Fillable NURSE AIDE LEVEL II APPLICATION SPRING 2021 (Wilson Community College)

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NURSE AIDE LEVEL II APPLICATION SPRING 2021 (Wilson Community College)

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NURSE AIDE LEVEL II APPLICATION ∙ SPRING 2021
Admission to Nurse Aide Level II for SPRING 2021 is by application. There are ten (10) spaces available.
Prospective students must be currently listed on the Nurse Aide I Registry. Registration fee is $218, which
includes $180 registration, $5 technology, $15 security, $2 accident insurance, and $16 malpractice
insurance.
This 166-hour course prepares students to perform more complex nursing skills for patients or residents,
regardless of the setting. Course includes class, laboratory and clinical learning experiences. Students
must attend 95% of all class sessions; absent no more than five hours of lecture/skills and five hours of
clinical; must maintain an 80% average on all tests; and final exam score must be 80% or better. Upon
successful completion of the course and skill/competency evaluation, the student will be eligible for listing
with the North Carolina Board of Nursing on the Nurse Aide II Registry. The cost of this is $24.00.
Students are required to show proof of AHA CPR – Health Care Provider certification.
APPLICATION REQUIREMENTS:
• Complete the Nurse Aide II 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:
• Must be listed on the NC Nurse Aide Registry (proof of non-expired listing required)
• High School Diploma, High School Equivalency, or Transcript
• Valid Picture ID (example: unexpired driver’s license)
• Proof of Current CPR certification (AHA) Health Care Provider
• Proof of the following immunizations:
• One TB skin test (within (12) months of class start date)
• Two MMR (Mumps, Measles, Rubella) injections
• Three Hepatitis B (at least the first injection prior to the start of class is required)
• Varicella injections or Titer (blood test to prove immunity to chicken pox)
• Tdap (within the past ten (10) years)
• Flu vaccine
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.
TEXTBOOK REQUIRED:
• Advanced Skills for the Healthcare Providers 2
nd
Edition - (Approximately $120)
REQUIRED PRIOR TO CLINICAL ROTATIONS:
UNIFORMS: Navy blue scrub-type top, navy pants, white lab coat, 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.
NURSE AIDE LEVEL II APPLICATION for SPRING 2021 ▪ Section #37008
January 11 – May 12 ▪ 5 – 9 PM ▪ Mondays & Wednesdays ▪ Building: G ▪ Room: 109
Clinical hours start on March 29, 2021 (5 hours each session) ▪ 5 – 10 PM ▪ (last class 4 hours)
& one Saturday clinical, 5/12/2021 for 8 hours
(Register by January 8)
Applications are now available on the WCC website or in the Continuing Education office, B105. Early
registration begins on November 9, 2021. 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 $218 fee is due at the time of 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 II 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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NURSE AIDE LEVEL II APPLICATION SPRING 2021 (Wilson Community College)

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Completed 3 February 2021

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