shape, texture, temperature, moisture, density and tonicity of
          Ability to identify and distinguish odors
          Ability to auscultate with stethoscope and differentiate body sounds
          Ability to appropriately discern, comprehend and demonstrate ethical written, verbal and non-verbal communication,
          and judgment in any given situation
          Demonstrate appropriate reading and writing skills for effective, expected, appropriate and professional
          communication with others, to include legible, understandable, concise, accurate documentation of course work and
          clinical paperwork
          Demonstrate critical thinking skills to problem solve and take appropriate indicated corrective action to include
          utilization of the nursing process
          Demonstrate ability to perform mathematical calculations correctly within a designated time period
          Demonstrate emotional health sufficient to respond to and maintain effective role-appropriate relationships with
          patients, families, and other healthcare members
          Demonstrate ability to interpret classroom and clinical computer data correctly
          Demonstrate ability to perform requirements of the student nurse
          Demonstrate appropriate student behaviors in class and clinical areas
          Demonstrate ability to recognize and protect self, patients, and other from safety and environmental risks and

People Skills
          Demonstrate interpersonal skills sufficient to interact appropriately with individuals, families, staff and groups from a
          variety of psycho-social, spiritual, emotional, cultural and intellectual backgrounds

Physical Requirements
          Perform physical functions such as reaching, balancing, carrying, pushing, pulling, stooping, bending and crouching,
          including being able to stand on your feet up to 12 hours at a time
          Perform lifting and transferring of adults and children from a stooped to an upright position to accomplish bed to
          standing to chair transfer and back and patient ambulation
          Perform lifting and adjusting positions of bedridden patients
          Physically apply up to 10 pounds of pressure to bleeding sites and to the chest in the performance of CPR using hands,
          wrists and arms
          Ability to carry/lift 50 pounds
          Ability to maneuver in small spaces quickly and easily
          Perform gross and fine motor skills to include manual dexterity that require hand/eye coordination in use of small
          instruments, equipment and syringes
          Perform palpation to feel and compress tissues to assess fro size, shape, texture, and temperature
          Respond and react immediately to auditory instruction, request, signals and monitoring equipment

Class: 1/15/09
                              Practical Nursing Application Checklist

Step One:        Carefully review the Essential Functions form. You must be able to perform all of the essential
                 functions either with or without reasonable accommodations.

Step Two:        Pay a $15 non-refundable application fee at the campus to which you are applying OR submit
                 documentation showing payment of the application fee at any pTEC campus.

Step Three:      Take the Test of Adult Basic Education (TABE), submit scores and consult with a pTEC counselor
                 regarding scores at the campus to which you are applying.
                 Consult with a pTEC counselor at the campus to which you are applying on valid and current TABE
                 scores (within the past two years) from another school or organization
                 Submit and consult with a pTEC counselor at the campus to which you are applying providing
                 proof of an Associate of Arts, Applied Science or higher degree from an approved U.S. accredited

Step Four:       Take the Test of Essential Academic Skills (TEAS). Information on the TEAS may be obtained form
                 the Website

Step Five:       TABE and TEAS qualified applicants must bring packets and any questions pertaining to
                 admissions to a mandatory admissions seminar on Wednesday, November 19, 2008 at 1:00

Step Six:        Determine you ability to cover the costs of the program and if needed, consult with a pTEC
                 financial aid specialist to discuss financial assistance that might be available to you.

Step Seven:      Submit to pTEC a fully completed application packet with items arranged in the order listed
                 below by noon on Friday, December 5, 2008. Incomplete packets will not be considered in the
                 selection process.

                 1.   Completed Program Application (printed from your electronic application)
                 2.   Copy of current Nursing Assistant Certification and/or CPR card if applicable
                 3.   Copy of TEAS scores
                 4.   Copy of TABE scores if applicable or copy of documentation of Associate Degree or higher
                      from a approved accredited U.S. educational Institution
                 5.   Follow the steps below to process the Pinellas County Schools Student Disclosure & Release
                      form. Include the indicated items in your packet.
                        A. Complete and include a copy of the original Precheck form in admissions packet
                        B. Send original form and payment of $48.50 either electronically (, or
                            via mail to
                                    1283 North Post Oak
                                    Houston, Texas 77055
                        C. Include in you admissions packet a copy of the confirmation page from an electronic
                            submission of Student Disclosure & Release OR documentation of the mailed disclosure
                 6.   Signed and dated Criminal Background Disclaimer Form
                 7.   Copy of standard high school diploma or high school transcript or GED. The diploma must be
                      issued from an approved U.S. accredited institution. Non-U.S. citizens may use a translated
                      and certified degree to meet the high school diploma requirement.
                 8.   Copy of any transcripts being submitted; pTEC first followed by any others
                 9.   Health screening of Health Science Education Form which must be completed and signed by a
                      healthcare provider. Include any supporting documentation of immunization updating.

