Admission to Nurse Aide Level II for SPRING 2018 Is by Application (On the Reverse Side)

Admission to Nurse Aide Level II for SPRING 2018 is by application (on the reverse side). There are ten (10) spaces available. Prospective students must be currently listed on the Nurse Aide Registry. Registration fee is $223.00 which includes registration, $180; technology, $5; security, $15, accident insurance, $2, and $16 malpractice insurance, and $5 CPR. The required textbook is approximately $100 for new book and approximately $78 for used textbook.

This 170 hour course prepares graduates to perform more complex nursing skills for patients or residents, regardless of setting. Course includes class, laboratory and clinical learning experiences. Students must attend 95% of all class sessions; absent no more than five hours of lecture/skills and five hours of clinical; must maintain an 80% average on all tests; and final exam score must be 80% or better. Upon successful completion of the course and skill/competency evaluation, the graduate will be eligible for listing with the North Carolina Board of Nursing on the Nurse Aide II Registry. The cost of this is $24.00.

The Division of Continuing Education of Wilson Community College recognizes and is fully supportive of clinical agencies that require a drug screen, and background check. Costs of these tests are the responsibility of the student. The College has partnered with castlebranch.com for these tests. No other provider will be accepted. Students have ten (10) days after class begins to complete this task and sign up with castlebranch.com. The cost of signing up with Castle Branch is $ 35.00 at present. Students are directed to access the web address as follows: http://portal.castlebranch.com/WD68. The Nurse Aide II package is: WK71im: Medical Document Manager.

APPLICATION REQUIREMENTS

Completed and signed application with each of the following required copies attached. It is the student’s responsibility to obtain these copies. Wilson Community College will not make copies of required paperwork. Keep the original records and BRING COPIES ONLY.

Ø  High School Diploma, High School Equivalency, or Transcript

Ø  North Carolina picture ID (example: driver’s license)

Ø  Proof of the following immunizations:

·  One TB skin test (within nine months of class start date)

·  Two MMR (Mumps, Measles, Rubella)

·  Three Hepatitis B (at least the first shot prior to the start of class is required)

·  Varicella injections or Titer (blood test to prove immunity to chicken pox)

·  Tdap (within the past ten (10) years)

·  Flu shot required

REQUIRED prior to clinical rotations:

UNIFORMS: Navy blue scrub-type top, white pants, white lab coat, and white, closed-toe shoes. Skirts and/or dresses must be approved by Program Coordinator prior to clinical rotation. Uniforms and name badges are available at Wilson Community College’s Bookstore.

NURSE AIDE LEVEL II APPLICATION for SPRING “2018”

SECTION #: 30301

January 8th – May 9th (Register by Jan. 5th)

Mondays & Wednesdays of each week

5:00 p.m. until 9:00 p.m.

Building G, Room 109a

The Program Coordinator will review and approve applications for students starting on October 5th. Students wishing to have applications approved are welcome to call 252-246-1325 for any questions regarding the approval process. Classes fill up quickly so pre-registration is encouraged. Once your application has been approved, be prepared to register and pay $223 beginning on November 6th. Registration will continue until the class is full or until January 5th.

Mail-in applications will not be accepted.

NAME: Last: ______First: ______Middle Initial: ______

ADDRESS: ______City/State: ______Zip: ______

PHONE: Home: ______BIRTHDATE: ______Month ______Day ______Year

Cell: ______SEX: _____Male _____Female

RACE: ____White ____Black ____American Indian ____Hispanic ____Asian ____Other

EMPLOYMENT: ___Unemployed ___Part-Time ___Full-time EMPLOYER: ______

CAREER PLANS: ______

DO YOU HAVE PREVIOUS EXPERIENCE IN THE HEALTHCARE FIELD? ___Yes ___No

IF YES, PLEASE LIST: ______

AGREEMENT

I have attached all required copies to my application; I have read, understand, and agree to all stated requirements of the Nurse Aide Level II program; I understand the required clinical dress code, and agree to comply upon acceptance; I understand this is an application only and it does not constitute acceptance into the program. I understand that I will be dismissed from the program if documented as verbally or physically abusive to college administration, clinical site staff, patients, or visitors.

SIGNATURE: ______DATE: ______

THIS MUST BE SIGNED AND WITNESSED AT TIME OF REGISTRATION:

If any facility prohibits the student from participating in the clinical experience, the student will be dismissed due to an inability to progress and complete the program.

______

Student’s signature Signature of Witness Date