Fillable Practical Nursing Program Application Applications Available: June, 2020 (Anne Arundel Community College)

Fill Online, Printable, Fillable, Blank Practical Nursing Program Application Applications Available: June, 2020 (Anne Arundel Community College) Form

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

Practical Nursing Program Application Applications Available: June, 2020 (Anne Arundel Community College)

On average this form takes 14 minutes to complete

The Practical Nursing Program Application Applications Available: June, 2020 (Anne Arundel Community College) form is 5 pages long and contains:

  • 0 signatures
  • 14 check-boxes
  • 51 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Anne Arundel Community College

BROWSE ANNE ARUNDEL 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
 
Practical Nursing
Program Application
Applications Available: June, 2020
Application Deadline: December 15, 2020
Program Start: Summer, 2021
ADMISSION REQUIREMENTS
To become a candidate for selection to the Anne Arundel Community College Practical Nursing program, please
complete and return the attached application. The application must be emailed to ramanning@aacc.edu
or mailed to
Anne Arundel Community College
ATTN: Health Sciences Admissions FLRS 112
101 College Parkway Arnold, MD 21012
First consideration will be given to candidates whose resident address is in Anne Arundel County for at least three
months prior to the date the application is submitted. The Address Verification form must be submitted with the
application. Out-of-county applicants will be reviewed if space is available.
To be considered for conditional acceptance, the applicant must meet the following criteria:
• Attend an Information Session. Please visit
http://www.aacc.edu/apply-and-register/credit-application/health-
science-applicants for dates and times. We are currently offering only virtual sessions. Admission and selection
information will be reviewed.
• High school graduate or equivalency. Official high school transcript or official GED equivalency transcript must be
submitted to the college through the online process. You can submit to the Records and Registration office by mail
but the process time will take longer.
• Satisfactorily completed the chemistry academic requirement, with a grade of C or better, or show current
enrollment in a chemistry course (credit or non-credit). Students must demonstrate successful completion of this
course by the end of the fall 2020 semester to be eligible for selection.
• Achieved a score of 27 or better on the Arithmetic Placement Test by the application deadline. This test may be
retaken one time. For scores of less than 27, students must enroll in MAT 005 and demonstrate successful
completion of this course with a grade of C or better by the end of the fall 2020 semester. Test scores must be
within 7 years from the date the Health Sciences program application is submitted. Retake is allowed if test is past
this time frame. One retake is allowed after that if needed. There is no time limit on MAT 005.
• Complete the four (4) prerequisite courses with a grade of C or better by the end of the fall 2020 semester.
• Official transcripts, if applicable.
• Have a minimum adjusted grade point average (GPA) of 2.0 at this college.
Eligible applicants will receive a selection packet assigning them to one of the following categories:
o Conditional Acceptance: Applicants who have met the academic and admission requirements and have been
selected into the Practical Nursing program. With the selection packet, conditionally accepted students will
receive the health examination record, criminal background check and CPR instructions to be completed by a
designated deadline. Conditional acceptance candidates who do not meet this deadline will not be considered for
admission and the next person on the list will be contacted.
o Wait List: In the event there are more qualified applicants than seats available, qualified applicants not initially
conditionally accepted will be placed on the wait list in rank order and notified of selection if and when seats
become available. Qualified out-of-county applicants will be placed at the end of the wait list.
Final acceptance into the program will be contingent upon satisfactory completion of a criminal background check,
health examination record and submission of a copy of the required CPR card.
IM
PORTANT INFORMATION
1. Direct all inquiries regarding the application process to Health Sciences Admissions Office via email at
ramanning@aacc.edu
. Following review of all applications, students will receive a letter regarding the status of their
application.
2. All Health Sciences students who are offered admission and/or clinical placement will be required to submit to a
complete criminal background check and urine drug screen. All student applicants’ final acceptance in the program
shall be contingent upon satisfactory completion of a criminal background check and of a urine drug screen.*
All letters of acceptance shall state that the acceptance is conditional and contingent on submission to a criminal
background check and urine drug screen—as may be required by the program--that results in satisfactory reports. If
an accepted student tests positive for an illegal or un-prescribed drug, the student shall be denied admission or
