PRACTICAL NURSE PROGRAM

APPLICATION INFORMATION Dear Prospective Student, Thank you for your interest in the Northwest Mississippi Community College Practical Nursing Program located on the Senatobia Campus, Benton-Marshall Campus, DeSoto Campus, and Oxford Campus. The PN program accepts applications from January through April 30 each year for the fall semester. The Oxford Campus also begins a new class each January. PN applications for this class (spring semester) will be accepted from June through mid-October each year. The PN program is a twelve-month course, which begins each August and January for Oxford. A campus-wide schedule is followed with regard to holidays, semester registration, and breaks. Admission criteria for acceptance into the program:

• You must include a new/updated application to Northwest. • You must make application to the Practical Nursing Department. (see deadlines above) • You must have a high-school diploma or GED equivalency. • You must provide proof* of a composite score of 16 or higher on the enhanced ACT.

*PROOF REQUIRED: OFFICIAL HIGH SCHOOL TRANSCRIPT OR ACT PRINTOUT OF SCORES. • You must be 18 years of age or older. • You must be physically sound and have no felonious or criminal record. • After these requirements are met, you will then be eligible to take the TEAS (a nurse entrance

test). • There is a $50.00 cash fee for the TEAS test. • Testing begins in February for the fall semester and mid-SEPTEMBER for the SPRING SEMESTER at

the Oxford Campus. • Call Rhonda Still, 662-562-3366 (Senatobia or Benton-Marshall), or Brenda Holmes, 662-238-7952

(Oxford) after mid-January to schedule a testing date and time for the fall class and mid-August to schedule a testing date and time for the Oxford Campus spring class. Dr. Tim Williams, 662-280-6127, at the DeSoto Campus will be mailing notifications of TEAS test dates and times.

• Practical Nursing candidates who score at or above the program average (62) for math and reading on the TEAS will be considered for admission.

All admission applications for the PN program must be submitted to the Practical Nursing Departments of each respective campus. The mailing address is listed on the Practical Nurse Program Application.

Admission Policy Practical Nursing (PN) – Students desiring to enter the PN program will be selected based on the following criteria: 1. Applicants must be at least 18 years of age. 2. Applicants must have a high school diploma or GED equivalency. 3. Applicants must submit a new or updated Northwest application and a PN application to the campus they are planning to attend. 4. Applicants must have an enhanced ACT composite score of 16 or greater and must send proof of their ACT score to Northwest’s Registrar’s Office. PROOF REQUIRED: Official high school transcript or ACT printout of scores. 5. Once a prospective student has all required documentation on file with the PN Program, an opportunity to sit for the Test of Essential Academic Skills (TEAS) can be scheduled by calling Brenda Holmes at 662-238-7952. * The Practical Nursing Program accepts applications from mid-January through April 30 of each year. Testing begins each February. ** The LYTC-Oxford Campus also accepts applications from June through mid-October for students planning to attend Spring semester. Testing begins for this class in September. Persons interested in applying for the Practical Nursing program at the Oxford campus should make application to the following address:

ATTN: PN Program NWCC/Lafayette-Yalobusha Technical Center 1310 Belk Drive Oxford, MS 38655

ESTIMATED COST OF PN PROGRAM FIRST SEMESTER: TUITION …………………………………………………… $1,125.00 BOOKS & KIT……………………………………….…….. 1,250.00 CPR (First Aid) ………………………………………….. 35.00 UNIFORMS ………………………………………………. 350.00 INSURANCE ……………………………………………. 15.00 TOTAL FIRST SEMESTER ……….……………………………………………….$2,775.00 SECOND SEMESTER: TUITION …………………………………………………… $1,125.00 TOTAL SECOND SEMESTER ……….………….……………………………….$1,125.00 SUMMER SEMESTER: TUITION …………………………………………………… $1,125.00 TOTAL THIRD SEMESTER ……….………………………………………..…. $1,125.00 TOTAL ESTIMATED COST OF PN PROGRAM …………………………..……….$5,025.00

Northwest Mississippi Community College PRACTICAL NURSING

Advisors: Kitchens, Williams, Shawn, Hill The Practical Nursing Program prepares the individual to assist in providing general nursing care requiring basic knowledge of the biological, physical, behavioral, psychological, and sociological sciences; and of nursing procedures which do not require the skills, judgment, and knowledge required of a registered nurse. This care is performed under the direction of a registered nurse, licensed physician, or dentist. Students that complete the program requirements, 3 semesters, as identified by the Mississippi Department of Education, will be eligible to apply for PN licensure. The graduate of the program functions as a provider of care and a member of a profession. FIRST SEMESTER SEMESTER HOURS SECOND SEMESTER SEMESTER HOURS PNV 1213, Body Structure & Function 3 PNV 1614, Medical/Surgical Nursing 4 PNV 1426, Fundamentals of Nursing 6 PNV 1622, Medical/Surgical Nursing PNV 1437, Fundamentals of Nursing Clinical 2 Lab/Clinical 7 PNV 1634, Alterations in Adult Health 4 PNV1642, Alterations in Adult Health Clinical 2 PNV 1524, IV Therapy & Pharmacology 4 Total 16 Total 16 THIRD SEMESTER SEMESTER HOURS PNV 1715, Maternal-Child Nursing 5 PNV 1813, Mental Health Concepts 3 PNV 1914, Nursing Transition 4 Total 12 2013-2014

