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ASSOCIATE DEGREE NURSING

APPLICATION PROCESS

Spring 2021

Instructions/Check Off Sheet

Part 1 A

Temple College

Admissions & Records

 Apply or re-apply

 Official

Transcripts

Temple College

Admissions & Records

2600 S. First Street

Temple, TX 76504

If not already done, submit a completed application for admission or re-

admission to TC Admissions & Records Office in One College Centre.

This should be done immediately. You must meet all Temple College

requirements for testing, transcripts, etc. You must also be TSI

compliant. Arrange to have official transcripts (from every

program/college/university) you have ever attended sent to TC

Admissions & Records Office. Transcripts must be received by

Admissions & Records by August 28, 2020. If you transferred credits

from one college to another, submit an official transcript from the original

college. Failure to meet this requirement by the time your nursing

application is received could jeopardize the processing of your nursing

application. Applying to Temple College is a separate application

process from the nursing application process. Official transcripts

must be submitted to Admissions & Records and also included in your

nursing application packet. The Nursing Department will check with

Temple College Admissions & Records to make sure all of their

requirements have been met prior to processing your nursing application. All

HESI A2

Take the HESI Admissions Assessment Exam. Temple College Testing

Center currently offers it year round. Applicants may take the HESI A2 at

Temple College twice during their fiscal year (9/1-8/31). Appointment are

necessary for both Temple and Hutto. To make an appointment at either

campus, please email testingcenter@templejc.edu. Due to COVID 19

restrictions, seats are limited. You will be tested on math, reading, and

vocabulary (and Personality Profile and Learning Styles, which will not

be included in your overall score.) The fee is $65. You will be given the

results as soon as you finish your test. Your full name must be on the

test results. A score of 80 or higher in EACH category tested is needed

to apply. For more information, please contact the Testing Center (254)

298-8586. For testing at another facility: the test score must be less than

1 year old. You must have been tested on math, reading, and

vocabulary/general knowledge and nothing more with scores of 80 or

higher in EACH category. The scores must be inside a sealed letterhead

envelope from the facility where you tested. If you applied for

consideration for any of our nursing programs, ADN, VN (must meet the

80 or above in each subject requirement) or Bridging (within the last

year) and those test scores are dated AFTER June 1, 2019, please

indicate on your application that you wish to use them. Otherwise you

must submit valid HESI A2 scores with your application. If you are

unsure if your HESI A2 score from a previous application meets the

requirement(s), log onto you Elsevier account to view it.

Hepatitis B

You must submit documentation of at least 2 injections of Hepatitis B (or

a positive titer) with your application. If you applied for any of our nursing

programs within the past year, you do not need to provide them with this

application.

Application Packet

must include:

 Typed application &

curriculum worksheet

 HESI scores that meet

our requirements

 Official transcripts

from every college

attended, including TC

if you attended here.

(You acquire them and

keep them inside their

sealed letterhead

envelopes)

 Hep B documentation

Temple College

Nursing Department

2600 S. First St.

Temple, TX 76504

Further down in this document you will find the application and

curriculum worksheet. You must type in all information requested,

then print it (single sided only). Double check your information before

printing. Hand written applications WILL NOT BE ACCEPTED. The

curriculum worksheet is for you to tell the nursing department all of

the information about the pre-requisite courses and any of the co

requisite courses that you have completed. When it asks for “course

#” we want the course number from where you took the course. If

you are currently enrolled for the summer semester for any of the

courses, do not put anything in the “grade” area. The application

packet deadline is August 28, 2020. Incomplete applications packets

will not be processed. You must mail it to the TC Nursing

Department. We encourage you to use a mailing option that allows

you to have a tracking number. We will not accept faxed/scanned

applications. Official transcripts for coursework for Summer 2020 will

be due in this office no later than August 28, 2020. If these courses

were taken at another college, also make arrangements to have

official transcripts sent to TC Admissions & Records by August 28,

2020.

