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Health Science Application PacketProgram OverviewPractical Nursing (PN) St. PetersburgPractical NursingThe purpose of the Practical Nursing Program is to provide training for employment in the health care industry.Graduates complete courses in caring for medical and surgical patients. Included in the program are courses thatare designed to instruct students in the care of pediatric, obstetric, and geriatric patients, as well as convalescent,physically challenged, and rehabilitative physical and/or mental patients. Graduates are prepared to functionwithin the rules and regulations as defined by the Florida State Board of Nursing.The program length for Practical Nursing at Pinellas Technical College (PTC) is 1,350 hours. The first 450 hours ofthe program include classroom theory, laboratory experiences, and selected clinical experiences. A more detailedexplanation of essential job functions is included in this packet. Upon successful completion of the program,graduates are eligible to sit for the national examination, which qualifies them as a Licensed Practical Nurse.In total, students in the program will complete 675 clock hours in theory and 675 clock hours in clinicals(that will take place interchangeably) over the 15 months of enrollment. For clinicals, PTC utilizes specificallyapproved, local sites; no provision is available for students wishing to participate in clinicals at other facilities.The Pinellas County School Board and the Department of Education supervise the PTC Practical Nursing Program.It operates following the Standards established by the Florida State Board of Nursing, which include thenumber of program hours, the curriculum, and the types of clinical learning experiences that the studentwill successfully complete.Application PacketHealth Science programs at Pinellas Technical College have very specific application criteria and deadlines.This comprehensive application packet is valid only for the program and session indicated on the cover page.Refer to the cover page of this document for related deadlines and contact information.Admission SeminarImportant details about this Health Science program, and the PTC Health Science application process,are provided in an admission seminar. Attendance is optional for this program. Refer to the cover pageof this document for event schedule. For any questions about the PTC application process please contactArilee Still, Counselor at stilla@pcsb.org (or 727.893.2500 x 2523).NOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
Health Science ApplicationApplication Process (1 of 3)Practical Nursing (PN) St. PetersburgGetting Started (Completing the Health Science Application Packet)Important information, and steps for the application process, listed below. Print out ALL pages and CAREFULLY READ through the ENTIRE packet:o Review the Health Science Application Process, Dates & Deadlineso Make note of any questions you may still have If you feel confident about the process, start completing the steps/forms in the packet If you are unsure about ANY step of the process, contact Arilee Still, Counselor (St. Petersburg Campus)at stilla@pcsb.org (or 727.893.2500 x 2523)Application Notes & Tips: Applicants should follow the steps of the application process in the order given. Applicants should use the Checklist of Required Items to ensure ALL application packet items areaccounted for, and in their proper order, before submitting the packet for consideration. Please paperclip all items together; no elaborate cover or folder is required to submit a packet. Mostimportantly the packet contents should be neat, and in order, when submitting for consideration. Accepted applicants will be required to provide proof of their own medical insurance. Applicants who have completed PN/CNA training elsewhere (within 3 years), and want that training to beconsidered, must include an Official Transcript, from the previous school, when applying to the program.Applicants must have consistent access to working computer equipment (with Internet connectivity,required software, etc.). All PN students are expected to have computer access away from school(throughout their enrollment). While (and/or before) preparing the application packet for completion, applicantsshould have established financial aid, and/or have secured program payment. NOTE: All students that are accepted into the Practical Nursing (PN) program must completea 10-Panel Drug Screening. Details, guidelines and a timeline for required lab and drug screeningwill only be given to students accepted into the program.oDrug Screening must be completed within 30 days of the class start date. See counselor for details.oStudents who fail the Drug Screening will be automatically withdrawn from the program and not allowedto seek enrollment again for one entire fee term, or until the next start date, whichever is sooner.oStudents who are withdrawn (and seeking readmission) must resubmit, and clear, a newDrug Screening at the time of readmission (within 30 days of the new start date).NOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