Phone (662) 238-7952

PRACTICAL NURSE PROGRAM APPLICATION

ALL PRIOR FILES ARE INACTIVE. THE REQUIREMENTS FOR APPLICATION MUST BE COMPLETED IF YOU ARE RE-APPLYING.

Applications for the fall semester will be accepted from January through April 30 each year. Applications for the spring semester will be accepted from June through mid-October each year. NAME_____________________________________________________________________ Last First Middle Maiden MAILINGADDRESS__________________________________________________________________ Street City State Zip EMAIL ADDRESS _________________________________ DOB ___________________ TELEPHONE______________________________ ________________________________ Home Number Business or Cell Number Have you taken the ACT? (Circle) Yes No If yes, composite score___________________ (Minimum 16 ACT required - YOU MUST PROVIDE PROOF OF SCORE - H.S. Transcript or ACT printout) High School_______________________________________ Year Graduated____________ If you hold a GED Certificate, date received _____________________________________ Please circle yes or no for the following questions. These are questions that will be on the NCLEX PN (State Board Exam). 1. Yes No Have you been convicted of any criminal offense in any state or federal court (other than minor traffic violations)? 2. Yes No Have you been convicted of a felony? 3. Yes No If yes, have you been issued a Certificate of Relief from Disabilities by the Prisoner Review Board?

4. Yes No Have you had or do you now have any disease or condition that interferes with your ability to perform the essential functions of your profession, including any disease or condition generally regarded as chronic by the medical community, i.e., (1) mental or emotional disease or condition; (2) alcohol or other substance abuse; (3) physical disease or condition, that presently interferes with your ability to practice your profession? 5. Yes No Have you been denied a professional license or permit, or privilege of taking a an examination, or had a professional license or permit disciplined in any way by any licensing authority in Mississippi or elsewhere? 6. Yes No Have you ever been discharged other than honorably from the armed service or from a city, county, state or federal position? Note: Providing false information on this application may cause the applicant to be excluded from acceptance into the PN Program. ______________________________________________ ________________________ Applicant’s Signature (Legal Name) Date Return completed application to: ATTN: PRACTICAL NURSING Lafayette-Yalobusha Technical Center 1310 Belk Drive Oxford, MS 38655

Application for admissionRegistrar’s office4975 Hwy 51 north

P.O. Box 7047 Senatobia, ms 38668

Last First Middle Maiden

Street City State Zip County

Name:____________________________________________________________________________________________________

Physical Address:__________________________________________________________________________________________

Mailing Address: __________________________________________________________________________________________Street or P.O. Box City State Zip Countyif different from physical

City/State/Country of Birth: _______________________ MS Resident?

Race/Ethnicity: Are you Hispanic/Latino?

What is your race? (You may choose more than one) ___White ___ Black or African American

___ Asian ___ American Indian or Alaska Native ___ Native Hawaiian or Other Pacific Islander

Date of Birth: ___/___/____

Family Information

LastChoose One: ___ Parent ___ Guardian** ___Spouse Name: ______________________________________________

First

Mailing Address: ___________________________________________________________________________________Street or P.O. Box City State Zip

Location: ___________________________________ (Month/year)

Do you have a GED diploma? If yes, graduation date: _________ State where GED was completed: _______(Month/Year)

City State

College Information

Have you ever attended NWCC?

Last FirstList all colleges previously attended: Failure to list complete and accurate information could result in the cancellation of your enrollment.

What semester do you plan to attend NWCC? ___ Fall ___Spring ___ Summer What year? _____________________

High School: _________________________________________________________ Graduation Date: ___________________

High School information

GED Information

I certify the information I have provided on this application is accurate and that I have not intentionally withheld information requested. I further understand that falsification of information is a basis for denying admission or for immediate termination of enrollment. My signature above also authorizes the release of my transcripts from all schools previously attended to Northwest’s Registrar’s office.

Applicant’s Signature: ________________________________________________________________________________ Date: _______________________

**If you choose guardian, you must mail in official guardianship documents.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Social Security Number: _______ - _____ - _________

Intended Major: __________________________ Major Code: _____________ (See reverse for codes)

*Non-degree seeking students are not eligible for financial aid.

