Fillable NURSE AIDE LEVEL I APPLICATION FALL 2020 (Wilson Community College)

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NURSE AIDE LEVEL I APPLICATION FALL 2020 (Wilson Community College)

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NURSE AIDE LEVEL I APPLICATION ∙ FALL 2020
Admission into the Nurse Aide Level I program is by application, and only completed applications will be
accepted. Available classes for the FALL 2020 semester are listed on the reverse side. Registration fee is
$224, which includes $180 registration, $5 technology, $15 security, $2 accident insurance, $16 malpractice
insurance, and $6 CPR eCard.
Students must be at least 18 years of age. This course prepares students to perform basic nursing skills for
patients/residents, regardless of setting. Training includes class, laboratory, clinical experience and CPR
training. Students must attend 90% of all class sessions; maintain an 80% average on all tests; and the final
exam score must be 80% or better. Upon successful completion, students will be eligible to take the NNAAP
exam. Cost of certification exam is $120 – Students must pay by credit or debit card (Discover cards are not
accepted). Students will sign up for NC Certification Exam via computer. Students will use WCC email address to
setup account with Pearson Vue.
WCC is supportive of agencies who require drug screening and criminal background check. Allied Health
students may be required to submit a 13 panel drug screen and criminal background check. WCC recognizes
drug screening and criminal background from Castle Branch.com. Cost is $90.
APPLICATION REQUIREMENTS:
• Complete the Nurse Aide I application on the reverse side. Application can also be downloaded from
the wilsoncc.edu website, Continuing Education, Health Occupations page.
• Submit completed application to mkillette@wilsoncc.edu or to the Continuing Education office on
campus, B105.
• Copies of the following are required and must be submitted with application:
• High School Diploma, High School Equivalency, or Transcript
• Valid government issued (unexpired photo ID) required per NCNA Registry
• Social Security Card (must be signed, non-laminated)
• Proof of following immunizations:
• Two TB skin tests within twelve (12) months of class start date
• Two MMR (Mumps, Measles, Rubella) injections
• Three Hepatitis B (at least the first injection prior to the start date of class is required)
• Varicella injection or Titer (blood test to prove immunity to chicken pox)
• Tdap (within the past 10 years)
• Flu vaccine – starting September 2020
It is the student’s responsibility to obtain and attach copies of the required immunization records to application.
Keep the original record and SUBMIT COPIES ONLY.
TEXTBOOKS REQUIRED:
•
North Carolina Nurse Aide I Curriculum (2019) - (Approximately $75)
•
American Heart Association Textbook for CPR - (Approximately $20)
REQUIRED PRIOR TO CLINICAL ROTATIONS:
UNIFORMS: Navy blue scrub-type top; navy blue scrub pants and white, closed-toe shoes. The Instructor must
approve skirts and/or dresses prior to clinical rotation. Nametags are available in Building F prior to clinical
rotation. Nametags are required for clinical and are free to students. Analog watch required (a watch with
second hand).
NURSE AIDE LEVEL I APPLICATION ∙ FALL 2020
Indicate in the left hand column the class you are interested in taking:
CHOOSE
SCHEDULE
SPACES
AVAILABLE
SECT. #
DATES OF CLASS
DAYS OF WEEK
TIME
ROOM
10
36125
August 26 – December 10
(Register by August 25)
Wednesdays &
Thursdays
8:30 AM – 3 PM
G115
12
36125
August 18 – December 9
(Register by August 17)
Monday, Tuesday,
Wednesday
5 - 9 PM
G115
Applications are now available on the WCC website or in the Continuing Education office, B105. Early
registration begins on July 6, 2020. Students wishing to have applications approved are welcome to call 252-
246-1325 or email mkillette@wilsoncc.edu for questions regarding the approval process. Classes fill up quickly
so early registration is encouraged. Completed applications are accepted on a first come first served basis.
The $224 fee is due at the time of registration. Students will be assigned a WCC email address upon
registration. The registration and approval process will continue until the day before class starts or until the
class is full.
NAME: Last: First: Middle Initial:
ADDRESS: City/State: Zip:
PHONE: Home: Cell:
EMAIL ADDRESS: NC ID:
BIRTHDATE: Month Day Year SEX: ❑ Male ❑ Female
RACE: ❑ White ❑ Black ❑ American Indian ❑ Hispanic ❑ Asian ❑ Other
EMPLOYMENT: ❑ Unemployed ❑ Part-Time ❑ Full-time EMPLOYER:
CAREER PLANS:
DO YOU HAVE PREVIOUS EXPERIENCE IN THE HEALTH FIELD? ❑ Yes ❑ No
IF YES, PLEASE LIST:
AGREEMENT
I have attached all required copies to my application; I have read, understand, and agree, to all stated
requirements of the Nurse Aide Level I program; I understand the required clinical dress code, and agree to
comply upon acceptance; I understand this is an application only and it does not constitute acceptance into the
program. I understand that I will be dismissed from the program if documented as verbally or physically abusive
to college administration, clinical site staff, patients, or visitors.
SIGNATURE: DATE:
If any facility prohibits the student from participating in the clinical experience, the student will be dismissed
due to an inability to progress and complete the program.
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Completed 26 July 2020

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