terminated from any Health Sciences program.
Separate, additional criminal background checks and urine drug screens may be required by clinical sites prior to
placements. Students with an unsuccessful background check or urine screening who are denied by a clinical site
that is required to meet program competencies shall be dismissed from the program and their registrations shall be
withdrawn from courses related to the program of study. If the student tests positive for an illegal or un-prescribed
drug, the student shall be denied admission or terminated from any Health Sciences program even if a denied
placement was not required to meet program competencies. Successful reports of criminal background checks and
urine drug screens do not assure eligibility for specific clinical site placement, program completion, and/or eligibility
to sit for professional licensure/board examinations.
Students are reminded that licensing boards for certain health care occupations and professions may deny,
suspend, or revoke a license or may deny the individual the opportunity to sit for an examination even if the
individual has completed all program course work if it is determined that an applicant has a criminal history or has
been convicted of, or pleads guilty, or pleads nolo contendere or the like to a felony or other serious crime.
Successful completion of a Health Sciences program of study at Anne Arundel Community College does not
guarantee licensure, the opportunity to sit for a licensure examination, certification or employment in the relevant
health care occupation.
Students may be automatically denied admission or, if enrolled, dismissed from the program if they have not been
truthful or have provided inaccurate information on the application or on any other form or submission. Students
who have questions or concerns are encouraged to contact the Health Sciences Admissions Office at
healthsciencesadmissions@aacc.edu.
* Notwithstanding the statements herein regarding urine drug screens, as of September 2010, only certain
programs will be requiring drug screening. AACC shall inform students which programs presently require
them. However, AACC, at any time, has the right, upon notice, to require any and all students in any and all
programs to comply with drug screening.
S
tudents who have been convicted of a felony or a misdemeanor may not be eligible for licensure as a practical
nurse. These students are required to contact the Maryland Board of Nursing at (410) 585-1900 for more
information.
PRACTICAL NURSING
SUMMER 2021
Application Deadline – December 15, 2020
Program Application
Completed applications are to be emailed to ramanning@aacc.edu or mailed to
Anne Arundel Community College
ATTN: School of Health Sciences
101 College Parkway FLRS 112 Arnold, MD 21012
DEMOGRAPHIC INFORMATION (Please print)
Last Name
First Name
Middle
Address
City
State
County of Residence
Last 4 digits of social security #
College ID #
The mailing address you provide will be your address of record. It is your responsibility to notify the Health Sciences Office
of name, address and phone number changes during the application process.
Home Phone
Cell Phone
Work Phone
AACC Email Address – Required No other email is acceptable
@mymail.aacc.edu
Admission/Academic Requirement Checklist
By signing below, I agree/understand the following:
1. I have an active admission status at AACC and am in Good Standing (2.0 GPA>) with the college.
2. All academic admission requirements, including prerequisites, must be completed by the end of the fall 2020
semester. Pass/Fail grades are not acceptable.
3. I must submit final official transcripts from previously attended colleges from which I am transferring courses
toward the PN program by the stipulated deadline. International students must submit official transcript
eva
luation report from EC
E, WES or SpanTran to verify/authenticate college transcripts by the stipulated
deadline.
4. I understand that by filling in my name below, it will be considered my signature.
SIGNATURE
:
DATE
:
ADMISSION/ACADEMIC REQUIREMENTS
HIGH SCHOOL GRADUATE OR EQUIVALENCY
Submit your official High School / GED transcript by the application deadline. A copy of a high school/GED diploma does
not fulfill this requirement.
CHEMISTRY
Comp
lete a chemistry course with a grade of C or better by the end of the fall 2020 semester.
U.S.
High School Chemistry (1 credit) or CHE 011 (2 equivalent hours) or CHE 103 / 111 / 113 / 115 (3 – 4 credits)
*If from high school, you MUST submit a final official high school transcript.
If home schooled, the high school curriculum must be under a recognized umbrella organization with the supervision of
a state-approved curriculum. AACC may require a course syllabus so that our chemistry department chair can review
and approve the curriculum.
School where you completed the chemistry requirement:
Semester/Year:
Grade:
ARITHMETIC PLACEMENT TEST - This is not the same as the Mathematics Placement.
This test MUST be completed by the application deadline.
MY SCORE:
DATE
TAKEN:
Or
successful completion of MAT 005 with C or better completed by the end of the fall 2020 semester.
GRADE: WHERE TAKEN:
Provide official transcript if taken at institution other than AACC.
