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TVCC NURSING ASSISTANT I PROGRAM ENROLLMENT AGREEMENT & DISCLOSURE STATEMENTCOURSE FEESIN STATE-- 725OUT OF STATE-- 800Upon successful completion of the 155 hours OBSN approved Nursing Aide Course, you willreceive a Certificate of Completion. This certificate will enable you to take the OSBN state test. Whenthis exam is passed, you will be issued the designation of a "Certified Nurse Aide”.*Student must apply for Treasure Valley Community College s.jnz?portlet Apply Online 20&formname ApplicationAll required documentation must be received by the Nursing Program Coordinator ONE WEEK prior toclass beginning .REQUIRED DOCUMENTATION TO RECEIVE ENROLLMENT FORM:1.Application form2.Proof of current health care insurance.3.Copy of Immunization records (MMR’s, COVID, and influenza)4.Copy of High School Diploma/GED (desirable) or—College transcript with Writing 121 completed and passed with a “C” or better or—Reading test results (must pass with 55 or above if you are not a high school graduate)*Call for the hours the testing center is open, 881-5799.5.Documentation of successful completion of background check and drug screen urinalysisthrough American Databank. YOU MAY INITIATE YOUR AMERICAN DATABANKACCOUNT AT www.tvccbackgroundcheck.com6.Physical examination by your personal physician. (Form enclosed)7.Proof of CPR completion or will attend scheduled CPR the first Friday of the course.See instructor for CPR registration if needed.Once you submit all documents, the Nursing Program Coordinator will give you a registration form totake over to Student Services as proof you have been accepted into the Nursing Assistant Class (youcannot register without this form). Then return proof of registration to Nursing Program Coordinator.Revised: 5/2021 T:\CNA\CNA.APPLICATION Pkg. 2021-2022.docxPageUpon entering of the Nursing Assistant course, the student must be at least 16 years old and in goodhealth and be current on immunizations. Applicant must pass a background check and drug screenurinalysis. Enclosed is a copy of disqualifying offenses or view list on: www.tvcc.cc/academics/nursing.1SELECTION PROCESS: All classes are “first come, first serve” sooner your packet is in, thebetter chance of being in the class. The first 10 applicants for each session who meet all the requirementsand who have submitted all requested documents will be considered. The Nursing Program Coordinator willdate all submitted documents. Applicants who are not accepted into the session and who have met allrequirements will be given the option of being admitted into the next session without re-applying.*If applicants do not submit required documents, they may still be considered ONLY if there is notenough fully qualified applicants.

TVCC NURSING ASSISTANT I PROGRAM ENROLLMENT AGREEMENT & DISCLOSURE STATEMENTTreasure Valley Community College is offering Nursing Assistant Courses throughout the year. This is a 155hour course, which includes clinical experience at local healthcare agencies and a CPR class.*Outreach Centers Schedule to be announced (please check with your local outreach center).The dates of upcoming classes are to be announce; for date informationNo Program Coordinator present email only jhumble@tvcc.cc. EVENING Class hours: 5 pm-10 pm,Clinical hours may vary. SUMMER Day Class hours: 8 am-3:30 pm.There will be no day class for 2021-2022 Fall, Winter, Spring Quarters. Evening classes only.COURSE OUTLINEThis course is a combination of 155 hours of didactic and clinical learning. Specifically, 80 hours is spent in theclassroom and skills lab. The remaining 75 hours is for the clinical component spent in local long- term and acutecare facilities. The clinical time will be an opportunity for students to acquire “real life” experience as a nursingassistant.The objective is for graduates to have the knowledge to successfully pass the OSBN certification examination andhave the competency to safely provide nursing assistant care. To achieve the objective, course subjects include:Interpersonal Skills and CommunicationGrowth and Development throughout the life cycleCultural AspectsLegal/Ethical AspectsMedical and Nursing TerminologyGeneral Patient Care:Patient BathingTaking and recording vital signs FeedingPatientsInfection ControlCaring for Patient’s personal needsYou must purchase the textbook at the Treasure Valley Community College Bookstore before class begins.Read chapters 1-4 and complete pages 1-26 in your workbook.stATTENTION: You will be tested the 1 day of class on these chapters.stYOU MUST BE PREPARED THE 1 DAY OF CLASS! BRING A BLACK PEN.ENROLLEMNT AGREEMENT AND DISCLOSURES STAMENTS*Can be purchased at L&L in Fruitland)Revised: 5/2021 T:\CNA\CNA.APPLICATION Pkg. 2021-2022.docxCOST Estimated 2 725.00 800.00 95.00 45.00 60.00 50-70.00 25.00 10.00 72.00 5.00 106.00 64.50PageITEMSTVCC Tuition in-stateTVCC Tuition out-of-stateBackground check and drug screen urinalysis (AMERICAN DATA BANK)PhysicalBLS CPR Class (available at TVCC)*Scrubs (any color) & white rubber sole shoesWatch with second handGait beltTextbook –Hartman’s Nursing Assistant Care and Workbook (located in TVCC bookstore)Black pen and pocket notebookState application fee to the Oregon Board of Nursing for Certification ExamFingerprint Criminal Background processing fee for the Oregon State Board of NursingImmunizations- costs will vary dependent on vaccinations needed or titers required for proofof immunity – please see your health care provider for your MMR’s recordTOTAL (All but tuition is subject to change)

