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YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022Fingerprint Clearance CardArizona Department of Public Safety Level One Fingerprint Clearance cards are required for all applicants inthe Allied Health Programs at Yavapai College.1. Visit https://www.azdps.gov/services/public/fingerprint to determine how to obtain or renew an Arizona DPS Level IFingerprint Clearance Card.2. Click Apply for a Card3. Read the information and click Apply for a Fingerprint Clearance Card4. Click the Continue button Fingerprint Clearance Card5. Select Request a Replacement / Apply for a Card for Myself or Someone Else, and click Continue6. Create an account if needed or login.7. When asked, select non-IVP card and continue the process8. When asked why you are applying, choose Health Science Student and Clinical AssistantFingerprint processing services are available through Thales: Gemalto Cogent (a third-party vendor contracted withAZDPS). Students may access the online application through the website above and may need to contact thefingerprinting location by phone to process their fingerprint application for AZDPS.Applicants should check for an available fingerprinting location site and verify hours of operation prior to registration.Online registration is required on the DPS website before scheduling and processing payment for the fingerprint location.Applicants must bring their registration number along with a government issued photo id, and a secondary form ofidentification (as needed) to the location site.Processing may take 1-4 weeks from the date Arizona DPS receives the completed application packet. For thoseindividuals who do have a criminal record, the process may take 6 -13 weeks.For more information about Fingerprint Clearance Cards from the Arizona Department of Public Safety, please visitthe website above or call 602-223-2279.CPR Certification - Basic Life Support for Healthcare Providers (BLS)Basic Life Support for Healthcare Providers (BLS) from the American Heart Association is the required levelofCPR Certification needed for the AHS 114 Nursing Assistant class. BLS is a professional healthcare CPR classspecifically for professional rescuers, including students who will be in clinical settings. The entire course mustbe in-person.IMPORTANT: Any other type of CPR such as CPR/First Aid or online CPR will not be accepted and does not meet therequirements. It is the student's responsibility to locate a BLS course and ensure that it meets the program/ internshiprequirements. But please contact the Allied Health office if you have any questions.Below are some locations to contact and see if they are offering the class:American Red Crosswww.redcross.org (928) 445-4981New Life CPR (Prescott)www.newlifecpr.org (928) 445-5024Central Yavapai Fire District (Prescott Valley)www.centralyavapaifire.org (928) 772-7711Prescott Fire Department(928) 445-5555Heartwell CPRwww.heartwell.cpr.com (928) 772-107Sedona Fire Departmentwww.sedonafire.org (928) 282-6800Page 4 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022Yavapai Community CollegeNursing Assistant (AHS 114)Program Costs 2021-2022Tuition for AHS 114 (5 credits)(Arizona Resident) 610.00TextbookMosby’s Nursing Assistant TextbookAuthor: SorrentinoEdition: 10thISBN: 9780323655606*Visit the YC bookstore for the most accurate textbook info & cost62.99 93.00CastleBranchDocument SubmissionDrug Screen20.0059.00Other Required EquipmentStethoscope & wristwatch w/2nd hand75.00Arizona DPS Fingerprint Clearance Cardor Background Check (if under 18 years old, through CastleBranch.com)65.0046.50CPR for Healthcare Provider (BLS) Card40.00TB Test (2-Step) or Chest X-Ray Diagnostic Report60.00ImmunizationsFlu VaccineTetanus, Diphtheria, Pertussis (Tdap) VaccineMeasles, Mumps, Rubella (MMR) VaccineVaricella VaccineHepatitis B VaccineCOVID-19 Vaccine (No cost with insurance or through a federal program for the uninsured)Scrubs & Shoes State Exam FeeNavy blue scrubs and white or black shoes (no canvas shoes)45.0085.00230.00410.00350.00-75.00130.00The above information is provided to give students, parents and advisors an approximatecost of the Allied Health internship program. These are only estimates and are notall-inclusive of the costs associated with the program. The actual costs may behigheror lower. Tuition and other fees may change at the Governing Board’s discretionwhile this document is in effect.Please make sure that you take on the responsibility of knowing tuition and fees schedules asthey pertain to you.Page 5 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022ImmunizationsStudents should submit copies of their immunization records to CastleBranchand retain the originals for their own files. You may be required to submit thesedocuments to an internship site. The Department of Allied Health andCastleBranch are unable to provide copies of these records to replace