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Nursing ProgramEvening Part-Time SequenceApplication for Nursing Program Spring 2012Cleveland State Comm CollegePO Box 3570Cleveland, TN 37320(423) 478-6228(423) 478-6227Fax: (423) 614-8722www.clevelandstatecc.edu/nursingComplete this form online, print and return to the Department of Nursing after August 8, 2011. To be considered for admission tothe Spring Nursing Class 2012, you must be eligible for admission by September 1, 2011. (You must establish eligibility by the endof Summer Semester 2011, since grades for courses taken Fall Semester 2011 will not be available until after the freshman nursingclass of Spring 2012 has been admitted.) Cleveland State students are given admission priority over transfer students. The applicant isresponsible for notifying the Department of Nursing with any changes or updates to this application.(Please Print)Date:Date received in Nursing Office:Social Security #: Date of Birth: Email:NameLastFirstMiddle or MaidenAddress:City: State: Zip:Home Phone:Cell Phone:In order to be considered for the Nursing Program, you must first:1.2.3.4.5.6.Be currently enrolled in the college or have an application submitted to the admission office.Have official transcripts from all colleges sent to CSCC so transfer evaluations may be completed.Complete all required developmental classes.Complete chemistry with a grade of “C” or better.Maintain a GPA of 2.75 or better on nursing academics (must have grades of “C” or better).Pass HESI admission test: Reading Comprehension 75%, Cumulative/Overall 75%Once the above requirements have been met, submit this completed application along with:1.2.3.Copy of HESI admission test score.An unofficial CSCC transcript showing courses completed along with any transfer courses from other colleges.An unofficial transcript showing a chemistry grade (high school or college).Only completed applications will be accepted. Incomplete applications will not be processed. Completed applications must besubmitted by September 1, 2011.If you have ever had a nursing or health-related license suspended, revoked, denied, or subjected to disciplinary action or if youhave ever been convicted of a criminal offense other than a minor traffic violation, The Tennessee State Board of Nursing has theauthority to deny a license based on criminal convictions. You can review this information at I affirm that the information on my application is correct. Incorrect or incomplete information will make me ineligible forconsideration. All requested information must be submitted with the application. I acknowledge that I am responsible for the contentsin the RN Nursing Admission Information Packet attached to this application. I understand that once admitted to the Nursing Program,I have to submit to a criminal background check, drug screen, and meet all health requirements for admission to nursing.Date:SignatureApplicants not admitted to the program who wish to be considered for admission must reapplyAPP NUR/SPR2012/11174/05042011

Cleveland State Community CollegeNursing Program Evening OptionSteps Toward AcceptanceWe are excited you are interested in the nursing program, and we hope thisinformation is helpful.** Complete an application and be accepted to Cleveland State Community College.Provide all official transcripts to the college.** Establish eligibility for admission by completing the following prerequisites:1. All developmental courses as required by the placement test.2. A high school or college chemistry course with grade of "C" or better (it is your responsibilityto provide a transcript to the Nursing Department showing a chemistry grade).3. Students must take the HESI Test and score 75% on reading and 75% on the overall/composite.The HESI test will be available beginning Fall 2010. A student may be eligible to enter theprogram with a score below 75% on the HESI Test if they have achieved a 3.0 GPA in all threerequired science courses (BIOL2010/2011, BIOL 2020/2021, BIOL 2230/2231). A student mayrepeat the science courses only one time.** Complete a Nursing Program application for Evening Part-time Option and return it to the NursingOffice after August 8, 2011. Make sure that all items are attached to the application or your applicationwill not be accepted. Remember you must be eligible for admission by September 1, 2011. (You mustestablish eligibility by the end of Summer Semester 2011, since grades for courses taken Fall Semester2011 will not be available until after the nursing class of Spring 2012 has been admitted.) Cleveland Statestudents are given admission priority over transfer students.** Begin required nursing academics.** Establish and maintain a 2.75 or greater GPA in required nursing academics.(This is NOT a cumulative GPA.)NOTE: High school students attempting to enter the Nursing Program should consult the college catalogfor additional information. Please make sure that your high school transcript shows your chemistry grade,cumulative GPA, and your ACT scores.REMEMBER: You must maintain a 2.75 or greater GPA in the required nursing academics to maintainyour eligibility status. The developmental courses and the chemistry course are prerequisite; therefore,these courses DO NOT count in the required 2.75 GPA. An applicant scoring tool is utilized to admiteligible applicants when the number of eligible applicants exceeds the number of students that can beadmitted.

Cleveland State Community CollegeNursing Program Evening OptionRequired Nursing Academics(According to the current catalog, the courses listed below are the courses thatwill be considered when calculating an applicant’s GPA. To be eligible the GPAmust be 2.75 or higher.) GENERAL PSYCHOLOGY (PSY 1010)HUMAN ANATOMY & PHYSIOLOGY I Lab (BIOL 2010, 2011)HUMAN ANATOMY & PHYSIOLOGY II Lab (BIOL 2020, 2021)HUMAN GROWTH & DEVELOPMENT (PSY 2110)COMPOSITION I (ENGL 1010)COMPOSITION II (ENGL 1020) OR PUBLIC SPEAKING (SPE 2310)HUMANITIES and/or FINE ARTS ELECTIVE(Listed in the online college catalog. Please go to Academics Information, then General EducationRequirements, scroll down to Humanities/Fine Art, there are only 13 courses in this category.) MICROBIOLOGY Lab (BIOL 2230, 2231) ABNORMAL PSYCHOLOGY (PSY 2310)Remember: To be eligible for admission to the Nursing Program, you must** Complete the prerequisite chemistry, developmental courses, and the HESI Test.** Have a "C" or better in the prerequisite chemistry, any required developmental courses and all nursingacademics.** Score 75% on the reading section and theoverall/composite of the HESI Test. Astudent may eligible to enter the programwith a score below 75% on the HESI Testif they have achieved a 3.0 GPA in all threerequired science courses (BIOL 2010/2011,BIOL 2020/2021, BIOL 2230/2231).** Achieve and maintain a 2.75 or greater GPAin required nursing academics.** If you have already completed requiredscience courses (Human Anatomy &Physiology I and II, and Microbiology)these must be within 5 years of the dateof admission.Note that D's and/or F's in required academicsresult in ineligibility. Student making multipleD's and/or F’s should re-evaluate theirprofessional goals.

