Fillable Nursing Program Application (Arapahoe Community College)

Fill Online, Printable, Fillable, Blank Nursing Program Application (Arapahoe Community College) Form

Use Fill to complete blank online ARAPAHOE COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Nursing Program Application (Arapahoe Community College)

On average this form takes 29 minutes to complete

The Nursing Program Application (Arapahoe Community College) form is 7 pages long and contains:

  • 0 signatures
  • 12 check-boxes
  • 109 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Arapahoe Community College

BROWSE ARAPAHOE COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 1
Revised January 2019
Submit a complete 8-page Nursing Program Application and required forms. Every item contained in
the Application Checklist on pages 2 and 3 must be addressed, with required documents attached.
Leave no blank spaces.
Application dates and deadlines are firm. Incomplete applications will not be considered, and student
may not resubmit for the current semester.
It is the student’s responsibility to check the Arapahoe Community College Nursing Program
website for any changes or updates in requirements prior to submittal of the Application.
LEAVE NO SPACES BLANK – PLEASE PRINT LEGIBLY
APPLICATION
Last Name First Name Middle Initial
Street Address
City State Zip Student Number S
Student Email @student.cccs.edu Phone 1
Personal Email Phone 2
NURSING PROGRAM APPLICATION CHECKLIST AND REQUIRED DOCUMENTS:
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 2
Indicate document attached and/or information provided by checking off the box
Information Session Veri
fication Form (must obtain at the Information Session attended)
Transcript – Print a Student
/Unofficial copy of your Arapahoe Community
College Transcript
-
If any of your prerequisites were taken at another community college, college, university or
institution, you MUST have your transcripts officially evaluated at Arapahoe Community
College prior to submitting a Nursing Application
-
In the event you submit documentation of required prerequisites on any transcript other than
Arapahoe Community College, your application will be returned and you may not resubmit for
the current semester
-
If you completed all Nursing Program prerequisites at Arapahoe Community College, you
need
only to print a student/unofficial copy
Health Care Employment Verification Form (print additional copies of the form if
necessary.)
Write N/A on the form if you have none.
Health Care Certifications, Licenses, and Degrees Write “Not Applicable” if you have
none
HESI Nursing Admission Assessment Test Summary Page (copy)
Must
score at least 70% in English Language Composite and Math.
Immunizations and Health Assessment (do NOT write “see attached” anywhere on
forms)
Page 6 must be completely filled out with immunization dates, either inoculations or
titers.
If signed by Physician or Health Care Provider, no lab records are required, but
preferred. Please include them if you have them.
If unsigned, all lab records must be provided.
Flu Shot Note:
• Spring semester starts must include documentation of a flu shot.
• Fall semester starts will be advised to get the flu shot in September.
Current Certified Nurse Aide CNA Card (copy of card, can be from any state)
BLS Card – must be current, Two-Year Health Care Provider, American Heart
Association strongly preferred.
(copy of card)
Proof of Health Insurance (copy of card or letter/email of coverage)
Prerequisites - Highlight required prerequisites on your student/unofficial transcript
copy.
Enter the grade and semester from your Arapahoe Community College transcript copy:
Course Name
Grade
Semester/Year Taken
ENG 121
PSY 235
BIO 201 (7-year time limit)
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 3
Course Name
Grade
Semester/Year Taken
HPR 108 or HWE 100
Eligible to Register for MAT103
Additional Non-Nursing Curriculum Courses – REQUIRED for graduation, but
need not be completed prior to applying.
If you have completed any of the courses, please highlight the course(s) on your transcript:
Course Name Grade
S
emester/Year
Taken
MAT103 Math for Clinical Calculations (1-year time limit)
BIO 202 Anatomy & Physiology (7-year time limit)
BIO 204 Microbiology (7-year time limit)
BIO 216 Pathophysiology (7-year time limit)
3-credit Social/Behavioral Science, course name:
MAKE A COPY OF THE NURSING PROGRAM APPLICATION AND
DOCUMENTS PRIOR TO SUBMITTAL TO ACC NURSING PROGRAM
Additional details on these requirements can be found in the Nursing Program INFORMATION
section of this document.
Mail or hand-deliver to:
Arapahoe Community College Nursing Program
Campus Box 31, Room A2335
5900 South Santa Fe Drive
Littleton, CO 80160
NO electronic or facsimile submittals accepted.
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 4
HEALTH CARE R ELATED EMPLOYMENT
Please print. Complete one separate page/form for each Employer; you may include more than one
position with the same Employer. If none, complete top section of form and sign at the bottom.
