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Associate in Applied Science
School of Career and Technical Studies
Department of Allied Health and Nursing
2020 APPLICATION - PROGRAM ADMISSION
BOONE/LINCOLN CAMPUS
Medical Assisting
LOGAN CAMPUS
Paramedic Science
- EMT-B required
WILLIAMSON CAMPUS
Medical Assisting
DEADLINE:
J
uly 27, 2020 http://www.southernwv.edu/
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2020 Associate in Applied Science Application
School of Career and Technical Studies
Department of Allied Health and Nursing
(RETURN PAGES 2 & 3 with the required attachments listed on the NEXT PAGE)
Last Name: First Name: Middle Name:
_________________________ ______________________ __________________
Address: _____________________________________________________________________
City: ____________________ County: _______________ State: _________ Zip: __________
Telephone Numbers: Home: ______________ Work: _____________ Cell: ______________
Southern ID: ______________________ (If you do not have a Southern ID number, you
MUST ALSO APPLY for admission to Southern)
E-mail Address (MANDATORY): ________________________________________________
Are you a U. S. Citizen? Yes No Under Immigration and Naturalization Service’s rules, Southern
is
not an institution certified to receive international students.
Are you a Veteran? Yes No
Are you currently enrolled as a Health Care Professional major student? Yes No
You will only be considered for admission to the program(s) for which you apply. Please clarify
the program(s) of choice in numerical order. (ex. 1
st
, 2
nd
, 3
rd
, etc.)
_____ Medical Assisting – Boone Campus
_____ Medical Assisting – Williamson Campus
_____ Medical Laboratory Technology – Logan Campus
_____ Nursing – Logan Campus
_____ Paramedic Science Logan Campus – (Pre-requisite EMT-B)
_____ Radiologic Technology – Logan Campus
_____ Respiratory Care Technology – Williamson Campus
_____ Respiratory Care Technology – Wyoming Campus
_____ Surgical Technology – Logan Campus
*Failure to fully complete this application, provide truthful information, and/or send
required documentation will result in immediate ineligibility.
I certify that all information provided in connection with this application is true and correct to the
best of my knowledge. I understand that any misrepresentation or omission on this application
will result in immediate ineligibility from all Healthcare programs. I have applied for admission
to Southern West Virginia Community and Technical College and all transcripts are attached to
this application. I have also attached a copy of my ATI TEAS and/or ACT/SAT scores, if
applicable, to this application. By signing below I verify and hereby affirm that I have read and
understand this application.
________________________________________ ____________________________
Signature of Applicant Date
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You MUST ATTACH the following documents on the CHECKLIST below.
Copy of ATI TEAS results (Nursing applicants ONLY)
Copy of ACT or SAT or Accuplacer score (ALL applicants)
Copy of College Transcript(s) (ALL applicants)
Copy of University/College Degrees (ALL applicants)
Copy of Health Related Field Certifications (Accredited Programs) (ALL applicants)
(Examples: LPN, CNA, MA, RT(R), RRT, CRT, MLT, CST, Phlebotomist, NREMT, EMT-B)
Application Requirements
Medical Assisting (Boone/Lincoln and Williamson Campuses)
Pa
ramedic Science (Logan Campus) – (Pre-requisite – EMT-B) & Two endorsement letters
Allied Health Programs Listed Above
MUST be eligible to enter college level English and math.
Minimum cumulative GPA of 2.0 in all previous college level courses. If no college
courses available, high school GPA or equivalent will be considered.
Must submit an ACT or SAT score with this application.
ACCUPLACER, ACT, SAT scores may be used to demonstrate college readiness in
English and math.
Attach copies of transcripts from all colleges/universities attended.
Applicants who have not taken previous college level courses must attach a copy of their
high school or equivalent transcript.
Applicant must have English language proficiency.
Nursing Program (Logan Campus)
MUST be eligible to enter college level English and math.
Minimum cumulative GPA of 2.5 in all previous college level courses. If no college
courses available, high school GPA or equivalent will be considered.
Applicant must take the ATI TEAS pre-entrance exam and achieve a score of 60% or
higher and attach ATI TEAS results to the application.
TEAS exam can only be taken ONE TIME during CURRENT application period. Results
of testing that took place in the previous application period is permissible (October 2018 through
February 2019) TEAS test can be used.
You may retest during this application period if you have tested previously and the highest
score will be accepted.
ACCUPLACER, ACT, SAT scores may be used to demonstrate college readiness in
English and math.
Attach copies of transcripts from all colleges/universities attended.
Applicants who have not taken college level courses must attach high school or equivalent
transcript.
Applicant must have English language proficiency.
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Information provided to the School of Career and Technical Studies is confidential and is used
only for selection purposes.
The selection of Allied Health and Nursing students is a competitive process based on previous
academic performance that includes the following: TEAS exam score of 60 or higher (nursing
program only), ACT composite or SAT total score, college or high school transcripts, overall
Grade Point Average (GPA), as well as completed health related field degree(s) and health related
field certifications from an accredited institution.
If, after submission of your application, you have a change of name, address, phone number or
email you must contact the School of Career and Technical Studies and Student Records
immediately to update your information.
