The Green River Community College Practical Nursing Program is a four-quarter program beginning each Fall Quarter and concluding at the end of Summer Quarter. Program capacity is 30 to 40 students, which is determined by available faculty.

It is strongly recommended that the prospective applicant attend a general nursing information session sponsored by the Career and Advising Center. Go to www.greenriver.edu/infosessions for dates, times, and locations. Students working toward applying in the Practical Nursing Program should meet with the Practical Nursing Advisor by contacting ext. 2641 for an appointment after attending the information session.

Application Process

Selection and Submission Selection is based on the following system (not in order of priorities):

Grades in AP1, AP2, English, Communications, Math, Nutrition, and Human Development

Nelson Denny scores

HESI testing scores

Prior work as a NA-C, NA-R, MA, or HCA

Essay score

Additional points for service in the Military and/or being a Green River student†

Partial random draw

Professionalism: Applicants who have displayed unprofessional behavior risk losing points.

Students assume all responsibility for reading and following instructions. There will be no exceptions to the admission process.

Applications will be accepted beginning June 30, 2014. Applications must be received by 4:00 pm on July 9, 2014. Mail or hand deliver the application to:

Green River Community College Enrollment Services c/o: Admission/Practical Nursing Application 12401 SE 320th St. Auburn, WA. 98092-3622

Late or incomplete applications are denied!

Notification and Mandatory Orientation Applicants will be notified of acceptance into the program by July 30, 2014.

Admitted students and the top 10 waitlisted applicants are required to attend a mandatory orientation held August 8, 2014, at 3:00 pm in SC 137. Those who fail to attend forfeit their seat to the next applicant on the waitlist.

† Veteran and/or completion of Green River credits do not guarantee admissions. Applicants from other institutions are welcomed

and still encouraged to apply

Fall 2014 Application Packet

Practical Nursing

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Application Requirements

Prerequisite courses: Applicants must complete the following prerequisites at the time of application to the program. Most prerequisite courses must be taken within seven years of starting the Practical Nursing Program. Applicants must have a minimum grade of a 2.5 in each prerequisite to be eligible to apply. For the following prerequisites, students will only be able to repeat two courses from the list one time each within 5 years. The repeat includes withdrawals as well as grades below 2.5 and includes all colleges attended.

Course Title GREEN RIVER Course Number Specific Information

Anatomy & Physiology 1* AP 103 or Biol& 241 Must have been completed after 8/31/2007.

Anatomy & Physiology 2* AP 104 or Biol& 242 Must have been completed after 8/31/2007.

Pre-Algebra or higher Completion of Math 070 or higher Must have been completed after 8/31/2007.

Human Development H Sci 150 or Psyc& 200 Must have been completed after 8/31/2007.

Nutrition Nutr& 101 Must have been completed after 8/31/2007.

English Composition Engl& 101 or 126 or 127 or 128 No expiration date

Speech Communications CMST 238 or CMST& 210 or 220 or 230 No expiration date

*The two-quarter sequence of A&P should be taken at the same level (100 or 200) and from the same college or with the

same Common Course sequence.

HESI and Nelson Denny Reading Assessment: The Nelson Denny and HESI are available at the Assessment and Testing Center on a walk-in basis. For more information, call 253-833-9111 ext. 2652.

Nelson Denny

The Nelson Denny measures applicants’ vocabulary, reading comprehension, and reading rate. Applicants are required to achieve a grade equivalent of 10; scores must be included with the application. Individuals who do not achieve the appropriate score will be required to take an additional reading course prior to being allowed to retake the Nelson Denny. The reading portion of the COMPASS Assessment cannot satisfy this requirement.

HESI

Applicants are required to achieve a 50 or higher; scores must be included with the application. It is strongly

recommended that students study for the HESI ahead of time. One resource is the HESI Admission Assessment

Exam Review 3rd Edition, ISBN 9781455703333.

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Transfer Applicants: Students transferring from other colleges must first complete a Green River Community College admissions application online at www.greenriver.edu. If transfer credits are to be considered, official transcripts in their school sealed envelope and a “Transcript Evaluation Request” form must be submitted to Enrollment Services prior to applying to the Practical Nursing Program. Unofficial Transcripts from all colleges attended must also be submitted with the Practical Nursing application.

High School Diploma or GED®: Applicants must either have a high school diploma or GED®. Applicants must submit an official high school transcript or an official GED® transcript in the application packet. Applicants who need to order high school transcripts from other countries must allow extra time for transcripts to be translated into English and evaluated by a third party. For more information regarding translating and evaluating foreign transcripts, go to www.fis-web.com.

Required Immunizations and Tests: In order to participate in the Community Lab/clinical courses, students need to have all of the immunizations and tests complete. Documentation must be from a healthcare provider and include signature, credentials, and date (mm/dd/yyyy). For the complete details, please refer to Page 4.

Mandatory Meeting with Faculty: Applicants must attend a Mandatory Meeting given by the Nursing Faculty prior to submitting the application. The orientation must have been attended within a calendar year of application to the program. The dates of these meetings can be found at http://www.greenriver.edu/academics/areas-of-study/details/nursing.htm Be prepared to write a short essay at the meeting.