 If you applied for the any of our nursing programs within the last

year, please indicate it on the application. We will use those

transcripts. If you have taken additional coursework since

applying, you will only need to include an updated official

transcript in your packet. If course work was done at another

college, remember to make arrangements to have an official

transcript sent to TC Admissions & Records as well. If you want to

use the HESI scores from the above mentioned application

windows (for the VN application an overall score of 80 or higher

was required. For this application process all 3 areas must be 80

or higher), please indicate so on your application.

 Be sure to read the Licensure page (which you will keep) from the

Texas Board of Nursing (BON). If you can answer yes to any of

those questions, you must be prepared to do a Declaratory Order

with the TX BON and we highly recommend that you submit your

application to us as soon as the application window opens.

Your application packet must include: HESI A2 scores less than 1 year old (minimum score of 80 in

each category tested, inside sealed letterhead envelope if tested other than at TC), typed application,

typed curriculum work sheet, official transcripts from every college attended in original sealed

envelopes and documentation of at least 2 injections of Hepatitis B or a positive titer, unless you

previously applied as addressed above.

MATERIALS NOT RECEIVED BY A SPECIFIED DEADLINE MAY JEOPARDIZE YOUR APPLICATION.

KEEP THIS PAGE FOR

FUTURE REFERENCE

Spring 2021, Part 1A

Application Status:

After satisfactory completion of the application process, applicants

will be notified by email in early October, 2020 regarding your

application status. Please do not call regarding this notification

process before the beginning of October. During the application

process, keep an eye on your email account and also check your

“junk email”. To help prevent any of our email correspondence

(during the review of your application and our decision) from going to

your “junk mail”, please put the following email address into your

contacts: William.Jones@templejc.edu and

Cecilia.Morales@templejc.edu

Financial Aid:

It often takes 6-8 weeks or longer to complete the financial aid

process, so get started now. The deadline to apply for scholarships

is April 1

. The Financial Aid Office is in One College Centre.

Meningitis:

According to state law, some students will be required to show proof

of the bacterial meningitis immunization to Temple College A & R

prior to registration. If you are under the age of 21, check with

Temple College Admissions & Records regarding this requirement.

Clinical Facilities:

All ADN applicants must be 18 or older by January 1, 2021. Previous

employment issues with local healthcare facilities could prevent you

from attending clinical at that facility and could jeopardize your place

in the program, even after you begin the program. This includes

Baylor Scott & White Health Care System, Providence Healthcare

Network and Veteran’s Healthcare System. If you feel that you have

had employment issues with any of the mentioned facilities, please

contact this office for further instructions at 254-298-8666.

Core Performance

Standards for Nursing:

You will be required to sign an acknowledgement form saying you

comply with the Core Performance Standards for Nursing. Please

read over the information page included with this application. Keep

that page for future reference.

10.

Hepatitis B/ TB &

Immunizations:

Hepatitis B: To ensure the student is immune, when patient contact

begins in mid-March, students must be able to receive the 3

injection by March 1, 2021.

Additional immunizations//TB screening:

Tetanus (good for 10 years)

2 measles (or positive titer) 1 mumps (or positive titer)

1 rubella (or positive titer) 2 Varicella (or positive titer)

TB screening will be required. Although TB screenings are good for

1 year, accepted students will have a specific time frame to have the

screening administered. Wait for instructions before getting

screened.

The above documentation will only be required if accepted into the

program. Please do not submit with your application. All

students will have to submit documentation of the 2020/21 flu

vaccine by December 1, 2020.

11.

CPR:

You must show proof of successful completion of the CPR course: American Heart

Association Basic Cardiac Life Support for Health Care Providers, by January 5,

2021. This requirement remains in effect throughout the entire ADN program. This

documentation will only be required if accepted into the program. Please do not

submit with your application.

12.