Health Science ApplicationApplication Process (2 of 3)Practical Nursing (PN) St. PetersburgNext Steps01] Free Application for Federal Student Aid (FAFSA) – Complete now, online (www.fafsa.gov)Applicants should have their financial aid established, and/or secured payment for tuition, supplies and fees,at the time application packet is submitted. Federal School Code for PTC-St. Petersburg Campus: 01391702] Essential Job Functions – Review and complete nowApplicants must be able to perform ALL of the essential functions either with, or without, reasonableaccommodations. Please inform the PN admissions counselor if you will be requesting accommodations.03] Comprehensive Adult StudentAssessment Systems (CASAS) Testand/or Test of Adult Basic Education(TABE) – Take test(s) ASAPConsult with a PTC counselorregarding test scores.Basic Skills [ Minimum Qualifying Test Scale Scores (SS) ]CASAS — Reading: 249, Math: 245 and TABE — (A Level 11/12) Language: 631TABE — (A Level 9/10) Math: Grade 11, Language: Grade 11, Reading: Grade 11TABE — (A Level 11/12) Math: 657, Language: 631, Reading: 617Wonderlic Basic Skills — Verbal: 11 (297), Quantitative: 11 (288)OR – Consult with a PTC Counselor to explore acceptable testing exemptions: Submission of valid/current TABE, or Wonderlic, test scores from another schoolor organization (taken within the past two years). Submission of Official Transcripts of an Associates of Applied Science,or higher degree, from an approved U.S. accredited institution.04] Test of Essential Academic Skills (TEAS) – Take test ASAPLearn more about the TEAS at www.atitesting.com, Adjusted Individual Total Score mustbe at least 56% to apply for admission to the program (this score does not guarantee the student a seat). Studentsmay request to mix highest content area scores, to obtain the 56% minimum, between several unexpired tests. TheTEAS may be taken at a PTC Testing Lab or an off-site testing facility. Students testing off-site must contact ATIdirectly, to pay the required Score Transfer Fee, in order to have the official scores emailed to the appropriate PTCPractical Nursing Counselor: Clearwater Campus: fieldsy@pcsb.org (Yata Fields) or St. Petersburg Campus:stilla@pcsb.org (Arilee Still)05] Health Science/PN Admission Seminar – Attend one session, with your questionsAttendance is optional, but strongly recommended. Refer to the cover page of this document for event schedule.For any questions about the PTC application process please contact Arilee Still, Counselor atstilla@pcsb.org (or 727.893.2500 x 2523).06] Readiness for Education at a Distance Indicator (READI) — Take online assessmentThis free assessment measures learner readiness for taking online and/or technology rich courses. READI is not apass/fail assessment, rather it provides a score report to help learners understand their strengths and opportunitiesfor improvement. To take the READI assessment: 1] Visit http://myptec.smartermeasure.com/2] Login with Username: ptec Password: nursing 3] Once complete, print out your score reportand include copies of the first two pages in your application packet.NOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
Health Science ApplicationApplication Process (3 of 3)Practical Nursing (PN) St. Petersburg07] Required Documents – Provide all completed items below, with application packet1. Completed Checklist of Required Items (Use as Cover Sheet for submitted packet)2. Completed Program Application3. Copy of CASAS/TABE, or Wonderlic test scores (if applicable) or Official Transcript of an AAS/AA/AS Degreeor higher, from an approved, accredited U.S. Educational Institution. Documentation of other literacytest exemption.4. Signed and dated Instructor Interview/Admission Seminar FAQ & Notes (optional/if applicable)5. Signed and dated Essential Job Functions6. Copy of TEAS test scores (must be 56%, or higher) from PTC Testing Lab; for off-site testers, only officialscores will be accepted (transferred/emailed from ATI to the appropriate PTC Practical Nursing Counselor);no photocopies accepted.7. Copy of READI score report (first two pages only: Summary & Graphs)8. Official Transcript of standard High School Diploma or GED, Non-U.S. citizens should use an Official Equivalencyand Certified Degree to meet the High School Diploma requirement. No photocopies accepted.9. Signed and dated Criminal Background Check & Drug Screen Disclaimer10. Copy of Paid Receipt for EZ FingerPrints Level 2 Background Check11. Signed and dated Health Screening for Health Science Education (Proof of Immunization) form andDocumentation of test results/immunizations (refer to FAQ about form for details).12. Signed and dated Influenza Vaccination Proof of Immunization13. Signed and dated