Class: 1/15/09

Step Eight:      Completed application packets are evaluated, rated and ranked. Class slots are filled working
                 from the highest to lowest ranking applicants. The criteria is listed below
                         Criteria                                                                  Points
                         TEAS composite score above 90 ................................. 3
                         TEAS composite score 80-89 ...................................... 2
                         TEAS composite score 70-79 ...................................... 1
                         Recent (2-3 years) pTEC CNA or medical related
                           program graduate .................................................... 2
                         Non-traditional student (Male) ...................................... 1
                         Military.......................................................................... 1
                         Ethnic Diversity ............................................................ 1
                         Four-year degree ......................................................... 2
                         Two-year degree .......................................................... 1
                         Medical-related work experience ................................. 1
                         Previous applicant to a pTEC PN program .................. 1
                         Graduate of the Boca Ciega Center for Wellness
                           and Medical Professions .......................................... 1

Step Nine:       Letters are mailed to applicants specifying one of the following:
                     1. Accepted to begin the next available class with all fees due within 10 business days of the
                         start of the class
                     2. Accepted into the next available class as an alternate to be notified if someone from the
                         original acceptance roster should withdraw. All fees are due upon notification of space
                         availability. If not enrolled in class, the applicant will need to re-apply for the next
                         available class.
                     3. Class is full and the applicant will need to re-apply for the next available class.

                                                                                                                                Campus: St. Petersburg
Class: 1/15/09
    Practical Nursing Application                                                                                        Start Date: January 15, 2009
                                                                       Applicant Information
    Full Name:                                                                                                                        Date:
                       Last                                            First                                           M.I.

                       Street Address                                                                                  Apartment/Unit #

                       City                                                                                            State                  ZIP Code

    Social Security No.:                                                         E-mail Address:
    Home Phone:                                       Cell Phone:                                              Work Phone:
    Gender:           Male       Female       Date of Birth:                   Age:
    Race:             White, Non-Hispanic       Black, Non-Hispanic        Hispanic         Asian    American Indian/Alaskan Native           Multiracial
    Emergency Contact Name and Phone:
                                                       Name                                    Phone

                                                                   YES            NO           If not, provide Country of
    Are you a citizen of the United States?                                                    origin:
                                                                   YES            NO           If yes, what branch of
    Are you a military veteran?                                                                service?
    Have you previously applied for entry into the Practical Nursing Program?               Yes      No
    If Yes:      Date applied:                           Campus:

                                                                    Educational Background
    Highest level of education:       HS Diploma/GED           AA/AS     BA/BS        MA/MS         PhD
    Major in college or program of concentration:

    TEAS Test Date:                                    TABE Test Date:                               Score     Level
                                                       TABE Scores:                    Reading
    TEAS Score:                                                                       Language

    List any medical and/or health related training/education below:
    Type of training                       Dates                       School                                                                 Length

    Note: If you are a C.N.A. include a copy of your license in your application packet.

                                                                          Work Experience
    List below your work experience for the last three years, listing your MOST RECENT employment first.
              Job Title                       Date                           Name of Business                                           Reason for Leaving

                                                     Transfer or pTEC Re-entry Student Request
                                          (If applicable, check the one that applies to your admission request)
                        I am requesting Advanced Standing to enter into a Practical Nursing class and be given credit for previously completed coursework. (See attached
                        syllabus describing coursework completed and a transcript detailing coursework to be considered as part of my PTEC nursing program
                        and two sealed letters of recommendation; one from an instructor from previous school and one other reference letter)
                        If I can not be placed with credit for previously completed coursework I would like to start PTEC’s practical nursing program from the beginning
                        and agree that I will complete all assignments required of my classmates.
                                                                    Disclaimer and Signature
    I certify that my answers are true and complete to the best of my knowledge. Misrepresentation or omission of facts is
    an acceptable reason for denial into the program.