Background

Check:

Soon after your application has been reviewed, you will receive an email from this office

(refer to # 5 for nursing email addresses that you should put in your email contacts

now) indicating that your name (and personal information such as email address, SSN,

DOB, etc. ) has been submitted to the TX Board of Nursing (TX BON) on a roster. If

you have NEVER done a background check with the TX BON, within 15 business

days from receiving our email indicating the roster has been sent in, you should

receive an email from IDENTOGO giving you instructions on how to start the

background check process. It will go to the personal email address that you put

on this application. Constantly check your email account (and junk mail)! If you

have never done a TX BON background check and do NOT receive an email from

IDENTOGO within 15 business days of receiving our email, contact this office

immediately.

If you have done a background check with the TX BON, this roster should

generate a new form of clearance for you. Hold on to it when you receive it!

You must have Texas Board of Nursing clearance to register for nursing courses if

selected. Read the licensure page, which is included here. If you can answer YES to

any of the questions, or if you are not certain of the answer you must be prepared to

start the Declaratory Order process for the TX BON soon after you fingerprint. We

recommend that you submit your application to this office as soon as the application

window opens so that we can get you on a TX BON roster! All accepted and

alternate student must submit TX BON clearance to this office no later than

Wednesday, November 23; 2020; 6:00 pm.

13.

Orientation:

Currently we have scheduled an in person orientation day. It will be held on December

14, 2020 in the Dell Martin Nursing Education Center from 8:30 am to 5:00 pm. This is

mandatory. In the event that COVID 19 restrictions happen, it will be an online

orientation.

14.

Drug

Screen:

You must pass a pre-employment drug screen. Specific instructions will be given.

KEEP THIS PAGE FOR FUTURE REFERENCE

Texas Board of Nurse Examiners Licensure Questions:

All students seeking licensure as a registered nurse must pass the NCLEX-RN administered by the Texas Board of

Nurse Examiners. The Board may delay or refuse to admit persons to their examination or refuse to issue a license or

certificate of registration for any of the following reasons:

1) For any criminal offense, including those pending appeal, have you:

a. Been convicted of a misdemeanor?

b. Been convicted of a felony?

c. Pled nolo contendere, no contest, or guilty?

d. Received deferred adjudication?

e. Been placed on community supervision or court-ordered probation, whether or not adjudicated guilty?

f. Been sentenced to serve jail or prison time? Court-ordered confinement?

g. Been granted pre-trial diversion?

h. Been arrested or any pending criminal charges?

i. Been cited or charged with any violation of the law?

j. Been subject of a court-martial; Article 15 violation; or received any form of

military judgement/punishment/action?

(You may only exclude Class C misdemeanor traffic violations.)

NOTE: Expunged and Sealed Offenses: While expunged or sealed offenses, arrests, tickets, or citations need not

be disclosed, it is your responsibility to ensure the offense, arrest, ticket or citation has, in fact, been

expunged

sealed. It is recommended that you submit a copy of the Court Order expunging or sealing the record in

question to the BON office with your application. Failure to reveal an offense, arrest, ticket, or citation that is

not in fact expunged or sealed, will at a minimum, subject your license to a disciplinary fine. Non-disclosure of

relevant offenses raises questions related to truthfulness and character.

NOTE: Orders of Non-Disclosure: Pursuant to Tex.Gov’t Code § 552.142(b), if you have criminal matters that are

the subject of an order of non-disclosure you are not required to reveal those criminal matters on this form.

However, a criminal matter that is the subject of an order of non-disclosure may become a character and

fitness issue. Pursuant to other sections of the Gov’t Code chapter 411, the Texas Nursing Board is entitled to

access criminal history record information that is the subject of an order of non-disclosure. If the Board

discovers a criminal matter that is the subject of an order of non-disclosure, even if you properly did not reveal

that matter, the Board may require you to provide information about that criminal matter.

2) Are you currently the target or subject of a grand jury or governmental agency investigation?

3) Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted

surrender of, suspended, placed on probation, refused to renew a professional license, certificate, or multi-

state privilege held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined

you?

4) Within the past five (5) years have you been addicted to and/or treated for the use of alcohol or any other drug?

5) Within the past five (5) years have you been diagnosed with, treated, or hospitalized for schizophrenia and/or

psychotic disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or

borderline personality disorder?

