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2021-2022TVCC/OCNE NURSING PROGRAMAPPLICATION PACKET AND DIRECTIONSThank you for your interest in Treasure Valley Community College (TVCC) Nursing Program. TVCC's nursingprogram is a member of the Oregon Consortium of Nursing Education (OCNE). Applications will be evaluated onan initial 70-point scale, which includes TVCC's discretionary points. The top applicants will be invited forthe 2nd phase of the application process which is to sit for a proctored essay and interview. Applicants mustbe present for the proctored essay and interview or forfeit their application to TVCC's nursing program. Finalselection from the top applicants will be based on writing skills, answers to questions addressed in the essay, andperformance during the interview. Please visit: https://www.tvcc.cc/nursing/rn nursing program.cfm for moreinformation about application requirements.APPLICATION DEADLINE: February 16th 2021 at4:00 PM MST (as February 15. 2020 at4 pm MST is aSaturday and the College is closed and this is a State requirement). All items must be submitted to the NursingDepartment including a non-refundable nursing application fee. It is the applicant's responsibility to ensurethat all required documents listed below are received by the Department deadline. Documents submitted butnot requested (letters of reference, etc.) will be discarded.Applications may be mailed or hand-delivered to:TVCCNursing DepartmentAttn. Jill Humble650 College Blvd.Ontario, OR 97914MINIMUM ELIGIBILITY REQUIREMENTSApplicants are eligible to apply to TVCC's Nursing Program if they meet ALL the following requirements.Students must complete all courses from the Required Prerequisite courses listed below by the end of the TVCCSummer term prior to entering the nursing program. I must have completed 30 credits including BIOL 2 31 Anatomyand Physiology I and MATH 095 (or higher) in order to apply by the application deadline. All Nursing pre-requisite courses (as listed below) for the application must be earned with a lettergrade of "C" or better. Applicant must have a Nursing pre-requisite course average GPA of 3.0 or higher N!ll&;, 2 ScienceDepartment requires CHEM 104 be completed before BIOL 231 if not completed within past 5 years.However, if you have already completed BIOL 231 or equivalent you fil!JlQt need to take CHEM 104.Prerequisites/Required Preparatory CoursesBIOL231Human Anatomy & Physiology w/lab 1BIOL232Human Anatomy & Physiology w /labBIOL233Human Anatomy & Physiology w/labMicrobiology w/labBIOL234NutritionFNUT225MATH095Intermediate Algebra or higher-level mathGeneral PsychologyPSYC201PSYC237Seasons of LifeWR121English CompositionWR122English Composition(or WR 121, WR 122 and WR 123)Not all Colleges Require these courses as pre-requisites. For that reason, these are not included in the list ofNursing pre-requisite courses. We do not use these to calculate the GPA.BIOL101Gen. Biology I w/lab2 or College BiologyCHEM 104Survey of Chemistry (Health)1
FALL 2021NURSING APPLICATION PACKET CHECKLISTIt is the applicant's responsibility to ensure that all required documents listed below are received by the deadline. Candidateswill not be notified of missing application items. Make a copy of the completed packet for your files. Documents submitted butnot requested Oetters of reference, etc.) will not be accepted.I attest that I have fulfilled the following requirements:(Initial each item below)1. I have read the Fall 2021-2022 Nursing Program Information Packet Directions (pg. 1) and TechnicalStandards document found at hrms: //www.tvcc.cc/nursing/rn nursing proeram.cfm2. I have completed the TVCC Application for Admission and received my student ID #.Application is available at htt;ps://www.tvcc.cc/admissions/a1wly.cfm3. I have completed the TVCC/OCNE Nursing Program Application, including residency requirements(p. 4 & 5). I understand that by applying to TVCC's Nursing Program, I am also applying for co-admission andauthorizing the release of my application information to Oregon Health and Science University (OHSU). In addition, Iam authorizing my information to be released to the Oregon State Board of Nursing for research purposes only.4. Included is a money order for 50.00 made payable to Treasure Valley Community College, which is a nonrefundable nursing application fee.5. Attached are unofficial college transcripts from all institutions where pre-requisite courses havebeen taken through Fall term 2021.6. I will send official (Unopened) college transcripts to TVCC -Registrar's Office once accepted into the Nursing program.7. I understand that I must have completed all courses from the Required Prerequisitecourses listed below by the end of the TVCC Summer term prior to entering the nursing program.In order to apply, I must have completed 30 credits including BIOL 231 Anatomy and Physiology I and MATH 095 (orhigher) by the application deadline.l!iJH!:;. 