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2019TVCC/OCNE NURSING PROGRAMAPPLICATION PACKET DIRECTIONSThank you for your interest in Treasure Valley Community College (TVCC) Nursing Program. TVCC’snursing program is a member of the Oregon Consortium of Nursing Education (OCNE). Applicationsare evaluated on a point system. Applications will be evaluated on an initial 70-point scale,which include TVCC’s discretionary points. The top applicants will be invited for the 2nd phaseof 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 nursingprogram. Final selection from the top applicants will be based on writing skills, answers to questionsaddressed in the essay, and performance during the interview. Please visit:http://www.tvcc.cc/academics/nursing/ for more information about application requirements.APPLICATION DEADLINE: February, 15, 2019 at 4 pm MST. All items must be submitted to theNursing Department including a non-refundable nursing application fee. It is the applicant’sresponsibility to ensure that all required documents listed below are received by thedepartment deadline. Documents submitted but not requested (letters of reference, etc.) will bediscarded.Applications may be mailed or hand-delivered to:TVCCNursing Department650 College Blvd.Ontario, OR 97914MINIMUM ELIGIBILITY REQUIREMENTSApplicants are eligible to apply to TVCC’s Nursing Program if they meet ALL of the followingrequirements.Students are eligible to be considered for admission to the nursing program after completing 30 credit hoursof courses from the Required Prerequisite courses listed below. The 30 credits must include BIOL 231Anatomy and Physiology I and MATH 095 (or higher) by the application deadline. All requiredprerequisite courses must be completed with a C or better. Before in enrolling in nursing courses,students must complete the following classes: WR 121, WR 122, PSYC 237, PSYC 201, FNUT 225,MATH095 or higher, BIOL 231, BIOL 232, BIOL 233, and BIOL 234 by the end of 2nd session of thesummer term of the year they will be entering into the nursing program.Prerequisites/Required Preparatory CoursesBIOL101BIOL231BIOL232BIOL233Gen. Biology I w/lab2 or College BiologyHuman Anatomy & Physiology w/lab1Human Anatomy & Physiology w/labHuman Anatomy & Physiology w/labCHEM 104Survey of Chemistry (Health) 3Microbiology w/labIntermediate Algebra or higher level math1NutritionGeneral PsychologySeasons of LifeEnglish CompositionEnglish CompositionEnglish Composition21Classesthat must be completed by application deadline to be eligible.before entering into the 2nd yr. of the nursing program.3Science department requires CHEM 104 be completed before BIOL 231 if not completed withinpast 5 years. However, if you have already completed BIOL 231 or equivalent you donot need to take CHEM 104.2 Required All pre-requisite courses for the application must be earned with a letter grade of “C”or better.1
Applicant must have a pre-program, pre-requisite GPA of 3.0 or higher.Before in enrolling in nursing courses, students must complete the following classes: WR121, WR 122, PSYCH 237, PSYCH 201, FNUT 225, MATH095 or higher, BIOL 231, BIOL 232,BIOL 233, and BIOL 234 by the end of 2nd session of the summer term of the year they willbe entering into the nursing program.Post-Acceptance Admission RequirementsAll admitted TVCC nursing students must meet the following requirements before they can begin anynursing courses: Successfully complete any outstanding pre-requisite courses with a grade “C” or higher bythe end of summer term, 2019. Successfully pass a criminal background check from an agency designated by TVCC*. Successfully pass a 10-panel drug screen from an agency designated by TVCC*. Submit proof of current immunizations*. Submit proof of current CPR for Health Care Providers certification by American HeartAssociation. Complete a physical assessment by your medical doctor*Admitted students will receive specific instructions from TVCC’s Nursing Department on how tofulfill these requirements after formal acceptance to the program. Failure to successfully completeany of the above requirements will result in a rescinded admissions offer.BEFORE YOU SUBMIT YOUR APPLICATION! Did you remember to?o Apply to TVCC and you were accepted as a TVCC student.o Sign and date:1. Application Checklist (pg. 3)2. Application (pg. 4)3. How to received residency points (pg. 5)4. Statement Regarding Program and Licensure Requirements (pg. 6)5. Proof of Health Status and Immunizations (pg. 7)6. Work/Volunteer Experience Verification (pg. 8)APPLICANTS ARE RESPONSIBLE FOR COMPLETING AND SUBMITTING ALL REQUIRED FORMSAND MATERIALS, INCOMPLETE APPLICATIONS WILL BE RENDERED INELIGIBLE.2