TVCC NURSING ASSISTANT I PROGRAM ENROLLMENT AGREEMENT & DISCLOSURE STATEMENTISBN: 1604250747 54.00ISBN 9781604250756 16/00PageATTENDANCE, ADDING/DROPPING CLASSES, & WITHDRAWAL: Students are expected to attendclass each time the class meets. Excused absences may be permitted by the instructor. In all cases students arerequired and responsible for content and assignments missed during the absence as determined by the instructor.A student wishing to add, drop, or withdraw from any class must do so according to the academic calendarpublished in the quarterly class schedule. ALL adds, drops, and withdrawals must be officially recorded bysubmitting a Registration Form. Students are responsible for the grades assigned by the instructor ifRevised: 5/2021 T:\CNA\CNA.APPLICATION Pkg. 2021-2022.docx3TVCC CANCELLATION AND REFUND POLICY

TVCC NURSING ASSISTANT I PROGRAM ENROLLMENT AGREEMENT & DISCLOSURE STATEMENTattendance ceases without completing an official drop or withdrawal.PAYMENT & REFUNDS: Full payment or payment arrangements are expected upon registration. Paymentplans are available and must be approved by TVCC registration staff. Financial Aid is available for those whoqualify. If the training program discontinues after the fees and tuition have been paid, the program provider mustrefund the tuition and fees in full if the in full if the closure happened before the course is competed. If the studentcancels enrollment in writing three days before the commencement of the first day of classes all tuition and feespaid to the program specific to the enrollment agreement, will be refunded, less a cancellation fee that cannotexceed ten percent of the tuition and fees paid. Refunds for dropped classes may be offered according to theacademic calendar published in the quarterly class schedule.Page4COMPLAINTS:The Student must follow the chain of command for all program complaints per TVCC Board policy JFHA-AR(1). If the student feels the complaints have not been satisfactorily resolved the student may submit complaints tothe Oregon State Board of Nursing at OSBS,- C/o Debra Buck, 17938 SW Upper Boones Ferry Rd., Portland, Oregon 97224-7012 www.oregon.gov/OSBNRevised: 5/2021 T:\CNA\CNA.APPLICATION Pkg. 2021-2022.docx

TVCC NURSING ASSISTANT I PROGRAM ENROLLMENT AGREEMENT & DISCLOSURE STATEMENTATTENDANCE:1.2.3.4.5.All classroom hours and clinical hours are MANDATORY. Any missed hours must be made up. Thereis no guarantee that classroom clinical hours can be made up during the course. This will be determinedby the instructor. It is the student’s responsibility to schedule this make-up day with the instructor.The student must notify the instructor before the scheduled class/clinical time if the student is going to beabsent. Depending on the class location, the student will call the instructor at home, the clinical agency orTVCC Nursing Department (881-5940).Consistent tardiness (more than 3 times) will result in dismissal from the course.Any no-call, no-show from either class or clinical will result in dismissal from the course.Children are not allowed in classroom or clinical.EMPLOYMENT:Job assistance is not offered; however, the student can work with the TVCC Career center for assistance withjob placement. Please see your instructor for information regarding how to contact the Career Center.Nurse Aide Training and Competency Evaluation Program Reimbursement - Nurse AideTrainingPage5Criteria for reimbursement: NA Personally incurred the training costs Employed by a nursing facility enrolled in Medicare and/or Medicaid Employed by a nursing facility within 12 months of completion of the nurse aide training program Receipts of payments for training, textbooks, other required course materials and certification fees Training program Certificate of CompletionNote: This reimbursement can only be paid one time and it is not available when employed in otherpatient or residential care settings. The reimbursement may be prorated if the NA has not been employedby the first nursing facility employer for the full 12 months following the completion of training [OAR411-070-0470(3)].Revised: 5/2021 T:\CNA\CNA.APPLICATION Pkg. 2021-2022.docx