Accident/Medical Insurance Proof of Coverage andcopy of Medical Insurance Card (front & back)14. Other Official (Postsecondary) Transcripts being submitted; PTC first, followed by any others (optional)15. Copies of current Health Related Certifications: CNA, CPR, First Aid, Health CORE, etc. (optional)16. Application Packet – Submit completed packet by application deadline indicated on cover page.Submit completed application packet to the Guidance Office (PTC Student Services, St. Petersburg Campus)during regular office hours.08] Completed application packets are evaluated, rated and ranked – by PTC AdmissionsClass slots are filled working from the highest to lowest-ranking applicants (see TEAS – Testing for score criteria).09] Applicants are notified of admission status by email – from PTC AdmissionsAdmission Status is specified as one of the following: A] Accepted. B] Alternate, with a possible opportunityto be offered a seat, if an accepted student declines. C] Not-Accepted, please reapply.NOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
Essential Job FunctionsPractical NursingBasic Skills [ Minimum Qualifying Test Scale Scores (SS) ]CASAS — Reading: 249, Math: 245 and TABE — (A Level 11/12) Language: 631TABE — (A Level 9/10) Math: Grade 11, Language: Grade 11, Reading: Grade 11TABE — (A Level 11/12) Math: 657, Language: 631, Reading: 617Wonderlic Basic Skills — Verbal: 11 (297), Quantitative: 11 (288)Mental/Cognitive Factors Ability to visually read calibrated equipment inincrements of one-hundredth of an inch Ability to visually discriminate, describe and interpretdepth and color perceptions Ability visually identify contours, sizes, and movements Ability to view, read, and physically manipulate healthrecord information and pertinent data in a variety offormats, including paper-based records, handwrittendocumentation, computerizes data bases, typedreports and other institutional sources Ability to use tactile sensory contact to assess size,shape, texture, temperature, moisture, density andtonicity of tissues Ability to identify and distinguish odors Ability to auscultate with stethoscope anddifferentiate body sounds Ability to appropriately discern, comprehend anddemonstrate ethical written, verbal and non-verbalcommunication, and judgment in any given situation Demonstrate appropriate reading and writing skills foreffective, expected, appropriate and professionalcommunication with others, to include legible,understandable, concise, accurate documentationof course work and clinical paperwork Demonstrate critical thinking skills to problem solveand take appropriate indicated corrective action toinclude utilization of the nursing process Demonstrate ability to perform mathematicalcalculations correctly within a designated time periodDemonstrate emotional health sufficient to respond toand maintain effective role-appropriate relationshipswith patients, families, and other healthcare members Demonstrate ability to interpret classroom andclinical computer data correctly Demonstrate ability to perform requirementsof the student nurse Demonstrate appropriate student behaviorsin class and clinical areas Demonstrate ability to recognize and protectself, patients, and other from safety andenvironmental risks and hazardsPeople Skills Demonstrate interpersonal skills sufficient to interactappropriately with individuals, families, staff andgroups from a variety of psycho-social, spiritual,emotional, cultural and intellectual backgroundsPhysical Requirements Perform physical functions such as reaching, balancing,carrying, pushing, pulling, stooping, bending andcrouching, including being able to stand on yourfeet up to 12 hours at a time Perform lifting and transferring of adults and childrenfrom a stooped to an upright position to accomplishbed-to-standing-to-chair transfer and back and patientambulation Perform lifting and adjusting positions ofbedridden patients Physically apply up to 10 pounds of pressure tobleeding sites and to the chest in the performanceof CPR using hands, wrists and arms Ability to carry/lift 50 pounds Ability to maneuver in small spaces quickly and easily Perform gross and fine motor skills to include manualdexterity that require hand/eye coordination in use ofsmall instruments, equipment and syringes Perform palpation to feel and compress tissues toassess for size, shape, texture, and temperatureRespond and react immediately to auditoryinstruction, request, signals and monitoring equipmentI have read and understand the Essential Job Functions above.Applicant Name (PLEASE PRINT)Applicant Signature xNOTE: Refer to cover page for deadlines and contact information.DateOWI-246-HSA-PN-SP-2020-08