Healthcare Provider CPR: All applicants must be Healthcare Provider CPR certified by American Heart Association (AHA) in order to

apply. Please note that this is different from the standard CPR commonly offered. Although there are more

options available, here are two possible instructors: Laeticia Egesi (Ldile@hotmail.com) and Donette Parry

(donetteap@msn.com).

Background Check:

Community Lab courses include but are not limited to: residential care, long term care, drop-in medical clinics,

school district health care screening, health room experience, and medical centers. A criminal record may

prohibit a student from participation in the Community Lab/clinical courses and the nursing program. As part

of the application packet, each applicant should completely fill out the background check forms located in this

packet and include it in his/her application. Once admitted to the Practical Nursing Program, a Certified

Background check of each applicant will also be required to be in compliance with the Child/Adult Abuse

Information Act (RCW 43.43.840 and 43.43.842).

Drug Screening

All students will be required to submit a drug screen after acceptance into the program and prior to

registration completion. The student will be provided with the name and location of an authorized agency

who will conduct the screening. The student is responsible for all costs associated with the drug screening. If

the screen comes back ineligible, a medical review may be done for an additional cost (some RX drugs will

cause a positive drug screen). If a student fails to produce the requested sample by the date and time

designated, the student will be ineligible.

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Documentation must be from a healthcare provider and include signature, credentials, and date (mm/dd/yyyy).

General questions regarding immunizations may be directed to Nicole Castillo, Program Specialist, Health Sciences, at

NCastillo@greenriver.edu

Employment as a NA-C or Other Healthcare Professional (OPTIONAL): If an applicant has been employed as a Certified Nursing Assistant (NA-C or NA-R), Medical Assistant (MA),

Health Care Assistant (HCA), he/she may include proof of employment by having his/her employer fill out an

Employment Verification form found at the end of this packet. If he/she has worked as an NA-C, he/she must

also include a copy of his/her license as well. An applicant who has not been employed as a NA-C but has the

license may also include a copy of his/her license to possibly improve his/her chances.

Details Regarding Immunizations and Tests

Measles (rubeola), Mumps, & Rubella – Proof of vaccination (2 doses at appropriate intervals) or

proof of immunity by titer, showing immunity to all three.

Tuberculin Status [PPD(TB)] - If no records or more than 12 months since last Two-Step TST, a Two-

Step TST or QuantiFERON (QFT) TB Gold test must be done prior to enrollment in the program.

The 2-step process is explained as follows:

First Visit: Get the TB shot (make sure you get documentation for this – date and signature).

Second Visit: Two days after visit #1 you go back to get the TB Test Reading (results) – this should be given in millimeters (mm), which will determine whether the test is positive or negative.

Third Visit: No sooner than one week after visit #1 (1st TB shot), no later than two weeks after visit #1. You will get the whole process done over again. This visit you get your 2nd TB shot.

Fourth (Final) Visit: Two days after visit #3 you will get the 2nd TB shot reading. Again, you need documentation stating the results in millimeters (mm) and whether the result is positive or negative.

Note of Caution: Do not make the mistake of thinking that because a normal TB Test has 2 components (TB shot

and TB reading) that it will fulfill the 2-Step TB Test requirement. You must actually have 2 separate TB Tests. The

tests must be done within the proper timeframe.

There is a TB blood test called QuantiFERON (TB Gold Test). Results can be available within 24 hours. QuantiFERON

should be drawn on the same day as live-virus vaccines or 4-6 weeks after administration of live-virus vaccines.

Students with a history of positive TB results must provide proof of chest x-ray and submit an annual negative

symptom check from their healthcare provider.

Hepatitis B - Series of 3 vaccines at appropriate intervals (0, 1, 6 months) with post vaccination titer

confirming immunity 6-8 weeks after completion of the series.

Tetanus, diphtheria, pertussis (Tdap) - Tdap required once. Td required every 10 years after Tdap.

Varicella (Chickenpox) - Proof of vaccination (2 doses at appropriate intervals) or proof of immunity by

titer

Flu - Proof of vaccination not required in order to apply but is mandatory prior to participating in clinicals.

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Checklist (Mail the application in a white 9x12 envelope)

Before You Turn in the Application:

Attend a Mandatory Faculty Meeting- different from the Information Sessions put on by advising staff

Complete the required prerequisite courses with a 2.5 or higher

Submit Transcript Evaluation Request form to Enrollment Services if you submit official

transcripts

For non-Green River courses, submit all official transcripts (see below*) to Enrollment

Services

*Official transcripts are documents listing the courses you have taken at a college. They are ordered from each college you

attended. A college can send it directly to Green River or send it to you. If a college sends it to you, it needs to stay in the

original sealed envelope, and you turn it in to Enrollment Services located on the 2nd floor of the Lindbloom Center. You

need to contact each college and request the official transcript. Colleges may charge you money for official transcripts.