Submit application, with required attachments to:
Susan E. Wolford, Administrative Associate
School of Career and Technical Studies
Logan Campus, Building B, Room 229
Southern West Virginia Community and Technical College
PO Box 2900
Mount Gay, WV 25637
Phone: 304.896.7385
Email: Susan.Wolford@southernwv.edu
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STATEMENT OF UNDERSTANDING
(Do not return this Statement of Understanding –Keep for your information)
I understand the following:
1. It is my responsibility to contact the Registrar at 304.896.7443 to ensure that my
official transcripts and records are received, accurate and complete upon acceptance.
2. Travel is required in all Healthcare and Nursing programs. Day, evening, night, and/or
weekend clinical rotations may be assigned. All arrangements and expenses are my
responsibility.
3. Criminal background checks and drug screens are required at my expense upon
acceptance into a program. Payment and testing is required regardless of previous
acceptance into a program(s). Previous background checks and drug screens are not
acceptable.
4. At the discretion of certifying/licensing agencies, clinical agencies can require the
results of background checks, drug screens, or other investigative information and can
prohibit access to clinical facilities.
5. I may or may not be allowed to take the appropriate licensure/certification exam after
completion of a program if convicted of a felony or misdemeanor.
6. A random drug screen may be requested at any time while in the program. Failure to
comply with a request for a drug screen, or a positive or diluted drug screen, or tampering
with results, will result in immediate dismissal from the program.
7. If I have ever received, or am currently receiving, treatment for drug dependency, I
must submit a copy of the treatment/record or discharge summary, printed on the facility’s
letterhead upon tentative admission to a Healthcare or Nursing program.
8. Letters of recommendation ARE NOT required and, if submitted, WILL NOT be
used in the selection process.
9. Applications are not held over from year to year and if I am not admitted I must re-
apply. This application supersedes and takes precedence over any previous application
produced by the School of Career and Technical Studies.
10. Failure to provide any requested information or any proven misrepresentation,
dishonesty, deceit, falsification, or omission of information WILL result in immediate
disqualification of the application.
11. If any of the above statements are not fully understood, it is my responsibility to
request clarification from the School of Career and Technical Studies.
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12. Full admission to any Healthcare program is contingent upon results of background
check, drug screen and physical exam.
Affirmative Action
Southern West Virginia Community and Technical College is an EEO/AA/Title VI/Title
IX/Section 504/ADA/ADEA Institution in the provisions of its education and employment
programs and services.
It is the policy of Southern West Virginia Community and Technical College to provide equal
opportunities to all prospective and current members of the student body, faculty, and staff on the
basis of individual qualifications and merit without regard to race, ethnicity, sex, color, gender,
religion, age, sexual or gender orientation, disability, marital status, veterans’ status, or national
origin.
This nondiscrimination policy also applies to all educational programs, to admission, to
employment, and to other related activities covered under Title IX, which prohibits sex
discrimination in higher education.
Southern West Virginia Community and Technical College also neither affiliates with nor grants
recognition to any individual, group, or organization having policies that discriminate on the basis
of race, ethnicity, sex, color, gender, religion, age, sexual or gender orientation, disability, marital
status, veterans status, or national origin. Inquiries regarding compliance with any state or federal
nondiscrimination law may be addressed to:
Affirmative Action Officer
Mr. Doug Kennedy, Director of Human Resources
Southern West Virginia Community and Technical College
P. O. Box 2900
Mount Gay, WV 25637
304.896.7408
Title IX Coordinator
Mr. Darrell Taylor, Director of Enrollment Management and Student Engagement
Southern West Virginia Community and Technical College
P. O. Box 2900
Mount Gay, WV 25637
304.896.7432
Section 504 Coordinator
Ms. Dianna Toler, Director of Disability and Adult Services
Southern West Virginia Community and Technical College
P. O. Box 2900
Mount Gay, WV 25637
304.896.7315
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Disability Services
Consistent with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities
Act (ADA), Southern West Virginia Community and Technical College ensures that qualified
individuals with disabilities are afforded equal opportunity to participate in its programs and
services. Reasonable modifications in policies, practices, and procedures are affected to assure
equal access to individuals with disabilities.
Disability Services offers a supportive environment to ensure students with disabilities have equal
access to the programs, services and activities offered by Southern. Disability Services provides
and coordinates reasonable accommodations and disability-related services, advocates for an
accessible learning environment through the removal of physical, informational and attitudinal
barriers, and encourages self-advocacy and personal responsibility on the part of students with
disabilities.
Immediately following completion of the application to Southern, persons with disabilities should
contact Disability Services to plan for potential accommodation.
Reasonable and effective academic accommodations are provided on an individual basis and are
based upon appropriate documentation of the disability and the significant functional limitations
associated with the disability. Students having accommodation needs must:
schedule an initial interview with the Office of Disability Services
provide written documentation of disability from an appropriate professional licensed
to diagnose such disability
request services on an academic term basis
This process of providing disability-related services follows guidelines of the Americans with
Disability Act (ADA) and Section 504 of the Rehabilitation ACT of 1973 and is designed to assure
that reasonable accommodations are provided to all qualified students in a timely manner.
Persons with disabilities who plan to apply for the Nursing program and are required to take the
ATI pre-entrance exam should contact Dianna Toler, Director of Disability and Adult Services, at
304.896.7315 (TTY: 304.792.7054) at Southern West Virginia Community and Technical College
to plan for potential accommodation.
Information provided regarding Disability Services is considered confidential and is not disclosed
without the written permission of the student.