If you answered YES to any of the above questions or if you are not certain of the answer, then you

MUST be prepared to complete the declaratory order process! These questions will be asked when

you fingerprint and the TX BON will notify you via email with instructions. If you answered yes, you will need

to submit your nursing application as EARLY AS POSSIBLE once the application period begins. After your application has been processed,

we will then submit your name on a roster to the Texas Board of Nursing. The later you submit your nursing application the more you

delay the results from the Texas Board of Nursing.

Further instructions and forms can be obtained at: https://www.bon.texas.gov/forms_declaratory_order.asp

KEEP THIS PAGE FOR YOUR

RECORDS

If Ifi If you believe, at any time throughout the program, that you cannot meet one or more of these standards

without accommodations or modifications, you may request appropriate assistance and guidance.

Accommodations and modifications requests will be evaluated on an individual basis, to determine if they can

reasonably be implemented.

The Essential Requirements necessary to acquire or demonstrate competence in a discipline as complex as

Nursing and needed for successful admission, progression, and graduation by candidates for the Vocational or

Associate Degree in Nursing from Temple College include, but are not limited to the following abilities:

Core Performance Standards

Requirements

Standard

Examples of Necessary Activities

Critical Thinking

Critical thinking ability for effective clinical

reasoning and clinical judgement consistent with

level of educational preparation.

TBON 213.29 Fitness to Practice

TBON Rule 213.27 Good Professional Character

TBON Rule 217.11 Standards Applicable to

Professional Nurses

ANA Provision 4

NLN Nursing Judgement & Spirit of Inquiry

 Identification of cause/effect relationships

in clinical situations.

 Use of the nursing process

 Evaluation of the effectiveness of nursing

interventions implemented.

 Solve problems and make valid rational

decisions using logic, creativity, and

reasoning.

 Respond instantly to emergency situations.

 Exhibit arithmetic competence that would

allow the student to read, understand, and

perform calculations for computing dosages.

Professional

Behavior

Student Nurses are expected to respect the nursing

profession to which they aspire and perform and

behave in a respectful, ethical and professional

manner with others in class, lab and clinical.

TBON 213.29 Fitness to Practice

TBON Rule 213.27 Good Professional Character

TBON Rule 217.11 Standards Applicable to

Professional Nurses

ANA Provision 1, Provision 2, Provision 3, Provision

4, Provision 5,

NLN Human flourishing, Professional Identity,

Nursing Judgement & Spirit of Inquiry

 Integrates ethical behavior in nursing

practice.

 Performs activities safely, so as not to injure

or harm others.

 Interacts respectfully with peers, superiors,

and patients.

 Capacity to engage in successful conflict

resolution.

 Recognizes that as a student they represent

the nursing profession, and must behave

accordingly.

 Respects and adheres to the policies and

procedures of the College, VN Program and

clinical agencies.

 Reflects on personal behavior and practice

performance with patients, engages in self-

evaluation.

 Refrains from disruptive behavior as

described in the Temple College Student

Handbook including sleeping in class,

belligerent attitude, ignoring instructor’s

directions, talking at inappropriate times,

use of unauthorized personal devices (e.g.

gaming, browsing the internet, texting,

listening to music, etc.)

Communication

Communication abilities sufficient for verbal,

written and electronic format.

TBON 213.29 Fitness to Practice

TBON Rule 217.11 Standards Applicable to

Professional Nurses

ANA Provision 1, Provision 2, Provision 3

NLN Human flourishing & Nursing Judgement

 Write and speak English effectively in order

to be understood by the general public.

 Communicate therapeutically with patients,

families, and groups in a variety of settings.

 Communicate respectfully and

professionally with faculty and peers.

 Documentation and interpretation of

nursing actions and patient/client

responses.

 Provide health teaching information for

patients, families, and/or groups based on

assessed needs, available resources, age,

lifestyle, and cultural considerations.

 Remember pertinent information and

communicate to all interdisciplinary team

members, client and family where

consented.

Physical Ability

Physical abilities sufficient for movement from

room to room and in small spaces. Gross and fine

motor abilities sufficient for providing safe, effective

nursing care.