All official college transcripts are required for admission to be complete.

E-mail: _____________________________________________________@________________________________________

Phone Number: ( ) - _________ - _____________

Gender:

U.S.Citizen?

Official high school transcript or GED and ACT scores (see NWCC catalog for exceptions) are required for admission to be complete.

Male Female

Yes No

(mark one)

Yes No

Yes No

Yes No

Yes No

X

Campus you plan to attend:

Senatobia DeSoto Oxford Online

If any of your transcripts are from out of state, you must provide proof of residency.

Degree Seeking Non-degree Seeking*

Dates attended: _____________________________________________

Name at time attended: ______________________________________

Personal Information

CODES FOR MAJORS

205 Accountancy120 Animal Science405 Art704 Biology220 Business & Computer Teacher Education218 Business Administration708 Chemistry416 Communications/Public Relations410 Communications/Broadcasting415 Communications/Journalism213 Computer/Management Information Systems712 Computer Science515 Criminal Justice305 Elementary Education345 Exercise Science130 Forestry510 General College Curriculum105 General Agriculture

724 General Science340 Health & Physical Education505 Liberal Arts417 Marketing Communications/PR Mgmt784 Mathematics420 Music, Music Education, Music Performance423 Music Business/Industry605 Nursing (Associate Degree)240 Office Administration131 Outdoor Recreation & Mgmt788 Physics720 Pre-Architecture744 Pre-Clinical Laboratory Sciences347 Pre-Communicative Disorders730 Pre-Cytotechnology732 Pre-Dental734 Pre-Dental Hygiene716 Pre-Engineering710 Pre-Forensic Chemistry

127 Pre-Health Information Management 742 Pre-Health Sciences726 Pre-Horticulture718 Pre-Landscape Architecture722 Pre-Landscape Contracting736 Pre-Medical748 Pre-Nursing (BSN)752 Pre-Occupational Therapy738 Pre-Optometry756 Pre-Pharmacy760 Pre-Physical Therapy764 Pre-Radiological Sciences768 Pre-Veterinary Medicine770 Pre-Veterinary Medical Technology520 Psychology342 Recreation307 Secondary Education535 Social Work425 Theatre

ASSOCIATE OF ARTS DEGREE

ASSOCIATE OF APPLIED SCIENCE

CAREER CERTIFICATE

6005 Accounting Technology6022 Agricultural Business & Mgmt Tech/Animal Husbandry6010 Agricultural Tech/John Deere Tech8014 Automotive Technology8014 Automotive Tech/Chrysler College Auto Program6012 Aviation Maintenance Tech6045 Business & Marketing Management Tech6098 Cardiovascular Technology6030 Civil Engineering Technology6032 Civil Engineering Tech/Pre- Surveying/Geomatics MSU

6052 Drafting & Design Engineering Tech/Arch Eng6025 Early Childhood Education Technology6070 EMT-Paramedic6085 Funeral Service Technology6035 Graphic Design Technology6079 Health-Care Data Technology8015 Heating, Air Conditioning & Refrigeration Tech 6065 Hotel & Restaurant Mgmt Tech6056 Industrial Electronics Engineering Tech6038 Information Systems Tech/ Computer Networking

6041 Information Systems Tech/ Computer Programming 6009 Microcomputer Technology6014 Office Systems Technology6090 Paralegal Technology6099 Paralegal Tech/Pre-Paralegal Studies UM 2+2 Option6093 Respiratory Therapy6092 Surgical Technology7005 Precision Manufacturing and Machining Technology

6031 Civil Engineering Technology (One-Yr Certificate)8005 Collision Repair Technology8075 Commercial Truck Driving8035 Cosmetology

8036 Cosmetology/Nail Technician Option6071 EMT-Basic8062 Health Care Assistant

6013 Office Systems Technology (One- Yr Certificate)8060 Practical Nursing8070 Welding And Cutting

AFFIRMATIVE ACTION—Northwest Mississippi Community College does not discriminate on the basis of race, color, national origin, sex, religion, age, dis-ability or status as a veteran or disabled veteran in employment, programs, or provision of services. Compliance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act is coordinated by Mr. Michael Dottorey, Disability Support Services Coordinator, McLendon Student Center, P.O. Box 5555, Highway 51 North, Senatobia, Mississippi 38668, telephone number 662-562-3309, email address mldottorey@northwestms.edu. Compliance with Title II of the Age Discrimination Act and Title IX of the Education Amendments of 1972 is coordinated by Mr. Gary Mosley, Vice President for Fiscal Affairs, James P. McCormick Administration Building, P.O. Box 7017, 4975 Highway 51 North, Senatobia, Mississippi, 38668, tele-phone number 662-562-3216, email address gtmosley@northwestms.edu.