    Signature:                                                                                                                Date:
Class: 1/15/09

                                 FULL NAME ________________________________________________________________________________________

                                 Any Other Names Used _______________________________________________________________________________

                                 Social Security No. _______ /_____ / ___________ Date of Birth ______________________________________________

                                 Current Address ______________________________________________________________________________________

                                 City ______________________________________ State ________________ Zip _________________________________

                                 Driver’s License State ____________________________ No. _________________________________________________

                                 Address: ____________________________________________________________________________________________
                                 Have you ever been convicted of a crime? Yes ο No ο

  Credentialing and              Offense _____________________________________County ____________________ State __________ When_________
  Background Investigation
                                 Please provide all locations where you have resided for the past seven (7) years, starting with your current residency.
                                                    City                               State                                                 Dates
                                                                                                                                  From                            To

                             Clinical Privileges for Students Pursuant to the requirements of the Fair Credit Reporting Act, I acknowledge that a credit
                                                                  2                                                         3

                             report, consumer report and/or investigative consumer report may be made in connection with my clinical privileges
                             as a student. I understand that these investigative background inquiries may include credit, consumer, criminal, driving, prior
                             employment and other reports. These reports may include information as to my character, work habits performance and
                             experience, along with reasons for termination of past employment from previous employers. Further, I understand that a
                             clinic/hospital and PreCheck, Inc. may be requesting information from various federal, state, and other agencies which maintain
                             records concerning my past activities relating to my educational/school records, driving, credit, criminal, civil and other
                             experiences, as well as claims involving me in the files of insurance companies.

                             I authorize, without reservation, any party or agency contacted by PreCheck, Inc. to furnish the information mentioned
                             above. A photocopy of this authorization shall have the same effect as the original.
                             I understand the information obtained will be used as one basis for clinical privileges or denial of clinical privileges. I hereby
                             discharge, release and indemnify the prospective clinic/hospital, PreCheck, Inc., their agents, servants and employees, and all
                             parties that rely on this release and/or the information obtained with this release from any and all liability and claims arising by
                             reason of the use of this release and dissemination of information that is false and untrue if obtained from a third party without
                             It is expressly understood that the information obtained through the use of this release will not be verified by PreCheck, Inc. The
                             authorization granted herein shall be effective throughout the term of my education.
                             I have read and understood the above information, and assert that all information provided by me is true and accurate.

                             Applicant’s Signature _______________________________________________________ Date ______________________

                             If you are denied clinical privileges, either wholly or partly because of information contained in a consumer report, a disclosure
                             will be made to you of the name and address of the investigative agency making such report. Upon your written request within a
                             reasonable period of time, the investigative agency compiling the report will make a complete and accurate disclosure of the
                             nature and scope of the investigation.
                                 The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age. This
                             information is for consumer report purposes only
                             . A “Consumer Report” may consist of employment records, educational verification, licensure verification, driving record, previous address and public records
                             relative to criminal charges.
                              An “Investigative Consumer Report” means a consumer report or portion thereof in which information on a consumer’s character, general reputation, personal
                             characteristics, or mode of living is obtained through personal interviews with persons having knowledge.

  1283 N Post Oak Rd.                                                                          Method of Payment ($48.50)
  Houston, TX 77055
  800.207.2778 fax               Visa ο MasterCard ο American Express ο Money Order ο
                                 Credit Card Number _______________________________________________________________
  713.861.5959 phone
                                 Name as it appears on card ________________________________________Expiration Date __________________              Billing Address _________________________________________________________________________________               City _________________________________ State _____________________________ Zip _________________
                                 Signature _____________________________________Date _________________________________

                                                                                                                                                                             PR-Student (0510)
                     Criminal Background Check


                             January 15, 2009

Pursuant to Florida Statute 435, certain criminal offenses will disqualify the
Licensed Practical Nurse from state licensure and/or employment. Therefore, as a
prospective student applying to the Practical Nursing Program at the PTEC – St.
Petersburg Campus, I fully understand that if my background check reveals any
disqualifying offenses, I will not be allowed to enter the PN program or be
withdrawn if already started forfeiting any deposits made. (Guidelines of those
disqualifying offenses are enclosed in the admissions packet.)

Student Signature


                    HEALTH SCIENCE EDUCATION
All potential students who will be in positions designated by law as positions of trust or responsibility are
required to undergo security background investigation as a condition of participation in a clinical setting. For
more information on this law refer to www.

Note: For the purpose of these guidelines, criminal convictions mean a conviction by a jury or by a court and
shall also include forfeiture of any bail, bond or other security deposited to secure appearance by a person
charged with having committed a felony or misdemeanor, the payment of a fine, a plea of nolo contendere, the
imposition of a deferred or suspended sentence by the court, adjudication withheld, finding of guilt, a plea of no
contest or pre-trail intervention.


Convicted of felony crimes of violence, felony sale of controlled substances, felony sexual related crimes, lewd
and lascivious crimes, and indecent exposure and felony child abuse crimes.


Conviction was within the last 10 years, will consider and carefully review if conviction was beyond 10 years,
other felony crimes and any other misdemeanor crimes of a sexual nature, crimes related to children.