TBON 213.29 Fitness to Practice

TBON Rule 217.11 Standards Applicable to

Professional Nurses

ANA Provision 4, Provision 5,

NLN Professional Identity & Nursing Judgement

 Movement about patient's room, work

spaces, and treatment areas.

 Administration of rescue procedures-

cardiopulmonary resuscitation.

 Lift, move, position, and transport patients

without causing harm, undue pain, or

discomfort to the client or one’s self.

 Stoop, bend, squat, and reach overhead as

required to safely reach equipment and

provide nursing care.

 Correctly administer oral and parenteral

medications to maintain client safety.

 Calibration and use of equipment.

 Provide or assist with activities of daily

living such as bed bath, hygiene, toileting,

positioning patients, making an occupied or

unoccupied bed.

Sensory

Auditory ability sufficient for monitoring and

assessing health needs. Visual ability sufficient for

observation and assessment necessary in patient

care. Tactile ability sufficient for physical

assessment. Olfactory ability sufficient for

observation and assessment necessary for safe

client care.

TBON 213.29 Fitness to Practice

TBON Rule 217.11 Standards Applicable to

Professional Nurses

ANA Provision 4, Provision 5,

NLN Professional Identity & Nursing Judgement

 Ability to hear monitoring device alarm and

other emergency signals.

 Ability to discern auscultatory sounds and

cries for help.

 Ability to observe patient's condition and

responses to treatments and recognize

subtle physical changes.

 Ability to palpate in physical examinations

and various therapeutic interventions.

 Recognize environmental odors.

Emotional Stability

Emotional stability sufficient to tolerate rapidly

changing conditions and environmental stress.

TBON 213.29 Fitness to Practice

TBON Rule 213.27 Good Professional Character

TBON Rule 217.11 Standards Applicable to

Professional Nurses

ANA Provision 1, Provision 4, Provision 5

NLN Human flourishing, Nursing Judgement &

Professional Identity

 Establish therapeutic interpersonal

boundaries.

 Provide patients with emotional support.

 Adapt to changing environment and stress

while maintaining professional conduct and

standards without displaying hostility,

agitation, rudeness, or belligerence.

 Poses no threat to self or others.

 Manage and respond to multiple priorities in

stressful situations.

Der

Derived from the Southern Regional Education Board

(The Americans with Disabilities Act Implications for Nursing Education, 2016)

http://wwww.sreb.org/plublication/american-disabilities-act

KEEP THIS PAGE FOR YOUR RECORDS

ASSOCIATE DEGREE NURSING

STUDENT APPLICATION FOR

ADMISSION

Spring 2021

Please type in all of the required information, double check your entries and then print this document SINGLE SIDED.

Hand written applications will not be accepted. Your signature CANNOT be an electronic signature. Incomplete

application packets will NOT be processed!

DATE

LAST NAME (LEGAL)

FIRST NAME (LEGAL)

MIDDLE NAME

MAIDEN NAME

PREVIOUS APPLICATION: If you applied to a Temple College Nursing program in the past year, complete the section

below; otherwise skip down to the next question:

Have you applied to a TC Nursing program in the past year?

IF YES:

Please indicate the MOST RECENT program that you applied for:

HESI A2 SCORES: HESI A2 scores can be used from a previous application period

listed above IF the test score is less than 1 year old and you have an 80 or higher in

EACH of the 3 categories. If you are uncertain of your score, log onto you Elsevier

account and access it. If you answered NO, your packet must include HESI A2

requirements that meet the Temple College ADN requirements

OFFICIAL TRANSCRIPTS: You will only need to include official transcripts in your packet IF you have taken or

repeated pre-requisite courses in our curriculum and/or if you were in a nursing program AFTER applying to our

program. If this coursework was done elsewhere, make sure that Temple College Admissions & Records has the

updated transcript(s) as well

Have you attended any OTHER nursing program?