2science Department requires CHEM 104 be completed before BIOL 231 if not completed within past 5 years.However, if you have already completed BIOL 231 or equivalent you fil!JlQt need to take CHEM 104.8. I understand that the cumulative GPA for all nursing program pre-requisite courses must be 3.0 or higher.9. I have signed the attached statements regarding:o TVCC/OCNE Nursing Program Applicationo Program and Licensure Requirementso Proof of Health Status and Immunizations(pg. 4 & 5)(pg. 6)(pg. 7)10. I have signed and completed the Nursing Application Packet Checklist (this page).11. I have signed the Health Care Experience Documentation Form (pg. 8 & 9) and attached proof ofWork/Volunteer Experience.12. I understand that although co-admitted to the Oregon Health & Science University School of Nursing, thosewho choose to transition from the Treasure Valley Community College Nursing Program to OHSU will have toundergo a criminal background check for OHSU prior to enrollment in OHSU courses and enrollment may benegatively impacted by any criminal history in their background.13. If you claim on your application you are bilingual- a TVCC representative will be contacting you to set up anappointment to demonstrate that you are bilingual.DateSignatureNameStudent ID#SignatureDate3
Fall 2021TVCC/OCNE Nursing Program ApplicationSTUDENT INFORMATIONPlease type or print neatly in blue or black ink.Last NameFirst NameTVCC ID#Current Mailing AddressMiddle InitialPrevious Last NameLast 4-digits of Social Security # Date of BirthStateCityPlace of BirthZipLength of Residency at Current Mailing AddressAlternative PhonePrimary PhoneoMaleoFemaleEDUCATION INFORMATIONLIST ALL COLLEGES WHERE YOU HAVE COMPLETED NURSING PRE-REQUISITES &/OR A DEGREE. Officialtranscripts will be required for all colleges and universities listed.CollegeStateDates ofAttendanceNumber ofCreditsDegree EarnedHOW TO RECEIVE POINTS FOR RESIDENCYResidency is defined as a person's domicile, his/her true fixed and permanent home and place of habitation. It is theplace where one intends to remain, and to which one expects to return when one leaves without intending toestablish a new domicile elsewhere. Domicile is not established by mere attendance at the college.To qualify for residency, you must meet the following criteria:1. Reside in the TVCC taxing district (Malheur County).2. Live and/or reside within a 30-mile radius of Ontario, OR (your city of residence is used to determinethe 30-mile radius).You must submit proof of physical residence by submitting the following documents:4
Utility receipts with your name and physical address listed showing proof of residencyin the "community" for a 12-month period. Submit the following two documents:1. Utility receipts from Dec. 2019 thru Jan 2021If the applicant is a dependent and resides in the "community" with a parent(s), thefollowing documentation must be provided:2. Driver's license with physical residence listed andA letter from the parent verifying your place of residence and dependent status.Are you a veteran? (circle one)YES/NOAre you bilingual? If so, what language(s) do you speak?YES/ NOThe points for "living in the community" will not be given without this documentation. Uthere appears to beinconsisteng. the nursing faculty m(O' require further documentation.All Nursing Department written communication will be mailed to the address listed.I have read and understand the admission criteria for the nursing program at TVCC. J understand that it is myresponsibility to meet all program and application criteria. I verify that all statements on this application are completeand true. I understand that falsification ofany information may lead to disqualification or dismissal from the program.I give my permission for release of pertinent application information to the OCNE partner schools, including OHSU andto the Oregon State Board of Nursing, as necessary to facilitate my program of study and to enhance the applicationprocess for future applicants.SignatureDate5
HEALTH CARE EXPERIENCE DOCUMENTATION FORMStudent ID#Applicant NameDateTO BE COMPLETED BY THE APPLICANTPlease check one of the following that best describes your work/volunteer experience.oI have a CNA, LPN, EMT, Paramedic, Surgical Tech, Patient Care Technician, or CMA (Certified MedicalAssistant) certification and have:400 or n patient care hours.Provide the following documentation: A copy of state or national license with original date of issue ( must be issued on or prior toJanuary 2021). A copy of the certification card or printed verification from the state board website which areboth acceptable forms of documentation. Certificates of training completion, diplomas, or transcripts from health care training programs areNOT acceptable forms of documentation.ALL HEALTH CARE EXPERIENCE DOCUMETATION MUST BE SUBMITTED FOR THE APPLICANT TO RECEIVEPOINTS.Health care experience must be completed by January 2021. Health care experience completed after January2021 will not be considered. Points will not be awarded if forms are incomplete or if documentation is missing.All required documentation must be received in the Nursing Department office no later than February 16th, 2021at 4:00 pm MST as February. 15, 2020at 4:00 pm, MST is a Saturday and the College is closed. If you havequestions regarding this form, please contact the Nursing Department Program Coordinator at 541-881-5940.8
TVCC's nursing program is a member of the Ore gon Consortium of Nursi ng Education (OCNE). Applications will be evaluated on an initial 70-point scale, which includes TVCC's discretionary points. The top applicants will be invited for the 2nd phase of the application process which is to sit