NURSING CANDIDATE NAME
EMPLOYER
CITY
STATE ZIP
SUPERVISOR/HUMAN RESOURCES INFORMATION:
CONTACT NAME _________________________________ TELEPHONE
SUPERVISOR/HUMAN RESOURCES EMAIL
CANDIDATE
JOB TITLE
S
TART
AND
END
DATE
OTAL
ESTIMATED
HOURS IN
DUTIES
My signature on this “Health Care Related Employment Verification Form,” attests that I was employed
in the position(s) noted above.
Signature of Applicant
Date
This Employment Verification is Page of Total Pages
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 5
HEALTH CARE RELATED CERTIFICATIONS, LICENSES, AND DEGREES
CANDIDATE NAME
PLEASE PRINT
Certification(s), license(s) and degree(s) related to health care may include, but not be limited to Medical
Assistant, Massage Therapist, Emergency Medical Technician, Paramedic, Unit Secretary, Pharmacy
Technician, Laboratory Technician, Phlebotomist, and Physical Therapist Assistant. If none, fill out and
sign form, write N/A in section below.
CERTIFICATION, LICENSE, OR DEGREE
AGENCY AND/OR
TRAINING INSTITUTION
DATE
AWARDED
EXPIRATION
DATE
I understand by signing this Verification of Health Care Related Certification(s), License(s) and
Degree(s) form, I attest the information to be true.
Candidate Signature
Date
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 6
IMMUNIZATIONS AND HEALTH ASSESSMENT REPORT
Student Name Date of Birth
Student “S” Number Last 4 digits of Social Security #
Street Address
City, State, Zip
Personal Email Phone #1
Student Email (Required) @student.cccs.edu Phone #2
In case of Emergency Please Contact:
(Contact Name and Relationship to Student)
Contact Phone #1 Contact Phone #2
IMMUNIZATIONS AND TESTS REQUIRED
Fill in ALL blanks – if an element does not apply to you, write “N/A” or “--- “. Do not write “see
attached.” Must be signed by a Health Care Provider (you may include lab reports):
VACCINE
D
OSE
1
MONTH/DAY/YEAR
AND RESULT
D
OSE
2
MONTH/DAY/YEAR
AND RESULT
D
OSE
3
(
IF REQUIRED
)
OR
TITER
Tuberculosis
Indicate skin test or QFT blood test (both
expire 1-year from date of test)
OR
X-Ray (expires 5-years from date of test)
Measles, Mumps, and Rubella
(2 doses required or titer)
Hepatitis B
(3 doses required or titer)
OR
History of Hep B (Anti-HBC Positive)
Varicella (Chickenpox)
(2 doses required or titer)
Attestation of History of Disease is NOT
accepted
TDAP (every 10 years)
FLU Shot (Spring Semester Applications
Only)
(May include lab report and dates must still be entered)
Name of Physician or Nurse Practitioner (PRINT)
Physician or Primary Care Provider Signature Date
Health Assessment Report – Immunizations
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 7
RANKING CRITERIA
FOR INFORMATION ONLY PLEASE DO NOT SUBMIT WITH APPLICATION
CRITERIA POINTS
TOTAL
POINTS
AWARDED
GPA POINT VALUE ACHIEVED = POINTS AWARDED
Maximum Point Award is 4
GPA calculated on prerequisite classes ONLY: ENG 121 (3 credits), PSY 235 (3 credits), BIO 201
(4 credits), HPR 108 (1 credit), or HWE 100 (3 credits).
A = 4, B = 3, C = 2. Multiply grade value by number of credits for each class. Divide by total
number of credits for GPA. If you took HPR 108, divide by 11; if you took HWE 100, divide by 13.
HEALTH CARE EMPLOYMENT
Maximum Point Award is 3*
Employer verification of healthcare employment in the last 5 years.
600-750 hours = .5 points
751-1000 hours =.75 points
1001-1500 hours = 1.0 point
1501-1750 hours = 1.5 points
1751-2000 hours = 1.75 points
2001-2500 hours = 2.0 points
2501-2750 hours = 2.5 points
2751-3000 hours =
2.75 points
Over 3000 hours = 3.00 points
*Only CNA employment is guaranteed to count for the points above.