Please note that this is not the same as a general education mathematics course.
Arithmetic Placement test scores must be within 7 years from the date Health Sciences program application is submitted.
Retake is allowed if test is past this time frame. One retake is allowed after that if needed. There is no time limit on MAT
005.
PREREQUISITE COURSES
Must be completed with a C or better by the end of the fall semester
Pass/Fail grades are not accepted for this program
COURSE GRADE CREDITS
COLLEGE WHERE
COMPLETED
TERM
AND YEAR
COMPLETED
Human Biology 1 BIO 231
and
Human Biology 2 BIO 232
OR
Anatomy and Physiology 1 BIO 233
and
Anatomy and Physiology 2 BIO 234
Introduction to Psychology PSY 111
General Education Mathematics
INTERNATIONAL STUDENTS
Have you submitted an official transcript evaluation report from ECE, WES or SpanTran to verify/authenticate your high
school and/or college transcripts to the records office?
Yes No Agency Used:
BACKGROUND INFORMATION
Submit explanation of questions for which you answer "yes" and provide documents relating to your answer in a
sealed envelope with this application with attention: Tammie Neall or email to tdneall@aacc.edu
Do not write explanation(s) on the application.
Yes
No
Were you e
ver disciplined for any academic or behavior/conduct issue by any college, university,
or any other educational institution after high school including, but not limited to, probation,
dismissal, suspension, disqualification, or imposition of a failing grade as a disciplinary sanction? If
your answer is yes provide a written explanation and all relevant documents relating thereto.
No
Have you ev
er been convicted of a crime, driving while intoxicated or impaired (either by alcohol
or drugs), had your driving privileges suspended or revoked, and/or are there any pending
charges regarding any of the above? If your answer is yes provide a written explanation and all
relevant documents relating thereto.
No
Have you ev
er surrendered your driver's license or had such license suspended or revoked? If your
answer is yes provide a written explanation and all relevant documents relating thereto.
No
Have you ever surrendered a professional license, certification or registration, or had one restricted,
suspended or revoked? If your answer is yes provide a written explanation and all relevant
documents relating thereto.
Yes
No
Have you e
ver been placed on professional probation, had conditions or limitations placed on your
ability to work even if your license had not been restricted, suspended or revoked? If your answer
is yes provide a written explanation and all relevant documents relating thereto.
Yes
No
Have you ever had your clinical privileges at any office or facility restricted, suspended or
revoked? If your answer is yes provide a written explanation and all relevant documents relating
thereto.
NOTE: Licensing boards for certain health care occupations, including Nursing, may deny, suspend, or revoke a license or may deny the
individual the opportunity to sit for an examination even if the individual has completed all program course work, if it is determined that an
applicant has a criminal history or is convicted or pleads guilty or nolo contendere to a felony or other serious crime. If applicable, it is
recommended to contact the Maryland Board of Nursing for clarification at 410-585-1900.
I certify that the information on this application is true and accurate to the best of my knowledge. Falsification or
misrepresentation of any information on this application may result in being denied admission to the program. I
understand that final acceptance into the PN program shall be contingent upon satisfactory completion of a
criminal background check and satisfactory completion of a health examination record.
I understand that by filling in my name below, it will be considered my signature.
Signature: Date:
PRINT NAME:
Notice of Nondiscrimination:
AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410-777-2306 or Maryland
Relay 711, 72 hours in advance to request most accommodations. Requests for sign language interpreters, alternative format books or assistive technology
require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual assault, sexual misconduct, discrimination or harassment,
contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or Maryland Relay 711.
R
LTH
\HDrive\AHCOMMON\TDN\Applications 2020-2021 IC Approved\PN Application Final.IC.approved.5.21.2020.docx
ERIFICATION
Yes
Ye
s
Yes
101 College Parkway, Arnold, Maryland 21012-1895 410-777-2243
ADDRESS VERIFICATION FOR HEALTH SCIENCE PROGRAM APPLICANTS
Directions: This form must be completed entirely and supporting documents submitted as part of the health sciences
program application process. Applications submitted without this document will be returned as incomplete.
If you the student support yourself, provide a minimum of two of the documents listed below in your name, at current
resident address that are dated three months prior to the application deadline date.
OR
If for the most recent 12 months, you, the student, have resided in Anne Arundel County, but are supported by someone in
another Maryland county or state, provide a minimum of two of the documents listed below in your name, at current resident
address that are dated three months prior to the application deadline date.