FALL 2019NURSING APPLICATION PACKET CHECKLISTIt is the applicant’s responsibility to ensure that all required documents listed below are received by the deadline.Candidates will not be notified of missing application items. Make a copy of the completed packet for your files.Documents submitted but not requested (letters 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 2019 Nursing Program Information Packet Directions (pg. 1) and TechnicalStandards document found at: http://www.tvcc.cc/academics/nursing/general information.cfm2. I have completed the TVCC Application for Admission and received my student ID #. Application isavailable at: http://www.tvcc.cc/admissions/apply.cfm3. I have completed the TVCC/OCNE Nursing Program Application, including residencyrequirements, (p. 4 & 5). I understand that by applying to TVCC’s Nursing Program, I am also applying for coadmission and authorizing the release of my application information to OHSU. In addition, I am authorizing myinformation to be released to the Oregon State Board of Nursing for research purposes only.5. Included is a money order for 50.00, which is a non-refundable nursing applicationfee.4. Attached are unofficial college transcripts from all institutions where pre-requisite courses havebeen taken through Fall term 2018.5. Send official (Unopened) college transcripts to TVCC – Registers Office, once accepted into the 2ndphase of the nursing application process.6. I understand that I must have completed 30 credit hours of courses from the Required Prerequisite.The 30 credits must include BIOL 231 Anatomy and Physiology I and MATH 095 (or higher) by the applicationdeadline. Before in enrolling in nursing courses, students must complete the following classes: WR 121, WR 122,PSYC 237, PSYC 201, FNUT 225, MATH095 or higher, BIOL 231, BIOL 232, BIOL 233, and BIOL 234 by the endof 2nd session of the summer term of the year they will be entering into the nursing program.7. I understand that the cumulative GPA for all nursing program pre-requisite courses must be 3.0 orhigher.8. I have signed the attached statements regarding:7. Application Checklist (pg. 3)8. Nursing Application (pg. 4)o How to received residency points (pg. 5)o Program and Licensure Requirements (pg. 6)o Proof of Health Status and Immunizations (pg. 7)o Work/Volunteer Experience Verification (pg. 8)9. I have signed and completed the Nursing Application Packet Checklist (this page).10. I have attached proof of Work/Volunteer Experience11. I understand that although co-admitted to the Oregon Health & Science University School of Nursing,those who 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.”12. If you claim on your application you are bilingual – a TVCC representative will be contacting you to setup an appointment to demonstrate that you are bilingual.SignatureDateNameStudent ID#SignatureDate3
Fall 2019Nursing ApplicationSTUDENT INFORMATIONPlease type or print neatly in blue or black ink.Last NameFirst NameTVCC ID#Middle InitialLast 4-digits of Social Security # Date of BirthCurrent Mailing AddressCityLength of Residency at Current Mailing AddressPrimary PhoneooPrevious Last NameStatePlace of BirthZipAlternative PhoneMaleFemaleEDUCATION INFORMATIONLIST ALL COLLEGES WHERE YOU HAVE COMPLETED NURSING PRE-REQUISITES &/OR A DEGREE.Official transcripts will be required for all colleges and universities listed.CollegeStateDates ofAttendanceNumber ofCreditsDegree EarnedBilingual:Yes:No:If yes, what language:SignatureDate4
HOW TO RECEIVE POINTS FOR RESIDENCYResidency is defined as a person’s domicile, his/her true fixed and permanent home and place ofhabitation. It is the place where one intends to remain, and to which one expects to return when oneleaves without intending to establish a new domicile elsewhere. Domicile is not established by mereattendance 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 usedto determine the 30-mile radius).You must submit proof of physical residence by submitting the following documents:Utility receipts with your name and physical address listed showing proof of residencyin the “community” for a 12-month period. Submit the following two receipts:1. Utility receipts from Dec. 2017and Dec. 2018 or2. Utility receipts from Jan. 2018 and Jan. 2019.If the applicant is a dependent and resides in the “community” with a parent(s), thefollowing documentation must be provided:1. Driver’s license with physical residence listed and2. A letter from the parent verifying your place of residence and dependent status.The points for “living in the community” will not be given without this documentation. If thereappears to be inconsistency, the nursing faculty will 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. I understand that itis my responsibility to meet all program and application criteria. I verify that all statements on thisapplication are complete and true. I understand that falsification of any information may lead todisqualification or dismissal from the program. I give my permission for release of pertinent applicationinformation to the OCNE partner schools, including OHSU and to the Oregon State Board of Nursing, asnecessary to facilitate my program of study and to enhance the application process for futureapplicants.SignatureDate5