IF YES:

Where (College name and state)

When? (time frame)

Reason for leaving

By signing below, I acknowledge the following:

I have reviewed the Texas Board of Nursing (BON) Licensure questions and I acknowledge that my personal information will

be sent to them. I am aware that I must report to the BON and be cleared of any issues or conditions addressed in these

licensure questions. If I am not cleared in all of the areas addressed, I understand that I will not be allowed to register for

nursing courses.

I must have background check clearance by the Texas Board of Nursing by Wednesday, November 23; 2020; 6:00 pm, should

I be conditionally accepted into the program or placed on the alternate list.

I give permissions for the Temple College Nursing Department to contact me at the personal email address provided.

I certify that all given information is correct and complete. I understand that failure to provide correct & complete information

could result in being removed from the application process or immediate dismissal, should I be accepted into the program.

I will be over 18 by January 1, 2021. Previous employment issues with local healthcare facilities could prevent me from

attending clinical at that facility and could jeopardize my place in the program, even after beginning the program. This includes

Baylor Scott & White Health Care System, Providence Healthcare Network and Veteran’s Healthcare System.

Please print (single sided) and sign and date the application. Electronic signature will not be accepted.

Applicant’s Signature

Date

Temple College is committed to nondiscrimination practices based upon race, gender, gender identity and expression, disability,

age, religion, national origin, genetic information, or veteran status.

Spring, 2020

Click

CURRICULUM WORKSHEET (Spring 2021)

Last Name (LEGAL)

First Name (LEGAL)

Middle Name

Maiden Name

Social Security #

000-00-0000

Date of Birth

00/00/0000

PERSONAL Email Address

TC ID #

(REQUIRED!)

Cell phone number w/area

code

Mailing Address:

House

Street

Apt.

City

County

State

Zip Code

Physical Address:

House

Street

Apt.

City

County

State

Zip Code

Are you a US Citizen?

Have you previously been employed by Baylor Scott & White? Are you currently employed by Baylor Scott & White?

List ALL colleges attended. Official transcripts (including TC if you attended) must be included in your packet. Official transcripts from all colleges attended

must ALSO be submitted to TC Admissions & Records (A & R). Failure to have your transcripts in TC A & R by the application deadline could jeopardize the

processing of your application as it would be considered incomplete.

Fill in all of the information below about your coursework. Remember to include any courses that you are currently enrolled in, but do not put in a

grade.

For office use only

Prerequisite Temple

College Course #

College Name

(You may abbreviate)

Course # from where your course

was taken

EX: ENGL 1301, ENG 101A

Sem.

Hrs.

Sem/year

Taken

EX: SP 15)

Final

Letter

Grade

EQ/SUB

ENGL 1301

Composition I

BIOL 2401

Human Anatomy &

Physiology I*

PSYC 2301

General Psychology

Co-requisite

Course

Temple College

Course Number

College

(You may abbreviate)

Course # from where your

course was taken

EX: PSYC 2314, PSY 201

Sem.

Hrs.

Sem/year

Taken

(i.e. Fall

2009)

Final

Letter

Grade

EQ/SUB

BIOL 2402

Human Anatomy &

Physiology II*

PSYC 2314

Lifespan Growth

& Development

Elective (3 credits)

See list of options

below

Elective options: ENGL 2322, 2323, 2327, 2328, HIST 2311, 2312, HUMA 1301, HUMA 1315, SPAN 1411, 1412, ARTS 1301, 1303, 1304, DRAM 1310, MUSI 1306, 1308, 1310

*BIOL courses must be less than 10 years old.

For Office Use Only

Review # 1

Initials

Last 4

All trans in packet

 yes  no

FINAL

Review #2

Initials

HESI

______ rounds to

_____

Applied to TC

 yes  no

GPA

Service Area

 yes  no

All trans in A & R

 yes  no

Letter Type

 yes  no

TSI Compliant

 yes  no

Date Sent

US Citizen

 yes  no

Previous BSW employee

 yes  no

BON Roster

Entered

 yes  no

BON Roster Reviewed

 yes  no

+18 by 1/1/2021

 yes  no

FOR OFFICE USE ONLY: ________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________

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