lostoriginals.Students are responsible for remaining in compliance with all mandatedimmunizations, immunization records, and students must adhere to all deadlinerequirements. Copies of updates to immunization records must be submitted toCastleBranch for the student files as mandated by the Division to continue in theprogram. Please note that if an immunization is due to expire during the term,it is the student’s responsibility to provide updated records, or risk notparticipating in the clinical experience.All immunization records must include your name and the name andsignature of the healthcare provider giving the immunization and the date.Required Immunizations to submit to CastleBranch1. MMR (measles/rubella, mumps, rubella)Options to meet this requirement:a. Submit a copy of proof of two previous MMR vaccinationsORb. If you have had all three illnesses OR you have received thevaccinations but have no documented proof, you must have a titerdrawn for each illness.i. If the titer results are POSITIVE, attach a copy of the results tothe health declaration form.ORii. If the titer results are NEGATIVE, you must get two MMRvaccinations (each 30 days apart) and submit documentation.Page 6 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 20222. Varicella (chicken pox)Options to meet this requirement:a. Submit a copy of proof of a POSITIVE IgG titer for Varicella.ORb. If the titer is NEGATIVE, submit a copy of proof that you received twoVaricella vaccinations (each 30 days apart).3. Hepatitis BIn order to apply to the Program, you must complete one full vaccine series.Options to complete this requirement:Submit a copy of proof of completion of Hepatitis B injections:a. 3 dose vaccination series: Engerix-B or Recombivax HB or HepA-HepB(Twinrix) – one to six months to completeORb. 2-dose vaccination series Heplisav-B at least 4-weeks apartORc. Submit a copy of proof of a POSITIVE HbsAB titer (lab report required)ORd. Declination waiver4. Flu Vaccination (optional for summer applicants)Submit proof of current flu vaccination. The vaccination must be for thecurrent flu season. Please do not submit a receipt – ask for an actual medicaldocument with the vaccine information.5. COVID-19 Vaccine (Please see pages 8 - 10 for more information)a. Provide proof of two-dose vaccination of Pfizer-BioNTech or ModernaVaccine.ORb. Provide proof of one dose vaccination of Johnson & Johnson’s Janssenvaccine.ANDc. Also, provide proof of a booster dose if there has been sufficient intervalsince your initial vaccination. (see https://tinyurl.com/2p86bc33 for more info)ORd. If applicable, provide a copy of your completed exemption form notingthat by declining the Vaccine, you continue to be at risk of acquiringCOVID-19. *Please note that a completed exemption form does notguarantee clinical or simulation placement and may result in requiredremoval from the clinical course, resulting in a possible incomplete,withdrawal, or failure of the program of study .continued on page 8.Page 7 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022 Documentation of your COVID-19 vaccination/s must be submitted at the same time forapproval. Documentation must include the vaccine manufacturer. The applicant should be aware that in order for an intern/practicum site to acceptstudents, the student must meet all requirements of the site. The requirements includeproviding proof of full vaccination against COVID-19. The student should understandthat if they are not fully vaccinated by the time the internship/practicum begins, and/orthe site does not accept a vaccination exemption, they will not successfully completethe required hours and would fail to achieve a passing grade in the course.6. Tuberculosis (TB) -- please call the Allied Health office if you need clarificationregarding this requirement!Options to complete this requirement:a. Attach a copy of a recent Mantoux Method two 2-step TB skin test.A two-step TB skin test consists of two separate TB tests and results.Thesecond TB test must be administered 1 to 3 weeks after the first test.A two-step TB skin test is valid for one year, so please be sure your testdoes not expire during the semester. Records for Mantoux Method 2step skin testing for tuberculosis requires name and signature of thehealthcare provider and findings.ORb. If you have a POSITIVE TB skin test you must submit a chest x-raydiagnostic report stating negative for TB, with accompanying TBquestionnaire signed by a healthcare provider. This must be current.7. Tetanus/Diphtheria and Pertussis (Tdap) immunization within the past 10years. This immunization is good for only ten years. Please determine if youneed a booster by looking at the date of your original immunization.8. Basic Life Support (BLS) for Healthcare Provider (CPR)Submit documentation of one of the following:a. Basic Life Support (BLS) card (Both sides of the card required)ORb. American Red Cross Certificates (CPR/AED for Professional