STATEMENT REGARDING PROGRAM AND LICENSURE REQUIREMENTSStudents accepted for admission into the Nursing Program at TVCC are advised, prior to enrollment,of the following Oregon State Board of Nursing (OSBN) rules concerning Application for Licensure byExamination OARS 851-031-0006:(2) Limits on Eligibility:(a) If an applicant has a major physical or mental condition that could affect the applicant'sability to practice nursing safely, a physical or psychological assessment may be required, toassist in the determination as to whether or not the applicant's physical or mental health isadequate to serve the public safely.(b) If an applicant has been arrested, charged or convicted of any criminal offense adetermination shall then be made as to whether the arrest, charge or conviction bears ademonstrable relationship to the practice of nursing, in which case licensure may be denied.The college cannot be responsible for a student’s physical, mental, or emotional health or ability toqualify for licensure. If you are unable to qualify under the above requirements, you may wish toreconsider your choice of program.Examples of crimes for which an individual will be denied licensure include: Crimes against another person such as murder, manslaughter, assault, rape, sexual abuse,child abandonment or neglect. Conviction within seven years for a crime against property such as first degree offensesincluding burglary, arson, criminal mischief, robbery, or forgery. An extended history of arrests and convictions demonstrating habitual disregard for societalrules.You will be required to complete a criminal records check after you are accepted to the nursingprogram. Some clinical agencies may require additional security checks. A criminal backgroundcheck will also be required by OSBN when you apply for licensure. A criminal record detected in thismanner will preclude your ability to complete the required clinical experience and result in dismissalfrom the program.Upon graduation you are eligible to be licensed in any state.I have read the above statement and I verify that I qualify for clinical experience at all clinical sites andfor nursing licensure in the State of Oregon. I also agree to release any criminal backgroundinformation to TVCC for use in the Nursing Program.SignatureDate6
PROOF OF HEALTH STATUS AND IMMUNIZATIONSListed items are to be completed once you have been notified that you are accepted into the nursingprogram. However, this signed form is to be turned in with application as acknowledgement ofstudent responsibility.I understand that once accepted to the TVCC Nursing Program, I must complete the following andprovide proper documentation by the deadline stated in the acceptance letter.1. A physical examination by a licensed health care professional.2. A tuberculosis skin test, with follow-up chest x-ray if skin test is positive. Note: This test must berepeated each year in the program.3. Immunizations or titers, as appropriate, for Measles, Mumps, Rubella, and Chicken Pox.4. Tetanus immunizations within the last 10 years.5. As a nursing student you may be at risk for contracting Hepatitis B. Therefore, you are required toobtain the Hepatitis B vaccination. This is a series of three injections given over a six-month period.Only the first dose must be completed prior to the start of the program.6. It is also recommended that you obtain the Influenza immunization, no earlier than October 1st andno later than November 1st. This immunization is required for your safety and the safety of yourpatients.7. I further understand that I will be required to take a drug test at my expense prior to the start ofthe nursing program. Results of the testing will remain confidential.8. I further understand that I will be required to take a criminal background check at my expenseprior to the start of the nursing program. Results of the testing will remain confidential.SignatureDate7