Cleveland State Community CollegeNursing Program Evening OptionNursing Faculty Office HoursWhen you make application to the college with pre-nursing as your degree major, you will be assigneda nursing faculty advisor. The nursing faculty offices have name plates on the office doors and are locatedon the 2nd floor of the Career Education Building. Nursing faculty members have office hours postedon the doors to their offices during the academic school year (Mid-August through April). Appointmentsmay be made on an individual basis.It is important to note the times your advisor will be available (days & times). The nursing faculty maybe in class, skills labs, or making assignments at the clinical facilities. The nursing faculty are typicallyinvolved in clinical instruction two days during the week and, thus, they may not be on campus every day.(Example, the freshman faculty are in the clinical facilities on Thursdays and Fridays, while the sophomorefaculty are in clinical on Tuesdays and Wednesdays).Remember the days and hours faculty are scheduled to be in their office will be posted on their officedoor during the academic school year. If a faculty member is not readily available, please call or emailto make an appointment. All faculty members have voice mail. Please leave a message so the facultymember can return your call. You may call the college’s main number472-7141, then the faculty member’s phone extension.Please remember that the nursing faculty members are typically in the clinical facilities two days aweek and do not hold office hours on those days.The Nursing Faculty/Advisors are as follows:Faculty/AdvisorMillie CarrollSonya FranklinSheila HalesNancy HerrigVictoria HightNancy MooreJudy NortonJennifer ShearerDawn andstatecc.eduEvening Part-Time Coordinator:Nancy 446473-2383473-2373Office 05E-210BE-210A

Cleveland State Community CollegeNursing Program Evening OptionEstimated Expenses for Nursing Students(All Fees are Subject to Change)STATE RESIDENTSTuition-per hour 111NON-STATE RESIDENTSTuition-per hourOut-of-State Tuition-per hourTotal per hour 111 349 460The Nursing Program is designed to take five semesters to complete however; many students opt to completetheir required academics before they enter the Nursing Program. Therefore, it may take some students morethan five semesters to complete their program of study.REQUIRED CSCC FEESCollege Application FeeCampus Access FeeTechnology Fee ( 14.25 per semester hour) maxStudent Activity FeeNursing lab fee (per semester)Student Government Fee 10.00 5.00 112.50 6.00 30.00 6.00ADDITIONAL ESTIMATED COSTS FOR NURSING STUDENTSRequired Physical Exam (including lab work and vaccinations) varies(Approximate costs beginning at 300)Criminal Background Check 75Urine Drug Screen 15Uniforms 300Skills Lab Pack 180Books 1,500 – 2,000Travel expenses cannot be estimated since they may be different for each student depending on where theyare traveling. In addition to traveling to class, students are required to attend clinicals. Distances to clinicalsvary because they are held in different locations, and the students rotate every three to six weeks.Added expenses (watch with a second hand, bandage scissors, etc.) 100 - 200Liability Insurance (per year) 10.50Licensing Exam (after graduation)Tennessee Board of NursingNCLEX-RNCogent’s Criminal Background Check (CBC) 100 200 75

Cleveland State Community CollegeNursing Program Evening OptionApplicant Scoring ToolNameGPARequied Nursing Academic CoursesMaximum possible points 10(20% of total possible points)Maximum possible points 15(30% of total possible points)Science Courses BIOL 2010; 2230(Human Anatomy & Physiology I and II Microbiology)Hours CompletedToward Nursing MajorMaximum possible points 15(30% if total possible points)HESI ScoreMaximum possible points 10(20% of total possible points)4.00 – 3.8 10All Required CoursesExcept PSY 2310 (Abnormal PSY) 1526 – 30 Hours 15Score 95–100 103.79 – 3.6 9Three Science Courses 0 to 4 Other Required Courses 1421 – 25 Hours 14Score 90 – 94 93.59 – 3.4 8Two Science Courses0 to 4 or More Other Required Courses 5 or More Other Required Courses 12 1316 – 20 Hours 13Score 85 – 89 83.39 – 3.2 7One Science Course 5 or More Other Required Courses 1111 – 15 Hours 12Score 80 – 84 73.19 – 3.0 6One Science Course 0 to 4 Other Required CoursesNo Science Courses but5 or More Other Required Courses 106 – 10 Hours 11Score 75 – 79 62.9 – 2.75 5No Science Courses but1 to 4 Other Required CoursesTotal Score is Sum of All ColumnsNote: Maximum Possible Points 50 9 80 – 5 Hours 10Student Score Date Faculty Initials