Rescuers)Documentation must be valid 6 months from the date of submission.9. Level One Fingerprint Clearance CardPlease provide your Arizona Department of Public Safety Level One FingerprintClearance Card-- copy of front and back of card, must show date issued, date ofexpiration, and card number.Page 8 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022August 27, 2021In accordance with Arizona Executive Order 2021-15, signed by Governor Douglas Ducey on June 15, 2021: (excerpt)1. The Arizona Board of Regents, a public university or community college may not mandate that students obtaina COVID-19 vaccine, show proof of COVID-19 vaccination or place any condition on attendance or participationin classes or academic activities, including but not limited to mandatory testing and mandatory mask usage, if aperson chooses not to obtain a COVID-19 vaccine or disclose that they have been vaccinated against COVID-19,unless such requirement has been mandated by law in the State of Arizona.2. Students participating in clinical settings at a healthcare institution licensed under A.R.S. Title 36 which includeshospitals, nursing care institutions, residential care institutions, intermediate care facilities for individuals withintellectual disabilities (ICF-IID), group homes, or other medical facilities may be required to provide proof ofCOVID-19 vaccination and subject to regular health screenings and testing as determined by the healthcareinstitution.You may view Arizona Executive Order 2021-15 in its entirety at: https://azgovernor.gov/executive-ordersIf a healthcare institution requires proof of COVID-19 vaccination, students will upload the appropriatedocumentation into Castle Branch and/or My Clinical Exchange. As part of our affiliation agreements withhealthcare institutions, Yavapai College is required to provide healthcare institutions with pertinent healthcaredocumentation upon their request and would obtain the documentation from Castle Branch and/or My ClinicalExchange.It is important to understand that while Yavapai College does not mandate COVID-19 vaccinations or testing,our healthcare partners have the right to do so, and are the decision makers on whether a student will beallowed to take part in patient care at their facility.Students registering for courses or programs with clinical requirements (direct patient care) may not be ableto complete the course/program without proof of COVID-19 vaccination and/or regular health screenings andtesting as determined by the healthcare institution.It is strongly advised that students consult with their dean, program director, or instructor if they have anyquestions or concerns about Executive Order 2021-15 and how it pertains to their education in healthcare.www.yc.edu/alliedhealth 3800 N. Glassford Hill Road Prescott Valley, AZ 86314 928.771.6126Page 9 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022January 12, 2022NOTICE OF CLINICAL SITE COVID-19 VACCINE REQUIREMENTS FOR HEALTHCARE PROFESSIONS STUDENTSDear Student:Pursuant to recently enacted federal regulations governing YC’s partners or agencies, providing clinical education,individuals providing care or having direct care contact with patients in clinical settings at a licensed healthcareinstitution which includes hospitals, nursing care institutions, residential care institutions, intermediate carefacilities for individuals with intellectual disabilities (ICF-IID), group homes, or other medical facilities includingambulances or fire agencies, may be required to provide proof of COVID-19 vaccination and subject to regular healthscreening and COVID-19 testing as determined in the sole-discretion of YC’s partner healthcare institutions.For more information regarding the COVID-19 Vaccine, visit the C.D.C. website es/about-vaccines/index.html. Students are not consideredfully vaccinated until 2 weeks after their second dose of the Pfizer-BioNTech or Moderna COVID-19 Vaccine or 2weeks after a single dose of Johnson & Johnson’s Janssen COVID-19 Vaccine.Federal regulations also require that employers grant employees certain exemptions from the COVID-19 vaccinationrequirements for religious or medical reasons. Some of YC’s clinical partners or agencies have agreed to make thesame exceptions available to YC Healthcare Profession students. While the requirements and exemption rules andprocess are determined by YC’s clinical partners, YC is assisting its clinical partners in this process by collecting theexemption requests. To request an exemption from a clinical partner’s COVID-19 vaccination requirement, studentsmust complete the attached exemption request and upload the form to Castlebranch, MyClinicalExchange orComplio; or visit https://www.yc.edu/alliedhealth to download the form.Please note that a completed exemption request does not guarantee clinical placement, which may result in requiredremoval from the clinical course, resulting in a possible