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LOUDOUN COUNTY PUBLIC SCHOOLS ADULT EDUCATIONPractical Nursing PathwayApplication Packet2022-2023LCPS Adult Education, 715 Childrens Center Rd., VA, 21075 Email: adult.education@lcps.org Phone: 571-252-2930

LOUDOUN COUNTY PUBLIC SCHOOLS ADULT EDUCATIONWelcome! Thank you for your interest in the Practical Nursing Program offered by LCPS Adult Education.Please complete the application and mail it by Wednesday, April 13th, 2022.The Practical Nursing pathway is a two-year program, beginning each fall and following the Loudoun County PublicSchool calendar. The Practical Nursing course consists of classroom and online instruction at the Adult EducationCenter and clinical experiences. The first year, called Practical Nursing I & II, combines classroom work, lab practice,and a 40-hour clinical experience at a Long-Term Care Center.The second year, Practical Nursing III consists of classwork, labs, and 400 hours of clinical experiences in the hospital,doctor offices, community health offices, and Long-Term Care facilities. The LCPS Practical Nursing program has fullapproval by the Virginia State Board of Nursing.After completing the 2-year program, students can apply to the Board of Nursing to sit for the NCLEX-PN licensingexamination and become Licensed Practical Nurses. Fees for the NCLEX exam are paid directly to the Board and thetesting agency. Exams are given in many area locations throughout the year.The LCPS Practical Nursing Program does not discriminate based on race, color, national origin, sex, disability, or agein its programs and activities and provides equal access to adult students. If you have a disability and requireaccommodations to fully participate, please contact the Leave & Disability Programs, 571-252-1690 or email:LCPSLeaveDisability@lcps.org to discuss your specific needs.Program Application Requirements for Admission1. Provide evidence of high school completion (transcripts), GED certificate, or College level transcripts.2. Complete the entire application packet (page 1 – 4), and mail to:Adult Education Office715 Childrens Center RoadLeesburg, VA, 20175.3. Include Resume with the application4. Three References Forms5. Complete payment for Admissions Test of Essential Academic Skills (TEAS) 65 Test tickets will be emailed, which must be printed and brought to the test location.Plan to spend 5 hours on the test.Date: TBDTuition – Payment deadline will be given to accepted students.PN I & PNII (1st year) tuition is 2,700PN III (2nd year) tuition is 3,600Fees cover malpractice insurance, criminal background check, NCLEX review courses, lab fees, Online Softwareresources, one set of scrubs (uniform) and other miscellaneous costs.RefundsRefunds must be requested two business days before class starts. Refunds ARE NOT given after classes start.LCPS Adult Education, 715 Childrens Center Rd., VA, 21075 Email: adult.education@lcps.org Phone: 571-252-2930

LOUDOUN COUNTY PUBLIC SCHOOLS ADULT EDUCATIONAdmissions offers will be sent by mail in June 2022. Acceptance of admissions offers is provisional and not final untilthe school receives the completed physical examination form along with required immunizations.For further questions, please email adult.education@lcps.orgAdmissions process1. Only completed applications will be reviewed for acceptance.a. Application Packet documents – 3 pagesb. Resumec. Transcripts, diploma, GED certificate, college transcripts2. Three references using the application’s Reference Form (each completed confidential reference form mustbe signed and emailed directly to adult.education@lcps.org)3. TEAS payment and Test Scores4. Panel Interview – only selected candidates5. Letter of acceptance offer or not offer notice will be mailed.Program Notes – Accepted Students to the program1. Immunizations are required of all healthcare workers and will be detailed in theacceptance letter.*It is required that each student has a physical exam and a series of immunizations.Send copies of the immunizations record and completed physical form to the Adult education officeby July 31st , 2022 . Please note that the immunizations series may take a few months to complete. Aflu vaccine is required for the student to be in a clinical facility each year. This vaccine is typicallyobtained in October of the school year. COVID 19 vaccines are required for clinicals.2. Negative TB skin test or chest x-ray by July 31st, 2022.3. Students must obtain a CPR certification card from the American Heart Association for HealthcareProviders. The card must be received by July 31st, 2022.4. Each student is strongly urged to carry health insurance due to the inherent risks involved withnursing. Health insurance is not provided by the program.5. Students must pass a criminal background check before any clinical rotations; we schedule this the firstmonth of school. The background check is included in the cost of tuition.Previous criminal convictions may require special investigation by the Board of Nursing for the applicantto be eligible to take the examination.6. Students are required to maintain a grade of 79% in the first year and a grade of 85% in the second yearin each of the nursing units. If the academic standards are not maintained, the student may be dismissedfrom the program.LCPS Adult Education, 715 Childrens Center Rd., VA, 21075 Email: adult.education@lcps.org Phone: 571-252-2930