What must be in Your Application Packet (in this order):

Practical Nursing Program Application Form (Pg. 6)

Signed Washington State Patrol form (Pg. 7)

Signed DSHS clearance form (Pg. 9)

Copy of valid photo ID

ALL UNOFFICIAL TRANSCRIPTS (GREEN RIVER included if attended) with

pre-requisites highlighted. *

Copy of your Nelson Denny scores

Copy of your HESI scores

Official high school transcript OR official GED® certificate or transcript

Photocopy of healthcare provider (AHA) CPR card (cannot expire before August 30, 2015)

Photocopy of NA-C license (If applicable)

Verification and Recommendation Form(s) (If applicable)

Photocopy of proof from a medical provider of all tests and immunizations listed on Page 4

*Unofficial transcripts can be a copied or opened official transcript or an unofficial transcript printed from the college’s

website. Unofficial transcripts are turned in with the application packet. Official transcripts are submitted to Enrollment

Services ahead of time along with the Transcript Evaluation Request form.

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Opens June 10, 2014/Due July 7, 2014

1. Student Information:

Name: ______________________________

Green River Student Number: ______________________ (You must have a Green River Student Number in order to apply.)

IMPORTANT! All communication will be done through your Green River student email. If

Green River Community College elects to contact you through other means, it will be done using the contact information already on record.

2. Activate your Green River student email:

Go to http://grcc.greenriver.edu/student-email/

3. Check your contact information:

Go to www.greenriver.edu/online-services.htm. Select the “Student Info” tab and select “Student Address”

By signing below, I verify that:

1. My information for this application is accurate and complete as of this date.

2. I activated my GREEN RIVER student email and will be checking it regularly.

3. I checked my contact information to ensure is correct and will keep it up to date.

Signature: ______________________________Date: _________________

Fall 2014 Application Form

Practical Nursing

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WASHINGTON STATE PATROL

REQUEST FOR CRIMINAL HISTORY INFORMATION

CHILD/ADULT ABUSE INFORMATION ACT

RCW 43.43.830 THROUGH 43.43.845 All students who will be placed in practicum education sites for Green River Community College’s health occupation programs are requested to complete the below Washington State Patrol Abuse Clearance section. The purpose of this abuse clearance is to assure the safety and well-being of patients, clients and children who come into contact with students. Practicum education sites are expecting that GREEN RIVER students will not pose undue risks to the safety of patients/children. The Washington State Patrol abuse clearance request is for the following: “Child/Adult Abuse Information: Response limited to convictions against children or other persons, dependency proceedings, abuse of vulnerable adults, and DOL disciplinary board final decisions and any subsequent criminal charges associated with the conduct that is the subject of the disciplinary board final decision”. Please be aware that information on other felony and misdemeanor convictions may be reported from the state patrol office. This abuse clearance is used only for the purpose of practicum education placement determination and further dissemination or use of the record is prohibited. As stated earlier, all students are required to complete this form. Any student choosing not to complete this process must be aware that the ability of faculty to arrange practicum education experiences will be severely restricted and in some instances impossible. A large number of facilities (all of them for nursing) require proof of this clearance before students are allowed to participate in any practicum activities. I have read and understand this information about the Washington State Patrol Abuse Clearance.

Please attach a copy of your driver’s license for identification verification. ________________________________________________________________ Student’s Signature and Date

PLEASE PRINT

Student’s Name: _____________________________________________________________

Last, First, Middle

Alias/Maiden Name: ___________________________________________________

Social Security Number: _______________________ Date of Birth: ____/____/ 19____

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This Section to be completed by Applicant

The next section is to be completed by the practitioner who supervised the applicant. After completion, the form should be placed in a sealed envelope with

the practitioner’s signature across the seal. The completed form should then be submitted with the application packet.

This Section to be completed by Employer

Please rate the applicant on a scale of 1 to 5 with 5 representing excellence and 1 representing unsatisfactory performance.

_____ Applicant arrives promptly and /or notifies supervisor if unable to attend experience at prearranged time.

_____ Applicant’s appearance is neat, clean, and appropriate for clinical setting.

_____ Applicant demonstrates interest in nursing profession.

_____ Applicant asks questions appropriately.

_____ Applicant communicates effectively with staff and patients.

_____ Applicant demonstrates initiative to increase learning.

Based on my supervision of this individual I:

_____ highly recommend this applicant for a career in nursing

_____ recommend this applicant for a career in nursing

_____ recommend this applicant for a career in nursing with reservations

_____ do not recommend this applicant for a career in nursing

Comments:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Signature: __________________________________________________ Date: _______________________________________

Printed Name _______________________________________________ Discipline:___________________________________

I verify that the above applicants has completed hours of work experience in the setting in which I work.

Applicant’s Name: _____________________________________________________________________________________________

Applicant’s Address: __________________________________________________________________________________

_________________________________________________________________________________________________

Date Range of Employment: ________________________________________________________ to: __________________________

Number of Hours Completed: __________________________

Check One:

[ ] I waive the right to view this recommendation/verification form in my file at Green River Community College.

[ ] I do not wish to waive this right; I wish to retain the right to view this letter in my file at Green River Community College if I am

admitted into the Practical Nursing program.

Verification and Recommendation Form

Practical Nursing