HESI NURSING ADMISSION ASSESSMENT EXAM
Maximum Point Award is 3
Science Composite Score
70% to 80%= 1 point
81% to 90%= 2 points
91% to 100%= 3 points
HEALTH CARE RELATED CERTIFICATIONS, LICENSES, AND DEGREES
Maximum Point Award is 1 (less than 1 point may be awarded)
Does not include required CNA or BLS.
CNA COURSE TAKEN AT ACC = 1 POINT
CANDIDATE CRITERIA TOTAL POINTS
Add all points calculated above from GPA, HESI, Employment, and Certifications (Maximum 12)
AVERAGE OF HESI ENGLISH LANGUAGE COMPOSITE AND MATH
Must score at least 70% in Reading Comprehension, Grammar, Vocabulary and
General Knowledge under English Language, and Math. Maximum 100 points.
The HESI Nursing Admissions Assessment Exam scores will be used as the determining
factor to rank candidates who share the same total score.
TOTAL COMBINED SCORE OF CRITERIA POINTS + HESI AVERAGE
OF ENGLISH AND MATH SCORES
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 8
DOCUMENTS AND INFORMATION REQUIRING A COPY (OR COPIES) AND/OR ACTION
DO NOT INCLUDE THIS PAGE WITH APPLICATION – INFORMATION PURPOSES ONLY!
Application – Pages 1, 2, and 3
Information Session Attendance Verification Form
Arapahoe Community College transcript (unofficial is ok), and highlight prerequisites.
Pre-requisite for MAT103 (NOTE: if you have taken BIO 201, you should have one of the prereq’s
below)
a. Prerequisite course of MAT050 or higher
b. Next Generation Arithmetic Accuplacer score of 265 or higher OR Next Generation
QAS score of 230 or higher
c. BAAD score of 106 or higher, PADI score of 80 or higher, any IADI score
d. ACT score of 19 or higher (within 5 years)
e. Completion of MAT103 within one year of application
Non-nursing Curriculum Courses, highlight if Completed – REQUIRED for graduation but
OPTIONAL for application submittal
a. MAT 103 Math for Clinical Calculations – may not be taken more than one year prior to
the start of the nursing program.
b. BIO 202 Anatomy & Physiology II, BIO 204 Microbiology, BIO 216 Pathophysiology –
NOTE: All BIO courses have a 7-year expiration.
c. 3-credit Social or Behavioral Science course.
Health Care Employment Form (p. 4)
Health Care Certifications (p. 5)
Health Immunization Report (page 6)
HESI Nursing Admission Assessment Exam Certified Nurse Aide - copy of card
BLS for Healthcare Providers – copy of card
Proof of Current Health Insurance Coverage
PLEASE DO NOT SUBMIT THIS PAGE OR SUBSEQUENT PAGES WITH YOUR APPLICATION -
Information and Instructions Follow on Pages 11 through 21
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 9
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM
INFORMATION
Thank you for your interest in the Arapahoe Community College Nursing Program.
Nursing Program Information Sessions
You must attend a Nursing Program Information Session prior to submitting your application to the
Nursing Program. When you attend the Information Session, you will receive an “Information Session
Attendance Verification Form,” and must retain this Form to submit with your Nursing Program
Application. Information Session dates and times may be found on the
Nursing Program home page
(http://www.arapahoe.edu/nursing).
Reservations are required. Email nursing@arapahoe.edu with one date only. In the SUBJECT line of
the email, type “Information Session RSVP” and in the content of your email give 1) your name, 2)
telephone number and 3) the date you wish to attend. You will receive an email reply confirming your
reservation and will include a copy of the most recent application. Please bring a copy of the Nursing
Program Application to the Information Session if you wish to make notes; no copies will be available at
the Session.
Attendees at previous Information Sessions have been polled to determine the best time to attend a
session and 85% consistently recommend attending at the beginning of the process. You may attend an
Information Session at any time prior to submitting your application. You are welcome to meet one-on-
one with the Nursing Program Assistant after you attend an Information Session.
Application to Arapahoe Community College (ACC)
The prerequisite courses for Arapahoe Community College’s Nursing Program may be completed at
Arapahoe Community College OR at any regionally accredited college or institution. To prepare to begin
your prerequisite course requirements, or to have your prerequisites from other schools transferred to
ACC, your first step is to complete an Arapahoe Community College application with the Admissions
and Records office at the main campus in Littleton, Colorado. You may also apply online at
the ACC
website (http://www.arapahoe.edu/); select Admissions, then select “Apply to ACC.”