Health Science ApplicationChecklist of Required ItemsPractical Nursing (PN) St. PetersburgRequired Items (To be submitted in order)Copy of TEAS test scores (must be 56%, or higher) from PTC Testing LabCOMPLETE this checklist and include itas the cover sheet for your applicationpacket. ENTIRE application packet mustbe completed, and ALL fees paid, priorto the start of the program. Applicationpacket is considered incomplete unlessALL required items are turned in. DO NOTattempt to email or fax any paperworkfrom this packet to Pinellas TechnicalCollege (none will be accepted).Copy of READI score report (first two pages only: Summary & Graphs)SUBMIT completed application packet Official Transcript of standard High School Diploma or GED, Non-U.S.citizens should use an Official Equivalency and Certified Degree tomeet the High School Diploma requirement. No photocopies accepted.In-Person to: Student Servicesduring regular office hours.Completed Checklist of Required Items (Use as Cover Sheet for packet)Completed Program ApplicationCopy of CASAS/TABE, or Wonderlic test scores (if applicable) or OfficialTranscript of an AAS/AA/AS Degree or higher, from an approved, accreditedU.S. Educational Institution. Documentation of other literacy test exemption.Signed and dated Instructor Interview/Admission SeminarFAQ & Notes (if attended)Signed and dated Essential Job FunctionsSigned and dated Criminal Background Check & Drug Screen DisclaimerCopy of Paid Receipt for EZ FingerPrints Level 2 Background CheckSigned and dated Health Screening for Health Science Education(Proof of Immunization) form.Signed and dated Influenza Vaccination Proof of ImmunizationBy Mail (US Postal Service w/tracking #) to:Student Services c/o Arilee StillPractical NursingPTC – St. Petersburg Campus901 34th St SSt. Petersburg, FL 33711Signed and dated Accident/Medical Insurance Proof of Coverageand copy of Medical Insurance Card (front & back)Optional ItemsOther Official (Postsecondary) Transcripts beingsubmitted; PTC first, followed by any othersCopies of current Health Related Certifications(CNA, CPR, First Aid, Health CORE, etc.)(PLEASE PRINT)Applicant NameEmailTelephoneApplicant assumes full responsibility for accuracy and confirmation ofpacket completion, prior to submission (PTC staff will not check packetsfor completion).xApplicant SignatureDate(PN SP)NOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
Health Science ApplicationProgram Application: Practical NursingApplicant Information (PLEASE PRINT)Full NameLastFirstM.I.DateAddressStreet AddressApt/Unit#SSN (Last 4 digits)Telephone (Home)GenderMaleFemaleRaceWhite, Non-HispanicEmergency Contact (Name & ck, Non-HispanicHispanicAsianAmerican Indian/Alaskan NativeMultiracialAre you a citizen of the United States?YESNOIf not, provide Country of OriginAre you a military veteran?YESNOIf yes, list Branch of ServiceHave you previously applied for the Practical Nursing Program at PTC?If yes, Date AppliedYESNOCampusEducational BackgroundHighest Level of EducationHS Diploma/GEDAA/ASBA/BSMA/MSPhDMajor in College (or program of concentration)List any medical and/or health care training/education below. NOTE: If you are a CNA, include a copy of your license in your application packet.TYPE OF TRAININGDATESSCHOOLLENGTHWork ExperienceList your last three years of work experience below (with MOST RECENT/CURRENT employment first)JOB TITLEDATESBUSINESS NAMEREASON FOR LEAVINGTransfer/PTC Re-entry Student RequestIf applicable, check which statement applies to your admission request:I am requesting Advanced Standing to enter a Practical Nursing classand be given credit for previously completed coursework. See attachedsyllabus describing coursework completed, and a transcript detailingcoursework to be considered, as part of my PTC Practical Nursingtraining.If I cannot be placed with credit, for previously completed coursework,I would like to start the PTC Practical Nursing program from the beginning,and I agree that I will complete all assignments required of the curriculum.DisclaimerI certify that my answers are true and complete, to the best of my knowledge. I understand thatmisrepresentation, or omission of facts, is an acceptable reason for denial into the program.xApplicant SignatureNOTE: Refer to cover page for deadlines and contact information.DateOWI-246-HSA-PN-SP-2020-08
CASAS/TABE – TestingInformation & StepsPinellas Technical College conducts mandated literacy testing as required by the Florida Department of Education*Students take the CASAS for Reading and Math skills assessment and the TABE for a measure of Language skills.The tests are free, and the test scores are valid for two years.NOTE: Reservation required for testingBoth tests can be completed in one test session. The entire testing session may take about 2 ½ hours to complete. Photo ID required to enter the building and to test No Backpacks, Large Bags or Electronic Devices** Arrive 30 minutes before testing time for processing Test sessions begin promptly; late arrivals are not permitted to testTesting Schedule (by appointment only)CLEARWATER CAMPUSCall for Reservation 727.538.7167 x 20066100 154th Ave N, Clearwater, FL 33760ST. PETERSBURG CAMPUSCall for Reservation 727.893.2500 x 2544901 34th St S, St. Petersburg, FL 33711 Mon – Thu7:30 amBldg 02, Rm 117 Mon Mon 8:00 amBldg 01, Rm G25:30 pmBldg 02, Rm 117 Wed & Thu 4:30 pm Tue8:00 amBldg 01, Rm G2Bldg 02, Rm 117 Wed 8:00 amBldg 01, Rm G2Test Prep Resourceswww.casas.org (free sample test items)www.mometrix.com (free CASAS practice test)www.fldoe.org (free Preparing for the TABE booklet)www.studyguidezone.com/TABE/ (study resources)* These tests are not required if you have a test exemption or an associate degree, or higher, from an accredited U.S. college.** Pinellas Technical College is not responsible for student’s lost or missing itemsNOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