LOUDOUN COUNTY PUBLIC SCHOOLS ADULT EDUCATIONFees/Expenses/Tuition/SuppliesThis is an itemized breakdown of approximate expenses you expect to incur while a student.COSTS ARE APPROXIMATE AND SUBJECT TO CHANGE.CPR Healthcare Provider courseFee: 25.00- 95.00Physical ExamVaries on health insuranceAnnual Flu shotVaries on health insuranceCOVID 19 VaccinesBooksApproximately 600 (Nursing books only)Student uniformsOne set of scrubs will be included in the tuitionScrubs cost - 35.00Nursing White Shoes - 25.00 - 75.00Stethoscope - 50.00 - 90.00Upon Graduation:UWORLD – NCLEX ReviewFee: 275.00NCLEX-PN ExamFee - 370.00State of Board Licensure (paid to the Board of Nursing)Fee - 170.00Nursing CapNursing Graduation PinLCPS Adult Education, 715 Childrens Center Rd., VA, 21075 Email: adult.education@lcps.org Phone: 571-252-2930

LOUDOUN COUNTY PUBLIC SCHOOLS ADULT EDUCATIONCandidate Application Checklist:(Completed Application must be mailed to the Adult Education Office)Transcripts (High School, GED, College)ResumeThree Personal Recommendations - Provide confidential reference forms to threeprofessional individuals, such as teachers, employers, doctors, nurses, etc.They must be emailed directly by the recommending individual, toadult.education@lcps.org or mailed to the Adult Education Office.Pay 65 for the TEAS testing fee. A payment link will be sent after the completeapplication is received.Print Testing ticket for TEAS Assessment, to be taken on date TBDLCPS Adult Education, 715 Childrens Center Rd., VA, 21075 Email: adult.education@lcps.org Phone: 571-252-2930

LOUDOUN COUNTY PUBLIC SCHOOLS ADULT EDUCATIONLCPS Adult Education Practical Nursing ApplicationPage 1Applicant General InformationName:LastFirstMiddleMaidenDate of Birth:Last four digits of Social Security NumberCurrent Address:Number and StreetCityStateZip CodePermanent Address:Number and StreetCityStateZip CodePhone Number:If the applicant does not have a social security number, in accordance with code 54.1-116(B) of the Code of Virginia, foreign nationals who are otherwise qualifiedas an applicant for a license, certificate or registration may be issued a temporary license or authorization to practice, effective for not longer than 90 days.Education InformationDo you have a high school diploma?(must provide an official copy of transcript)YesNoYear of GraduationName of High School:Do you have a GED certificate?(must provide an official copy of transcript)Year of CompletionYesNoPost-High-School: list educational institutions with years attended (must provide an official copy of transcripts):Do you have other education, training or certificates? Please list specific dates and certifications.LCPS Adult Education, 715 Childrens Center Rd., VA, 21075 Email: adult.education@lcps.org Phone: 571-252-2930

LOUDOUN COUNTY PUBLIC SCHOOLS ADULT EDUCATIONPage 2Employment HistoryEmployment History – List most recent firstPositionEmployer and AddressDates of EmploymentWhat characteristics do you possess that will make you successful as a licensed practical nurse?List below the names and addresses of 3 persons who will be providing a reference for you. A reference form isprovided at the back of this packet; you will need to make copies for your references.Name:Telephone:Relationship to ip to ip to Applicant/Position/Title:LCPS Adult Education, 715 Childrens Center Rd., VA, 21075 Email: adult.education@lcps.org Phone: 571-252-2930

LOUDOUN COUNTY PUBLIC SCHOOLS ADULT EDUCATIONPage 3Eligibility of the ApplicantI am a resident of Loudoun County; Virginia and I am a U.S. citizenI am a resident of Loudoun County; Virginia and I am an eligible non-citizen (must provide original resident alien documentation)I am a resident of Loudoun County, and I am not a U.S. citizen or an eligible non-citizenAre you able to provide identification to obtain a background check for clinical sites?YesNoHave you ever been discharged or refused contract renewal?YesNoYesNoHave you ever been convicted of a felony, a crime or moral turpitude, or any otheroffense involving the sexual molestation, physical or sexual abuse or rape of a child?YesNoHave you ever entered a plea of guilty or nolo contendere to the charge of a felony, a misdemeanorinvolving moral turpitude, the physical or sexual abuse or neglect of achild, sexual assault, use or possession of drugs, or obscenity and related offenses?YesNoHave you ever been requested to resign from a former position?Has a Social Services Department, Child Protective Service Unit or any other governmental agencyever investigated charges of child abuse or neglect against you and determined such charges to be“founded,” “probably founded,” “reason tosuspect,” or similar findings?YesNoI hereby authorize the Loudoun County Public Schools to conduct work history, personal reference, child abuse, and police recordinquiries to determine my acceptability for entrance into any program at the Academies of Loudoun. Additionally, I herebyauthorize and direct any and all federal, state, or local law agencies and any other agencies or offices that may possess theaforesaid information to cooperate and assist the Loudoun County Public Schools and its representatives in its investigation.I certify that, to the best of my knowledge, the information provided by me in this application is true, and that anymisrepresentation or omission of facts is reason for denial of admission.Applicant’s SignatureDatePlease email completed applications to: adult.education@lcps.org.If you have admissions inquiries, email: adult.education@lcps.orgAs required by federal laws and regulations, the Loudoun County School Board does not discriminate on the basis of sex, color,race, religion, handicapping conditions, or national origin in employment or in educational programs and activities.LCPS Adult Education, 715 Childrens Center Rd., VA, 21075 Email: adult.education@lcps.org Phone: 571-252-2930