Contact Information Central at 303-797-4222 with questions. Your INITIAL MAJOR at the time you
apply to the College should be “PRE NURSING”. By selecting PRE NURSING, you will facilitate the
transcript evaluation process if you have completed any or all of your prerequisites at another institution.
If you have taken all of your prerequisite courses at Arapahoe Community College, it doesn’t matter
what your initial major is as all courses will be on the ACC transcript.
The Arapahoe Community College application is a separate process and admission to Arapahoe
Community College does not guarantee admission to the ACC Associate Degree Nursing (ADN)
program. The Nursing Program admission is competitive, based on a points system (see page 8) with
most of the points coming from your HESI A2-ADN scores.
Transcript Evaluation
The only transcript accepted as part of the Nursing application, is an Arapahoe Community College
transcript. If your prerequisite courses were taken somewhere other than ACC, your transcripts from
other school(s), including other Colorado community colleges, must be officially transferred to Arapahoe
Community College for evaluation. Be sure to allow for the time it takes to have the transcripts officially
evaluated when planning for your targeted Nursing program application deadline: don’t wait until the last
minute.
Follow these steps if you took any or all of your prerequisites at another school:
1. Apply for admission to Arapahoe Community College.
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 10
2. Select PRE - NURSING as your initial major.
3. Request copies of official transcripts from any other college(s) attended, and have the
official transcripts sent directly to:
Arapahoe Community College, Admissions and Records,
Campus Box 14,
5900 South Santa Fe Drive
Littleton, CO 80160-9002
They can also be sent electronically, but must come directly from your prior school(s).
4. Your courses will be evaluated to ensure the course content meets our requirements. After
official evaluation by Admissions and Records, you will receive an email advising you the
transcript evaluation is complete. You may also be instructed to contact Advising for final
review for nursing pre-requisites. Follow the instructions in the correspondence from
Admissions upon receipt of the email.
Be sure to highlight the prerequisite courses on the Arapahoe Community College transcript that is
submitted with your application. A student or unofficial copy is sufficient.
If you submit documentation of required prerequisites on any transcript other than Arapahoe Community
College, your application will be considered ineligible.
If all of your prerequisites were taken at Arapahoe Community College, just print a student/unofficial
copy of your ACC transcript, highlight the prerequisites, and include with your application.
Prerequisites
The following four (4) prerequisite courses must be completed with a minimum combined GPA of 3.0.
Each course must be completed with a grade of C or better.
All prerequisite BIO courses must be completed within seven (7) years at the time of application.
All four prerequisites courses must appear on an Arapahoe Community College transcript at the time
you apply to the Nursing Program (see “Transcript Evaluation”):
• ENG 121 English Composition I
• PSY 235 Human Growth & Development
• BIO 201 Human Anatomy & Physiology I
• HWE 100 Nutrition OR HPR 108 Nutrition
Meet with an Advisor regarding prerequisites for ENG 121, PSY 235 and BIO 201.
Call 303-797-5664 for an appointment.
Any CLEP, DANTES or testing instrument will be awarded a grade of “C” for purposes of calculating
your GPA.
Math Prerequisite and Additional Non-Nursing Curriculum Courses
Prerequisite for MAT103 is MAT050 or higher or a score of 265 on the Next Generation Arithmetic
portion of Accuplacer or a score of 230 or higher on the Next Generation QAS portion of the Accuplacer,
or ACT score of 19 or higher within 5 years of application.
NOTE: If you have the required Biology course (BIO 201) you had to have taken a math class or
placement test that served as the prerequisite for MAT103.
There are four courses within the nursing curriculum that may be taken prior to acceptance to the
Nursing Program (required for graduation, but need not be completed before application):
* MAT 103 Math for Clinical Calculations – one year time limit
o The semester you take MAT 103 is not considered in the one year time limit.
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 11
* BIO 202 Anatomy & Physiology BIO 204 Microbiology
* BIO 216 Pathophysiology – all have a seven-year time limit
o May not be taken more than seven years prior to the start of the Nursing Program.
* 3-credit Social or Behavioral Science elective (some restrictions may apply)
Health Care Employment Verification Form
You may receive up to three points for health care related employment. Use the Health Care
Employment Verification form to document healthcare experience. Your experience may be for a paid
position or for volunteer assignments. You must include a supervisor or employer name and contact
information.
The experience you submit on the form may go back no more than five years. Your health care
experience may include, but not be limited to (for example) Certified Nurse Assistant, Medical Assistant,
Massage Therapist, Emergency Medical Technician, Paramedic, Unit Secretary, Pharmacy Technician,
Laboratory Technician, Physical Therapist Assistant, and Phlebotomist.
Health Care Certifications, Licenses and Degrees
Certification(s), license(s) and degree(s) related to health care may include, but not be limited to
Medical Assistant, Massage Therapist, Emergency Medical Technician, Paramedic, Unit Secretary,
Pharmacy Technician, Laboratory Technician, Physical Therapist Assistant, and Phlebotomist.
Please do not list your current CPR or CNA, as those are minimum requirements to apply to the Nursing
Program. The Health Care Certifications form is contained in the Nursing Program Application.
Health Education Systems Inc. (HESI) Nursing Admission Assessment Exam
You must take the HESI Nursing Admission Assessment Exam, version A2-ADN, and must achieve
scores of 70% or greater on English Language Composite and Math, to be eligible to apply to the
Nursing Program.
The test has 11 sections in 3 major areas:
1. English Language (reading comprehension, meaning-word use, conclusions,
implications, understanding, grammar, vocabulary & general knowledge),
2. Science (biology, chemistry, anatomy & physiology), and
3. Math (elementary algebra).
You may take the Exam a maximum of two times in the twelve (12) months prior to Nursing Program
Application submission.
A Resource and Study Guide is available at evolve.elsevier.com
.
Study Guide Info: Elsevier- HESI: Admission Assessment Exam Review,
ISBN: 9781455703333.
Study guides also available in the ACC library.
Practice testing online is recommended. Do a google search on HESI A2-ADN practice tests. There are
also 4 free smart phone apps.
To schedule an appointment to take the HESI Nursing Admission Assessment Exam, email
nursing@arapahoe.edu from your student email address and request instructions. Testing is done at
Prometric in Greenwood Village.
YOU MUST PRE-REGISTER for the exam on the HESI website. Instructions can be found on the
Nursing Program web page (www.arapahoe.edu/nursing)
Certified Nurse Aide
You must have current certification as a Certified Nurse Aide (CNA) at the time you apply to the Nursing
Program.
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 12
NOTE: ACC has a Nurse Aide Program, and you can earn one point in the competitive admission
system by taking the class at ACC.
Find information at ACC Nurse Aide Program
For a list of other approved nurse aide training programs in Colorado, you may visit the Colorado Board
of Nursing Website (http://www.dora.state.co.us/nursing), visit Approved Nurse Aide Training Programs
or call 303-894-2430.
Certification in Basic Life Support (BLS) for Health Care Providers
Certification in Basic Life Support (BLS) for Health Care Providers is a requirement of application to the
nursing program. The course must include two-person, infant/child CPR and airway obstruction, and
must be the two-year Healthcare Provider level.
After completing the BLS course, it may take 2 to 4 weeks to receive your CPR card in the mail, so plan
ahead.
BLS classes are available widely available in the metropolitan Denver area. We recommend that you
receive your training through:
American Heart Association
or 800-242-8721
Proof of Health Insurance
You must have proof of health insurance coverage at the time you apply to the Nursing Program. You
may make a copy of your insurance card or submit a letter and/or email of coverage. Coverage may
include private, public or military health care coverage.
If accepted to the Nursing Program, you will have liability insurance and Workman’s Compensation
when you are participating in clinical assignments.
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 13
ARAPAHOE COMMUNITY COLLEGE SCHOOL OF NURSING ASSOCIATE DEGREE
NURSING COURSE SEQUENCE GUIDE
5 SEMESTER PLAN
1
ST
SEMESTER (PRE-NURSING)
COURSE # COURSE TITLE
CREDIT
HOURS
ENG 121
English Composition 1
3
BIO 201
Anatomy and Physiology 1
4
PSY 101*
General Psychology
3
PSY 235
Human Growth and Development
3
HPR 108**
Nutrition
1
2
ND
SEMESTER
(Formal admission to the Nursing Program required for NUR courses)
COURSE # COURSE TITLE
CREDIT
HOURS
BIO 202
Anatomy and Physiology II
4
MAT 103
Math for Clinical Calculations
3
NUR 109
Fundamentals of Nursing
6
NUR 112
Pharmacology of Nursing I
2
3
RD
SEMESTER
COURSE # COURSE TITLE
CREDIT
HOURS
BIO 204
Microbiology
4
NUR 150
Maternal Child Nursing
6
NUR 106
Med-Surgical Nursing Concepts
7
4
TH
SEMESTER
COURSE # COURSE TITLE
CREDIT
HOURS
BIO 216
Pathophysiology
4
NUR 206
Advanced Concepts of Med/Surgical Nursing 1
6.5
NUR 211
Psychiatric-Mental Health Nursing
4
NUR 212
Pharmacology II
2
5
TH
SEMESTER
COURSE # COURSE TITLE
CREDIT
HOURS
NUR 216
Advanced Concepts of Med/Surgical Nursing II
5
NUR 230
Transition to Professional Nursing Practice
4
* Any Arts & Humanities or Social & Behavioral Science may be substituted for PSY 101
** or HWE 100 (3 credits)
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 14
Immunizations and Health Assessment
The Arapahoe Community College Nursing Program nursing courses include clinical rotations scheduled in
a variety of health care facilities.
Documentation of specific immunizations is required for participation. This is for the protection of both clients
and students.
Review the list of immunizations below, and complete ACC Nursing Program Immunization Assessment
Report (on the Nursing Program Application, page 6).
All immunizations and/or immunization series must be complete at the time of application or your
application will be deemed incomplete, and will not be considered.
Immunizations and Health Assessment Report: This page must be completely filled out. If signed by
your health care provider, no lab records are necessary. If you cannot obtain a signature, lab records for all
immunizations must be provided.
Rubeola (Measles)
Students must present evidence of two immunizations, or laboratory documentation of a
positive titer (positive rubeola antibody polyvalent screen).
Rubella (German Measles)
Documentation of two MMR immunizations, or laboratory documentation of a positive
titer is required.
Hepatitis B
The series of three Hepatitis B vaccinations, or laboratory documentation of a positive
titer, is required. Attention to timing is required, as the series takes 8 months to
complete.
PPD Tuberculin Test
There are 3 types of tuberculin tests that are acceptable:
1. Intradermal PPD, Mantoux method, good for one year from date of test.
2. X-ray: Good for 5 years from date of test, must include verification of freedom of TB
symptoms issued by a healthcare provider, or the Disease Control Service of the
City and County of Denver.
3. QFT: Quantiferon blood test, good for one year from date of test.
Varicella (Chickenpox)
Documentation of two Varicella immunizations, or laboratory documentation of a
positive titer, is required.
TDAP
Must have proof of inoculation record, within 10 years.
Flu Shot
Required for Spring nursing program starts. (Fall starts will be required to get the shot
by Oct 1)
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 15
Disqualifying Offenses
An Applicant will be disqualified from a CCCS nursing program based on the following
guidelines:
• Any violent felony convictions of homicide. (No time limit)
• Crimes of violence (assault, sexual offenses, arson, kidnapping, any crime against an at-risk adult
or juvenile, etc.) as defined in section 18-1.3-406 C.R.S. in the 10 years immediately preceding the
submittal of application.
• Any offense involving unlawful sexual behavior in the 10 years immediately preceding the submittal
of application.
• Any crime, the underlying basis of which has been found by the court on the record to include an
act of domestic violence, as defined in section 18-6-800.3 C.R.S. in the 7 years immediately
preceding the submittal of application.
• Any crime of child abuse, as defined in section 18-6-401 C.R.S. in the 7 years immediately
preceding the submittal of application.
• Any crime related to the sale, possession, distribution or transfer of narcotics or controlled
substances in the 7 years immediately preceding the submittal of application.
• Any felony theft crimes in the 7 years immediately preceding the submittal of application.
• Any misdemeanor theft crimes in the 5 years immediately preceding the submittal of application.
• Any offense of sexual assault on a client by a psychotherapist, as defined in section18-3-405.5
C.R.S. in the 7 years immediately preceding the submittal of application.
• Crimes of moral turpitude (prostitution, public lewdness/exposure, etc.) in the 7 years immediately
preceding the submittal of application.
• Registered Sex Offenders. (No time limit)
• Any offense in another state, the elements of which are substantially similar to the elements of any
of the above offenses.
• More than one (1) D.U.I. in the 7 years immediately preceding the submittal of application.
If the investigation reveals information that could be relevant to the application, the designated individual
responsible for background checks may request additional information from the applicant. The offense
shall be reviewed on a case-by-case basis. Students who have successfully completed the terms of a
deferred adjudication agreement will not be disqualified.
If any applicant feels the criminal background check is inaccurate, they may appeal the decision and
request a review with the specific community college with whom they applied. It is the applicant’s
burden to produce substantial evidence that proves the crimes charged are incorrect. (CCCS 6/8/07)
Equal Opportunity
Arapahoe Community College is an equal opportunity employer. The College operates under an Equal
Opportunity Plan that ensures equal access to opportunities for all students, faculty and staff.
Arapahoe Community College does not discriminate on the basis of race, sex, creed, color, age,
national origin, veteran status, or individual disability in the admission or access to, treatment of, or
employment in, its education programs or activities.
Inquiries concerning the Equal Opportunity policy and/or compliance with Federal and State regulations
should be directed to:
Director of Human Resources
Arapahoe Community College
5900 S. Santa Fe Drive, P.O. Box 9002,
Littleton, Colorado 80160-9002
and/or
Vice President of Legal Services
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 16
Community Colleges of Colorado
9101 East Lowry Boulevard
Denver, CO 80230
and/or
Office of Civil Rights
U.S. Department of Education
1244 Speer Blvd., #310,
Denver, Colorado 80204
Nursing Program Application Submission
Review your Nursing Program Application materials and utilize the checklist on page 2 & 3 of the
Application to confirm your Nursing Program Application and required documents are complete.
If you cannot check each of the elements on the application, you are not ready to apply!
MAKE A COPY for yourself before you submit it to the ACC Nursing Program.
Applicants who submit a Nursing Program Application with required documents will have their
application and documents reviewed by the ACC Associate Degree Nursing (ADN) Admissions
Committee. Provisional admission is based on a merit evaluation. Applicants meeting all minimum
admission criteria will be ranked on a point system.
Applications may be submitted by U.S. Mail or hand-delivered. Be sure your application is complete and
contains all required documents before posting or delivering.
• If hand-delivered, your application WILL NOT be reviewed at the time of delivery.
• The Nursing Program will not accept any additional application materials after the student has
submitted the application and documents.
• NO electronic (email or facsimile) Nursing Program Application will be accepted.
Hand delivery is recommended. If you hand deliver your application, please be aware, your application
will NOT be reviewed at the time of submittal; please do not ask. You may submit your application in
person to the Arapahoe Community College Nursing Program.
Nursing Program Assistant
Arapahoe Community College (Main Campus)
ANNEX Building, Room 2335
5900 South Santa Fe Drive, Littleton, CO 80120
Applications submitted by U.S. Mail should include a confirmed delivery method. The Nursing Program
is not responsible for misplaced application materials, late delivery, or failed delivery of application
materials. Please check with the nursing program the day before the deadline to be sure your
application was received.
Mail your Nursing Program Application and required attachments to:
Nursing Program, Campus Box 31
Arapahoe Community College
5900 South Santa Fe Drive
Littleton, CO 80120
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 17
Application Dates and Deadlines
APPLICATION DATES AND DEADLINES ARE FIRM AND APPLICATIONS ARE ACCEPTED ONLY WITHIN
THE TIME FRAMES AND DEADLINES LISTED BELOW.
Inquiries regarding the status of an application before the scheduled notification date will not be
accepted, and will only slow down the process.
Application dates and deadline for FALL SEMESTER (August) STARTS
Applications for Fall Semester will open on the THIRD MONDAY OF APRIL at 9:00 a.m.
and close on the THIRD FRIDAY IN MAY at NOON, immediately preceding the Fall
semester for which the student seeks admission.
Application dates and deadlines for SPRING SEMESTER (January) STARTS
Applications for Spring Semester will open on the FIRST MONDAY OF NOVEMBER at
9:00 a.m. and close on the THIRD FRIDAY OF DECEMBER at NOON, immediately
preceding the Spring semester for which the student seeks admission.
Nursing Program Review Process and Letters of Offer and Decline
OFFER LETTERS FOR ADMISSION
Will be mailed to the physical address contained in the Nursing Program Application, following the
Admissions Committee review of all applications, and no later than two (2) weeks following the
application deadline. Offer letters will include orientation, criminal background check, and additional
information needed to prepare selected candidates for the Nursing Program. Notify the Nursing
Program directly and immediately if your mailing address or contact information changes; you must also
notify Admissions and Records.
LETTERS OF REFUSAL
Will be mailed to the physical address contained in the Nursing Program Application, following the
Admission Committee review of all applications, and no later than two (2) weeks following the
application deadline.
In the event you are not selected as a candidate, you will be required to re-submit your entire
Nursing Program Application Packet for a subsequent semester. Be sure to MAKE YOUR
COPIES before submitting your application and required documents.
Thank you for your interest in the Arapahoe Community College Nursing Program. If you have
questions regarding the Nursing Program, please contact:
Assistant, Nursing Program
Arapahoe Community College
5900 South Santa Fe Drive
Littleton, CO80120
303-797-5939
nursing@arapahoe.edu
Note:
Information regarding median loan debt, completion and placement rates, occupations and
tuition/fees may be found at Gainful Employment Disclosure Information
.
ARAPAHOE COMMUNITY COLLEGE NURSING PROGRAM APPLICATION
p. 18
ESSENTIAL SKILLS AND FUNCTIONAL ABILITIES FOR NURSING STUDENTS
FUNCTIONAL
ABILITY
STANDARD EXAMPLES OF REQUIRED ACTIVITIES
Motor
Abilities
Physical abilities and mobility sufficient
to execute gross motor skills, physical
endurance, and strength, to provide
patient care.
Mobility sufficient to carry out patient
care procedures such as assisting with
ambulation of clients, administering
CPR, assisting with turning and lifting
patients, providing care in confined
spaces such as treatment room or
operating suite.
Manual
Dexterity
Demonstrate fine motor skills sufficient
for providing safe nursing care.
Motor skills sufficient to handle small
equipment such as insulin syringe and
administer medications by all routes,
perform tracheotomy suctioning, insert
urinary catheter.
Perceptual/
Sensory
Ability
Sensory/perceptual ability to monitor
and assess clients.
• Sensory abilities sufficient to hear
alarms, auscultatory sounds, cries for
help, etc.
• Visual acuity to read calibrations on 1
cc syringe, asses color (cyanosis,
pallor, etc.).
• Tactile ability to feel pulses,
temperature, palpate veins, etc.
• Olfactory ability to detect smoke or
noxious odor, etc.
Behavioral/
Interpersonal/
Emotional
• Ability to relate to colleagues, staff
and patients with honesty, civility,
integrity and in a nondiscriminatory
manner.
• Capacity for development of mature,
sensitive and effective therapeutic
relationships.
• Interpersonal abilities sufficient for
interaction with individuals, families
and groups from various social,
emotional, cultural and intellectual
backgrounds.
• Ability to work constructively in
stressful and changing environments
with the ability to modify behavior in
response to constructive criticism.
• Capacity to demonstrate ethical
behavior, including adherence to the
professional nursing code and
student code of conduct.
• Establish rapport with patients/clients
and colleagues.
• Work with teams and workgroups.
• Emotional skills sufficient to remain
calm in an emergency situation.
• Behavioral skills sufficient to
demonstrate the exercise of good
judgment and prompt completion of
all responsibilities attendant to the
diagnosis and care of clients.
• Adapt rapidly to environmental
changes and multiple task demands.
• Maintain behavioral decorum in
stressful situations.
F
UNCTIONAL
ABILITY
STANDARD EXAMPLES OF REQUIRED ACTIVITIES
Safe
environment
for patients,
families and co-
workers
• Ability to accurately identify
patients.
• Ability to effectively communicate
with other caregivers.
• Ability to administer medications
safely and accurately.
• Ability to operate equipment safely
in the clinical area.
• Ability to recognize and minimize
hazards that could increase
healthcare associated infections.
• Ability to recognize and minimize
accident hazards in the clinical
setting including hazards that
contribute to patient family and co-
worker falls.
• Prioritizes tasks to ensure patient
safety and standard of care.
• Maintains adequate concentration
and attention in patient care
settings.
• Seeks assistance when clinical
situation requires a higher level or
expertise/experience.
• Responds to monitor alarms,
emergency signals, call bell from
patients, and orders in a rapid
effective matter.
Communication
• Ability to communicate in English
with accuracy, clarity and
efficiency with patients, their
families and other members of the
health care team (including spoken
and non-verbal communication,
such as interpretation of facial
expressions, affect and body
language).
• Required communication abilities,
including speech, hearing, reading,
writing, language skills and
computer literacy.
• Communicate professionally and
civilly to the healthcare team
including peers, instructors, and
preceptors.
• Gives verbal directions to or follows
verbal directions from other
members of the healthcare team
and participates in health care
team discussions of patient care.
• Elicits and records information
about health history, current health
state and responses to treatment
from patients or family members.
• Conveys information to clients and
others as necessary to teach,
direct and counsel individuals in an
accurate, effective and timely
manner.
• Establishes and maintain effective
working relations with patients and
co-workers.
• Recognizes and reports critical
patient information to other
caregivers.
p. 19
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Nursing Program Application (Arapahoe Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 6 September 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document