TEAS– TestingInformation & StepsTest of Essential Academic Skills (TEAS) at PTCThe TEAS assesses 4 areas essential to academic success:Reading, Mathematics, English and Language Usage, and Science.The TEAS is comprised of 170 questions related to medical technology.Test attempts are timed and permit about 3.5 hours to complete.To be eligible to apply for the Practical Nursing, Dental Assisting,Pharmacy Technician or Surgical Technology programs students mustscore at least 56%. Note: The TEAS may be taken only four (4) timeswithin a 12-month period. A 30-day waiting period is requiredbetween test attempts.Test Fee 65.00 (each attempt); must be pre-paid at the PTCBookstore (keep receipt for test session admittance).PRIOR to taking the TEAS, first-time testers MUST create anonline account with ATI (Assessment Technologies Institute):1. Visit www.atitesting.com : Select Create Account2. Sign In Info: Provide Info Username, Password, Email, Security Questions,Personal Info, etc. Institution: Select most appropriate choiceo Pinellas Tech College - Clearwatero Pinellas Tech College - St. Petersburgo Pinellas Tech College - AHStudent/Employer ID, Credentials,Expected Graduation: Leave blankNon-Degree Seeking: CheckDemographic Info: Provide Info; Subscription Updates/Notes:Provide choiceUser Terms & ConditionsYes, I agree: Select (to complete online registration) 3. Print completed ATI Registration page(with Username/ID and Password; required for testing)Test Prep Resources Test preparation is strongly encouraged beforetaking this comprehensive test. Several computer-based practiceassessments and study manuals are available for free and for fee.Some resources include: NOTE: Reservation required for testing.TEAS PTC Testing Lab ScheduleCLEARWATER CAMPUSCall for Reservation 727.538.7167 x 20066100 154th Ave N, Clearwater, FL 33760Tue & Wed 8:00 am Bldg 02, Rm 117ST. PETERSBURG CAMPUSCall for Reservation 727.893.2500 x 2544901 34th St S, St. Petersburg, FL 33711Thu 8:00 am Bldg 01, Rm G2Verify availability of testing lab, for desiredtest date, at www.myptc.edu. Prepaymentdoes not guarantee a seat. Please arrive30 minutes before your scheduled testingtime to comply with campus sign-inprocedure. Testing space is limited.Late arrivals will not be permitted to test.Testers requiring special accommodationsmust schedule at least 48 hours in advance(provide documentation of disability whenscheduling).BRING these REQUIRED ITEMS foradmittance into TEAS Test Session: TEAS PTC Receipt (paid, pink copy)Photo ID (with your signature)Printed ATI Registration page(with Username/ID and Password)Other TEAS Testing Sites exist (withadditional steps and transfer fees).mometrix.com/academy/teas-test-study-guide/ (Test prep, free)teaspracticetest.com (Practice test, free)test-guide.com/free-teas-practice-tests.html (Test prep, free)purplemath.com (Math course, fee)atitesting.com (Test maker's site; test prep, study manual, fee)PTC Bookstore (Study manual, fee)NOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
Readiness for Education At a Distance Indicator(READI) – AssessmentThis free assessment measures learner readiness for taking online and/or technology rich courses. The READIassessment provides an indicator of the degree to which distance learning will be a good fit for you. READI is not a pass/fail assessment; there is no penalty for guessing READI score report helps learners understand their strengths and opportunities for improvement READI website also offers resources that will help you prepare for success as a distance learning student READI assessment is free of charge As the applicant for this program, it is imperative that you complete the READI assessmentby yourself without assistance from any other personsTo take the READI assessment: Visithttp://myptec.smartermeasure.com/ LoginUsername: ptec Once complete, print out your score report and include copiesof the first two pages in your application packet.NOTE: Refer to cover page for deadlines and contact information.Password: nursingOWI-246-HSA-PN-SP-2020-08