Conviction was within the last 5 years, will consider and carefully review if conviction was committed beyond
5 years. Misdemeanor drugs, misdemeanor crimes of violence, misdemeanor crimes involving weapons.

   Other misdemeanors
   Multiple arrests
   Offenses which are directly related to duties and responsibilities of the clinical experience
901 - 34th Street South                                                                        St. Petersburg, FL 33711

                                                St. Petersburg Campus
(727) 893-2500                                                                                        Fax (727) 893-2776

                                            PRACTICAL NURSING
                                         Required Book-Tool-Supply List

 TYPE OCP ITEM                                                                          QUANTITY UNIT COST TOTAL COST
Fee           Facilities & Equipment Use Fee-$10 to be paid every fee period
Fee           Lab Fee - $35 to be paid every fee period
Membership    Health Occupations Students of America (HOSA) -
                                                      $5 to be paid every fee period
Fee           CPR/First Aid                                                                      $ 6.00       $     6.00
Fee     A     Liability Insurance                                                          1     $ 23.30      $    23.30
Fee     A     Student Parking Tag                                                          1     $ 5.00       $     5.00
Fee     A     Student ID                                                                   1     $ 5.00       $     5.00
Fee     A     Graduation Fee                                                               1     $ 30.00      $    30.00
Supply  A     Notebook - 3 ring binder or folder with pockets                              1     $ 1.00       $     1.00
Uniform A     Uniform - see instructor
              The uniform for both men & women includes white duty shoes,
              a watch with second hand, standard bandage scissors,
              stethoscope, penlight and white lab coat/lab jacket/sweater.                                    $   169.00
Uniform       Sleeve Patch                                                                 1     $ 2.15       $     2.15
Supply    A   Blood Pressure Cuff                                                          1     $ 14.30      $    14.30
              Total OCP A                                                                                     $   255.75

Book      B   Mosby's Textbook for Nursing Assistants                                      1     $   58.45    $    58.45
Book      B   Clinical Nursing Skills & Techniques                                         1     $   77.95    $    77.95
Book      B   LPN Notes: Nurse's Clinical Pocket Guide                                     1     $   31.15    $    31.15
Supply    B   Three-ring binder, paper, pencils, pens, highlighter, index cards            1     $   25.00    $    25.00
Exam      B   *Application for Certified Nursing Assistant (FL res. last 5 yrs.)           1     $   126.00
                                                        OR (FL res. less than 5 yrs.)                         $   150.00
              Total OCP B                                                                                     $   342.55

Book      C   Taber's Cyclopedic Medical Dictionary                                        1     $   46.75    $    46.75
Book      C   Introduction to Medical-Surgical Nursing                                     1     $   77.95    $    77.95
Book      C   Introduction to Maternity and Pediatric Nursing, Text                        1     $   60.40    $    60.40
Book      C   Introduction to Maternity and Pediatric Nursing, Study Guide                 1     $   26.30    $    26.30
Book      C   Davis' Drug Guide for Nurses                                                 1     $   47.90    $    47.90
Book      C   Saunders Comprehensive Review for NCLEX-PN                                   1     $   37.00    $    37.00
Book      C    Herlihy's Human Body in Health & Illness, Text                              1     $   44.80    $    44.80
Book      C    Herlihy's Human Body in Health & Illness, Study Guide                       1     $   24.35    $    24.35

 TYPE OCP ITEM                                                                                QUANTITY UNIT COST TOTAL COST
Book        C Calculate with Confidence                                                             1       $ 51.62        $        51.62
Book        C ATI Comprehensive Assessment Review Program Package -
              includes 4 sets of resources to be purchased individually:
                                                                   Resource Set #1                  1       $   69.95      $        69.95
                                                                   Resource Set #2                  1       $   69.95      $        69.95
                                                                   Resource Set #3                  1       $   69.95      $        69.95
                                                                   Resource Set #4                  1       $   69.95      $        69.95
Exam        C *Application for License Practical Nurse Examination (includes
              testing company AND Florida Board of Nursing fees)                                                           $ 405.00
                Total OCP C                                                                                                $ 1,101.87
                Grand Total                                                                                                $ 1,700.17

                       Purchase of the following item is not required for completion of this program.

                                                         OPTIONAL ONLY

Book        C Mosby's Diagnostic & Lab Test Reference                                               1       $ 44.40        $        44.40

*Please see your instructor to review the application process for all examinations.

Textbooks and supplies are subject to state tax.

Item costs are approximate and may change at any time. Please check with your instructor before purchasing any item on this list.

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