OR
If for the most recent 12 months, another person(s) has provided one-half or more of your financial support, provide a
minimum of two documents listed below in your supporter’s name, showing current resident addresses that are dated three
months prior to the application deadline date.
In addition, you will need to provide one document from the list below in your name showing current resident address and
dated three months prior to the application deadline date in addition to the two documents from your supporter. The
supporter must also complete the information requested in Section B.
Military Personnel Only:
Complete this form with a copy of your military ID (also dependent ID, if spouse or dependent), copy of orders, and a copy
of housing assignment, lease, deed or utility bill showing your resident address.
Example: All documents must be dated three months prior to application submission date.
Acceptable Documents
• Maryland Driver’s License
• Voter Registration Card
• Copy of Deed of Trust or Signed Lease
• Maryland Withholding Form – MW 507 (Not U.S. W-2)
• Maryland Income Tax Return (not U.S.)
• Utility Bill including gas, electric, water, phone, cable, etc.
• Vehicle Registration Card
The college reserves the right to request additional information and documentation as necessary.
SECTION A – TO BE COMPLETED BY STUDENT
Student Name
Student ID or SSN (last 4 digits)
Resident Address
City
State
Zip
County
Day Phone
Evening
Dates of Occupancy at above address
Own
Rent
Previous Address
City
State
Zip
How long did you live at this previous address?
Are you registered to vote?
Yes
No
County
State
Do you possess a valid driver’s license?
Yes
No
If yes, what state issued?
County
Date of Issuance
OFFICE USE ONLY
Program and Term:
Practical Nursing SU21
Do you own a motor vehicle? Yes No
If yes, in what state issued? County Date of Issuance
Do you have the use of another person’s motor vehicle? Yes No
If yes, provide name Relationship to student
Are you paying Maryland income tax for this year on all earned income? Yes No
If yes, what county?
List where you have filed tax returns for the past two (2) years:
Year State County
Y
ear State County
If employed, is Maryland income tax currently being withheld? Yes No
If yes, what county?
For the most recent 12 months, has another person(s) provided one-half or more of your financial support?
*Yes No
*If the answer to the above question is “Yes”, SECTION B of this form must be completed by your supporter.
Additional Information
The college reserves the right to request additional information and documentation as necessary.
I CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS CORRECT TO THE BEST OF MY KNOWLEDGE.
Signature of Student (required) Date
OFFICE USE ONLY
ACCEPTABLE DOCUMENTS: MILITARY/BRAC WAIVER:
____ MD driver’s license ____ Military ID (& Dependent ID if spouse or dependent)
____ MD income tax return (not U.S.) ____ Copy of Orders
____ Voter Registration Card ____ Copy of housing assignment, lease, deed or utility bill
____ Vehicle registration showing resident address
____ Utility bill showing home address
____ Copy of deed of trust or signed lease
____ MD withholding form – MW 507 (not U.S. W-2)
STATUS OF RESIDENT ADDRESS
Anne Arundel County Other MD county Out-of-State Term & Year
Authorized signature: Date:
SECTION B
TO BE COMPLETED BY SUPPORTER IF YOU ANSWERED “YES” to the following questio
n:
For the most recent 12 months, has another person(s) provided one-half or more of your financial support?
Name of supporter Relationship to student
Supporters Address
City State Zip
County Day Phone Evening
Date of Occupancy at above address
Own
Rent
Previous Address
City State Zip
How long did you live at this previous address?
Are you registered to vote? Yes No County
Do you possess a valid driver’s license? Yes No
If yes, in what state issued? County Date of Issuance
Do you own a motor vehicle? Yes No
If yes, in what state issued? County Date of Issuance
Do you have the use of another person’s motor vehicle? Yes No
If yes, provide name Relationship to student
Are you paying Maryland Income tax for this year on all earned income? Yes No
If yes, which county?
List where you have filed tax returns for the past two (2) years:
Year State County
Y
ear State County
If employed, is Maryland income tax currently being withheld? Yes No
If yes, in which county?
Additional information:
The college reserves the right to request additional information and documentation as necessary.
Signature of supporter: Date:
Notice of Nondiscrimination:
AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410-777-2306 or
Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign language interpreters, alternative format books or
assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual assault, sexual misconduct,
discrimination or harassment, contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or
Maryland Relay 711.
G:\ALHEALTH\HDrive\AHCOMMON\TDN\Admissions Forms\Residence Petitions by Program\Residence Petition Template 5.22.2020
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

Practical Nursing Program Application Applications Available: June, 2020 (Anne Arundel 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 22 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document