Background Check & Drug ScreeningInformation & DisclaimerBy law, criminal background checks and drug screenings are required for employmentin the health care industry and to take licensing exams for the medical professions.Disqualifying offenses may be a history of felony and/or misdemeanor convictions or substance abuse. It is yourresponsibility as a program applicant/participant to understand all disqualifying offenses that may impact your abilityto become employed in the health care field or enroll/remain in a health care program at an educational institution.Additional information can be found online on Florida Department of Health websites: Nursing/CNA student inquiries stant-faqs/background/ Pharmacy student inquiries echnician-faqs/I fully understand that, as a prospective student applying to a Health Science programat Pinellas Technical College, If my background check reveals any disqualifying offenses or the drug screening indicates a positiveresult, I will not be allowed to enter the program to which I am applying and I may be withdrawn,if I have already started.oIf the withdrawal/dismissal occurs within the first 50 hours, I will receive a refundas allowed according to school policy.oIf the withdrawal/dismissal occurs after the first 50 hours, I will not be entitled to a refund. Passing the background check and drug screening does not guarantee certification,or registration, in the field I have chosen. The Level 2 Background Check and 10-Panel Drug Screening are specific to my enrollmentat Pinellas Technical College as a student. Should there be any interruption in myenrollment re-screenings will be required prior to re-enrollment.I acknowledge that I have read and understand the above disclaimer and information.Student Name (PLEASE PRINT)Student Signature DateNOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
Fingerprinting ProcessInformation & StepsBackground Checks for Health Science/Clinical Education Programs begin with Fingerprinting.EZ FingerPrints is PTC’s official provider for fingerprinting and background checks. Fingerprinting isconducted on-site, at their location (walk-in, or by appointment).EZ FingerPrintsAt EZ FingerPrints, you must:1725 East Bay Drive, Suite D Present EZ FingerPrints with your valid Driver’s LicenseLargo, FL 33771 Present EZ FingerPrints with your Social Security Card(Lakeside Professional Center) Identify yourself as a Pinellas Technical College student,Mon – Fri 8:30 am – 6:00 pmapplying for a Health Science/Clinical Education program(You do not need to know ORI, or OCA, code numbers) Walk-in (Please Call First) Appointment: 727.479.0805 orFingerprints are scanned electronically using an ink-free process.https://ezfingerprints.com/Once scanned, the fingerprints are sent electronically to the FloridaDepartment of Law Enforcement FDLE (which forwards them to theappropriate governing agency, i.e. AHCA or DCF); no mailing isnecessary. Depending on the agency, the entire fingerprintingprocess requires approximately 7-14 days to receive the results. Cost: 45.00 Cash, Personal Checks,and Credit Cards (VISA/MC/AmEx)are accepted.PTC cannot determine if previous offenses will, or will not, clear the background check.The results will be sent directly to the Pinellas County School Board Administration Building(you will be contacted only if there is a problem).Instructions for Individual using EZ Fingerprints: Go to EZ Fingerprints:1725 East Bay Drive,Suite D, Largo, Florida, 33771Monday – Friday 8:30 am – 6:00 pm Bring the following with you:o Completed Request Form/Receipt (below)o Your valid Driver’s Licenseo Your Social Security Card Complete SECTION 1 below Make an Appointment, OR Walk-In(no appointment needed)o Appointments: Call 727.479.0805or visit https://ezfingerprints.com/o Walk-Ins: Call 727.479.0805and let them know you are comingInstructions for Referring Company (if applicable): Give this completed request form/receipt to individual to be fingerprintedHealth Services Student Fingerprint Request Form/ReceiptSECTION 1 (Completed by individual)Individual Name (PLEASE PRINT)Reason for Screen:EmploymentWhat Company is this screening for?VolunteerOtherVECHS – PINELLAS COUNTY SCHOOL BOARDSECTION 3 (FOR EZ FINGERPRINTS USE ONLY)TCN # R #Payment Method (Circle One): CheckScreen DateCashCredit CardPend for PaymentSubmission DateEZFP Rep Signature xNOTE: Refer to cover page for deadlines and contact information.OWI-246-HSA-PN-SP-2020-08
Health Screening for Health Science EducationProof of Immunization (1 of 2)PINELLAS COUNTY SCHOOLSHEALTH SCREENING FOR HEALTH SCIENCE EDUCATIONStudent Name (Print)Students enrolling in a Health Science Education Program with a clinical component must have the items identified for their healthprogram completed prior to
15. Copies of current Health Related Certifications: CNA, CPR, First Aid, Health CORE, etc. (optional) 16. Application Packet - Submit completed packet by application deadline indicated on cover page. Submit completed application packet to the Guidance Office (PTC Student Services, St. Petersburg Campus) during regular office hours.
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