HEALTH CARE EXPERIENCE DOCUMENTATION FORMApplicant NameTO BE COMPLETED BY THE APPLICANTStudent ID#DatePlease check one of the following that best describes your work/volunteer experience.oHealthcare with a Certification: I have a CNA, LPN, Surgical Tech, Patient Care Technician,Home Health Aide, EMT/Paramedic, Medic in the Military and MA certification and have Postcertification patient care hours of: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 orprior to January 2019). A copy of the certification card or printed verification from the state board websitewhich are both acceptable forms of documentation. Certificates of training completion, diplomas, or transcripts from health caretraining programs are NOT acceptable forms of documentation.oHealthcare experience without a certification:o What type of experience/job title:o How many hours of experience:o Location of your experience:ALL HEALTH CARE EXPERIENCE DOCUMETATION MUST BE SUBMITTED FOR THE APPLICANTTO RECEIVE POINTS.Health care experience must be completed by January 2019. Health care experience completed afterJanuary 2019 will not be considered. Points will not be awarded if forms are incomplete or ifdocumentation is missing. All required documentation must be received in the Nursing Departmentoffice no later than February. 15, 2018 at 4:00 pm, MST. If you have questions regarding this form,please contact the Nursing Department Administrative Assistant at 541-881-5940.SignatureDate8
HEALTH CARE EXPERIENCE DOCUMENTATION FORM(With certification or without certification)Applicant NameTO BE COMPLETED BY THE EMPLOYERStudent ID#DateName of Company/FacilityCity StateJob Title of Applicant Certification held by ApplicantEmployment Status (please check)Full TimePart Time VolunteerBeginning Date End DateTotal Number of Hours Completed or Average Weekly Hours Completed(Only count hours completed through January 2019)Attach a current position description or provide a detailed description of the position duties in thespace provided below:Please provide the following information. Contact information will only be used to verify informationprovided on this document.Supervisor Name and Title:Telephone Number:Email Address:Supervisor Signature:Thank you for taking the time to complete this form. All health care experience documentation formsand other documentation must be submitted by February, 15, 2019 by 4:00 pm MST for applicants toreceive work experience points. If you have any questions regarding this form or the TVCC Nursingapplication process, please contact the Nursing Department office at 541-881-5940.9
Community Service Volunteer Verification FormApplicants to the Treasure Valley Community College Nursing Program may receive up to 5points for volunteering in any organization/circumstance where the individual was supervised(directly or indirectly) and provided a service to the community.Applicants should not submit volunteer verification documentation with their applicationif they have not performed at least 48 hours of volunteer service in the last 5 years.Note to applicant: Be sure to fill in necessary information in the top section before giving thisform to the supervisor/organization where the volunteer hours were performed. Volunteer hoursmust be verified using this form and include a letter of reference from your supervisor ortheir designee which describes the activity and how it serves the community. You mayduplicate this form as needed. You must include a reference letter from each organization fillingout a verification form. Be sure the form is complete. Incomplete forms or missing referenceletters cannot be given consideration in the point assignment process.Dear Human Resources/Supervisor,I am in the process of applying to the Treasure Valley Community College Nursing Program. Theselection points process requires verification of volunteer hours and a reference letter. Volunteerhours must be unpaid and completed within the last 5 years.I, (print program applicant’s name) authorize the collegeto contact the individuals listed on this form to verify the information provided.Applicant’s Signature: Date:The portion below is to be completed by Supervisor or Human ResourcesVerification of volunteer hours:A.C.Dates of Service: Total Hours:mm/dd/yy – mm/dd/yySupervised by:Print Name, TitleOrganization:D.Supervisor contact number:E.Supervisor signature: Date:F.PLEASE ATTACH A LETTER OF REFERENCE FOR THE APPLICANTDESCRIBING THE VOLUNTEER ACTIVITY AND HOW IT SERVES THECOMMUNITY.B.10
TVCC’s nursing program is a member of the Oregon Consortium of Nursing Education (OCNE). Applications are evaluated on a point system. Applications will be evaluated on an initial 70-point scale, which include TVCC’s discretionary