incomplete, withdrawal, or inability to complete the programof study. YC is working hard to find sufficient number of clinical experiences to accommodate all exemption requests,but demand for exemptions may exceed available clinical placements. It is also important to note that each clinicalsite may change its requirements over time, sometimes with little notice. YC will notify all impacted students of thechanged requirements for continuation in the placement.Note also, that students with approved exemptions may be required by the clinical partner or agency to be COVID19 tested up to 2 times each week at the student’s expense. Negative test results would be required as a conditionto continue placement. Disclosing the results of each test to the clinical partner or agency as well as with YC isrequired and the responsibility of the student. YC assumes that these students are testing negative and if there isa positive test result, the student would then immediately contact YC and their respective program and abide byall YC COVID protocols.Please be aware that even though YC may approve a student exemption, the clinical facility has final say over theexemption policies and procedures and may require additional information, and/or not approve any particularstudent exemption. In the event of a changed vaccine requirement or refusal to accept an exemption request, YCwill use reasonable efforts to find another placement one time, but such alternative placement may not bepossible, resulting in an inability to complete the required clinical course and program of study.Page 10 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022To meet the COVID-19 documentation requirements from our clinical partners:Provide a copy of proof of COVID-19 Vaccine proving vaccination.1. Provide proof of two-dose vaccination of Pfizer-BioNTech or Moderna Vaccine.OR2. Provide proof of one dose vaccination of Johnson & Johnson’s Janssen vaccine.AND3. Also, provide proof of a booster dose if there has been sufficient interval since your initial vaccination.(see https://tinyurl.com/2p86bc33 for more info)OR4. If applicable, provide a copy of your completed exemption form noting that by declining the Vaccine, youcontinue to be at risk of acquiring COVID-19. Please note that a completed exemption form does not guaranteeclinical or simulation placement and may result in required removal from the clinical course, resulting in a possibleincomplete, withdrawal, or failure of the program of study.Sincerely,Dean for the School of Health and WellnessPage 11 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022Yavapai College – Allied HealthHow to Place OrderWelcome toTo place your order, go to: www.castlebranch.com1. Click on “Place Order”2. Type in the Package Code:Click “Submit”YA75fall3. ReviewYavapai College – Allied Health includes the following package contents:Package Cod: YA75fallMedical Document Manager Annual CRRPackage cost: 20.00Check Box and Click ContinueYou will be prompted to create your secure myCB account.From within myCB, you will be able to:Upload documentsView order resultsManage requirementsComplete tasksPlease have ready personal identifying information needed for security purposes.The email address you provide will become your username.Contact Us: 888.914.7279 or servicedesk.cu@castlebranch.comPage 12 of 1302/18/22

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022Submitting DocumentsSubmitting documents to myCB can be achieved three ways: via upload, fax, or mail. This guide willcover uploading options. If you need any further assistance, please call myCB at 1-888-914-7279.UPLOADING DOCUMENTSThe most efficient way to submit. Uploading your documents through myCB is not only secure but ensures fasterprocessing time.Options for Digitizing Your Document Take a pictureUse the myCB appScan your documentUtilize a local FedEx, UPS, Library, or University’s resourcesSubmitting Through myCBthe same steps and then click Browse Click To-Do Lists within the myCB panel on the left Expand the requirement you wish to upload to Click Browse next to Your Computer or Flash Drive Select file(s) needed, one at a time Hit SubmitNote: Document removal may only happen before submission. Make sure you have attached the correct filename(s) before submitting. To remove a document, simply click Remove Document and re-attach the correctversion.Replacing Rejected Documents Read the rejected reason Re-upload using the same steps aboveThe two most common rejection reasons are missing information and illegible documentation. Make sure your documentsare easily legible and contain their essential info

YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022 . Page . 2. of . 13. 02/18/22. Completed applications are due July 15, 2022. Full name: . Prescott Valley, AZ 86314. YAVAPAI COLLEGE - ALLIED HEALTH - NURSING ASSISTANT APPLICATION - FALL 2022 . Page . 3. of . 13. 02/18/22. CNA Fall 2022 Class information: