Dear Nursing Applicant:

Thank you for applying to the Nursing program at Iowa Central Community College. In order to be considered for the upcoming Nursing program you must first complete the enclosed application packet, and submit all of the required documentation together in an individual envelope as soon as possible, pending openings for the nursing program. Failure to include all of the required information will affect consideration for the program. Your completed application packet should include documentation all of the following information.

____ Assessment Scores within three years (Unless taken at Iowa Central) ____ High School Transcripts or GED Scores (Unless already submitted) ____ College Transcripts (Unless classes taken at Iowa Central) ____ Proof of enrollment/completion of 75-Hour Nurse Aide course ____ Two completed Personal Reference forms ____ Nursing Application Essay

To ensure consideration for the Nursing Program, application packets must be received. It is the students’ responsibility to make sure their application packet is complete and has been received at the center of preference prior to the deadline. If submitted after the deadline, students will be accepted pending openings for the program. Please submit your completed packet to:

Fort Dodge Iowa Central Community College Health Science Office-Nursing One Triton Circle Fort Dodge, IA 50501

Storm Lake Iowa Central Community College Nursing application 916 Russell St Storm Lake, IA 50588

Webster City Iowa Central Community College Nursing application PO Box 370 1725 Beach Street Webster City, IA 50595

The Nursing Program is a limited enrollment program, and completion of the prerequisites and/or minimum requirements does not guarantee acceptance into the program. This is a competitive program, with an emphasis placed on academic performance, knowledge and experience of the health field, and the determination to succeed.

If you have any questions concerning the application process for the Nursing Program please contact the appropriate center associate below at 1-800-362-2793.

Sincerely,

Joan O’Hearn Center Associate

Webster City Center ohearn@iowacentral.edu

Melissa OsaiHealth Science Associate Fort Dodge Center osai@iowacentral.edu 515-574-1309

Meghann HenrichCenter Associate Storm Lake Center henrich@iowacentral.edu 712-732-2991 515-832-1632

Nursing Program ApplicationPractical Nursing (PN)Associate Degree Nursing (ADN)

Please complete all information. Please type or print clearly using black ink only.

Social Security Number ________ - ________ - ________

Legal Name __________________________________________________________________________________

Address ______________________________________________________________________________________

Home Phone ( ______ ) ________________________ Alternate Phone ( ______ ) _____________________

Email ________________________________________________________________________________________

High School(s) ________________________________________________________________________________

Graduation Date (Month/Year) ___________________________________ Cumulative GPA ______________

GED Test Date (Month/Year) ____________________ GED Test Score __________ HiSet ______________

*Please include a copy of either your high school transcripts or GED scores.An official transcript will be required upon acceptance into the program.

Post-Secondary Education

____________________________________ _________ ___________________ _______________________

____________________________________ _________ ___________________ _______________________

____________________________________ _________ ___________________ _______________________

____________________________________ _________ ___________________ _______________________

*Please include an unofficial/copy of transcripts from all colleges attended with your application,Send official transcripts to the Registrar at Iowa Central Community College for review.

Iowa Central Community CollegeNursing Program Application

Last First Middle Maiden

Street City State Zip

College State Dates Attended Degree(s) Earned

College State Dates Attended Degree(s) Earned

College State Dates Attended Degree(s) Earned

College State Dates Attended Degree(s) Earned

Iowa Central Community College IA

Revised 7/7/17

Minimum Requirements for ApplicationThe following criteria are required for admission into the Nursing Program. If a student does not meet both of the requirements below they will not be considered for the program until they have completed specific college courses and/or re-taken the appropriate assessment test(s). Please contact the health science office if you have questions regarding your status or to confirm assessment scores taken at Iowa Central.

High School Diploma or EquivalentHigh School GPA 2.5GED Scores 550HiSet 15(Scores must be within past three years or college-level math and English)

Assessment ScoresACT - 18 English 20 Math 18 ReadingSAT - 430 Verbal 475 Math NACompass - 65 Writing P64 or A51 Math (Placement Domain) 80 Reading Asset - 40 Writing 46 Math 40 ReadingAccuplacer 73 Sentence Skills 90 Arithmetic 65 Reading ComprehensionAleks 30

*Applicants must submit a copy of their ACT, SAT, Asset, or Compass test, unless taken at Iowa Central Com-munity College (Asset/Compass only). Only one test is required, however applicants who have taken a test more than once, or have taken different tests, are encouraged to send in as many different tests as they would like.The highest scores will always be used for evaluation. Only test scores within three years of a class start dateare considered for placement.

If a student has completed a college-level math and/or English course with a “C” or higher, we do not require the assessment test.

TOEFL RequirementNon-native speakers of English will need to submit results of the TOEFL examination (scores need to be within the last three years to be accepted.) TOEFL scores of 17 or above in each section - reading, listening, speaking and writing.

Which program would you like to be considered for?Please rank the order of preference (1-3), with 1 being your primary choice for your program location. If a student isn’t selected at their primary location, their packet will be sent to their next location of choice to be reviewed.

____ Fort Dodge (Fall/Spring) ____ Storm Lake (Fall only) ____ Webster City (Fall only)

Iowa Central Community CollegeNursing Program Application

Revised 7/7/17

January Nursing Program (Fort Dodge Center Only)If you are not accepted into the fall nursing program, would you like to be considered for the January nursing program?

____Yes, I would like to be considered for the January nursing program.

____ No, I am not interested in further selection at this time.

Personal ReferencesStudents must have two references complete the Personal Reference Form that is included in the application packet. References must not be friends or family members. References can mail the form in to the address on the back page or give it to applicant in a sealed envelope and handed in with application.

Completion of PrerequisitesStudents must be enrolled in, or have previously completed prerequisites of the program with a “C” or higher before they will be considered for the program. Students must submit proof of their enrollment in/or comple-tion of these classes prior to the application deadline. Students must also successfully complete the written and skills portion of the nurse aide state certification exam before they can begin the nursing program.

Clinical TravelStudents accepted into the program will be responsible for all expenses incurred while traveling to and from all clinical sites or classes.

Background CheckAll students starting the nursing program must complete a Criminal Record/Child and Adult Abuse Check prior to attending clinical. Background check forms will be distributed at the orientation to those students who have been accepted into the nursing program. Background checks are only allowing you to attend clinical for the program, this does not guarantee you to be hired by a facility.

The Nursing Program at Iowa Central Community College is a limited enrollment program.All students interested in this exciting and challenging program are encouraged to apply.

Applicant’s Signature ______________________________________ Date ___________________________

Revised 7/7/17

Iowa Central Community CollegeNursing Program Application

Iowa Central Community CollegeNursing Program of Study

Please mark any of the courses below you have completed or are currently enrolled in.

Prerequisites1. Human Anatomy and Physiology I w/lab*

Date Enrolled/Completed _________________________________________________________

2. Nurse Aide Course - 75 hours (credit or non-credit)Date Enrolled/Completed _________________________________________________________

General Courses1. Human Anatomy and Physiology II w/lab*

Date Enrolled/Completed _________________________________________________________

2. Nutrition*Date Enrolled/Completed _________________________________________________________

3. Medical TerminologyDate Enrolled/Completed _________________________________________________________

4. Developmental PsychologyDate Enrolled/Completed _________________________________________________________

5. Microbiology*Date Enrolled/Completed _________________________________________________________

6. Introduction to PsychologyDate Enrolled/Completed _________________________________________________________

7. Composition 1Date Enrolled/Completed _________________________________________________________

8. Introduction to SociologyDate Enrolled/Completed _________________________________________________________

9. Health Science College Experience (optional)Date Enrolled/Completed _________________________________________________________

Please enclose an official transcript if the above courses were completed at an institution other than Iowa Central Community College. If a transcript was previously sent to Iowa Central, please include an unofficial/copy of the transcripts in this packet. No points will be awarded if no official transcripts are provided.

*If previously completed, all science courses are suggested to be within the past five years.

Revised 7/7/17

Please list all previous work experience you have had in the health field, beginning with the most recent. All areas on this form must be completed for each position held or you will not be given credit for your work experience or volunteer position.

If you have no previous work experience in the health field, we recommend 15 hours of voluntary work specifically in a health care facility.

Voluntary positions should be included when completing this form, please note which positions were on a voluntary basis.

Dates of Employment: From ____________________ To __________________________________________

Name of Facility _______________________________ Total Hours Worked ___________________________

Phone Number ________________________________ Supervisor ___________________________________

Briefly describe your job responsibilities: __________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Iowa Central Community CollegeHealth Related Work Experience Verification Form

Dates of Employment: From ____________________ To __________________________________________

Name of Facility _______________________________ Total Hours Worked ___________________________

Phone Number ________________________________ Supervisor ___________________________________

Briefly describe your job responsibilities: __________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Dates of Employment: From ____________________ To __________________________________________

Name of Facility _______________________________ Total Hours Worked ___________________________

Phone Number ________________________________ Supervisor ___________________________________

Briefly describe your job responsibilities: __________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Revised 7/7/17

(month/year) (month/year)

(month/year) (month/year)

(month/year) (month/year)

Submitted essay questions must be typed in an essay format and the total essay should be a maximum of 500 words. Failure to complete all aspects will affect consideration for acceptance into the program.

1. Explain your perception of the role of a nurse.

2. Describe the different areas of specialization and advancement available to nurses.

3. Describe your short and long term professional goals.

4. Describe your strengths and weaknesses.

5. Describe your personal characteristics and life experiences you believe will contribute to your success as a

student and a nurse.

Iowa Central Community CollegeNursing Program Application Essay Questions

Revised 7/7/17

One Triton Circle, Fort Dodge, Iowa 50501515-576-7201 - 800-362-2793

www.iowacentral.edu

Practical Nursing Program of Study - Fort Dodge, Storm Lake, Webster CityPre-requisite Sem. Hours

HSC-172 Nurse Aide or equivalent Nurse Aide course....................3

BIO-168 Human Anatomy & Physiology I w/lab .............................4

First Semester Sem. HoursPNN-127 Fundamentals of Nursing in Health Care .........................5PNN-206 Medication Administration for Nurses ..............................1HSC-112 Medical Terminology ............................................................1PNN-121 Clinical Practicum 1 .........................................................1.5PSY-121 Developmental Psychology .................................................3BIO-151 Nutrition .................................................................................3BIO-173 Human Anatomy & Physiology II w/lab ............................4

Total Hours ......................................................................18.5

Second Semester Sem. HoursPNN-621 Life Span Health Care ...................................................... 8.5PNN-622 Clinical Practicum 2 .............................................................4

Total Hours ......................................................................12.5

Summer/Spring (Fort Dodge only) 6 wksSummer (Fort Dodge or Storm Lake) 6 wks Sem. Hours

PNN-811 Selected Clinical Nursing ....................................................1PNN-731 Clinical Practicum ............................................................ 2.5PNN-311 PN Issues & Trends ..............................................................1

Total Hours ........................................................................ 4.5

15 lecture hours = 1 semester hour30 lab hours = 1 semester hour45 clinical hours = 1 semester hour

Students may extend the Practical Nursing program over two years by taking the Arts and Science courses during the first year and the nursing courses during the second year.

Associate Degree Nursing Program of Study - Fort Dodge, Webster CityPre-requisite Sem. Hours

HSC-172 Nurse Aide or equivalent Nurse Aide course....................3

BIO-168 Human Anatomy & Physiology I w/lab .............................4

First Semester Sem. HoursPNN-127 Fundamentals of Nursing in Health Care .........................5PNN-206 Medication Administration for Nurses ..............................1HSC-112 Medical Terminology ............................................................1PNN-121 Clinical Practicum 1 .........................................................1.5PSY-121 Developmental Psychology .................................................3BIO-151 Nutrition .................................................................................3BIO-173 Human Anatomy & Physiology II w/lab ............................4

Total Hours ......................................................................18.5

Second Semester Sem. HoursPNN-621 Life Span Health Care ...................................................... 8.5PNN-622 Clinical Practicum 2 .............................................................4

Total Hours ......................................................................12.5

Summer Session Sem. HoursPSY-111 Introduction to Psychology ..................................................3BIO-186 Microbiology ..........................................................................4

Total Hours ............................................................................7

Third Semester** Sem. Hours.ADN-405 Maternal Child Health Care (7.5 weeks) ...........................6ADN-407 Clinical Practicum 3 (7.5 weeks)........................................2ADN-465 Psychiatric/Mental Health Care (7.5 weeks)....................5ADN-466 Clinical Practicum 4 (7.5 weeks)........................................2

Total Hours ......................................................................... 15

Fourth Semester** Sem. Hours.ADN-511 Adult Health Care ............................................................. 8.5ADN-512 Clinical Practicum 5 .............................................................4SOC-110 Introduction to Sociology.....................................................3ENG-105 Composition I ........................................................................3

Total Hours ......................................................................18.5

Summer Session (6 wks) Sem. HoursADN-805 Management in Health Care ..............................................1ADN-806 Clinical Practicum 6 ......................................................... 2.5

Total Hours ........................................................................ 3.5

**At the Fort Dodge Center, the third and fourth semesters are interchangeable

15 lecture hours = 1 semester hour, 30 lab hours = 1 semester hour, 45 clinical hours = 1 semester hourStudents may extend the program over 3 years by taking the Arts and Science courses during the first year and the nursing courses during the second and third years.

Associate Degree Nursing Program of Study - Storm LakePre-requisite Sem. Hours

HSC-172 Nurse Aide or equivalent Nurse Aide course....................3

BIO-168 Human Anatomy & Physiology I w/lab .............................4

First Semester Sem. HoursPNN-127 Fundamentals of Nursing in Health Care .........................5PNN-206 Medication Administration for Nurses ..............................1HSC-112 Medical Terminology ............................................................1PNN-121 Clinical Practicum 1 .........................................................1.5PSY-121 Developmental Psychology .................................................3BIO-151 Nutrition .................................................................................3BIO-173 Human Anatomy & Physiology II w/lab ............................4

Total Hours ......................................................................18.5

Second Semester Sem. HoursPNN-621 Life Span Health Care ...................................................... 8.5PNN-622 Clinical Practicum 2 .............................................................4PSY-111 Introduction to Psychology ..................................................3

Total Hours ......................................................................15.5

Summer Session Sem. HoursADN-465 Psychiatric/Mental Health Care .........................................5ADN-466 Clinical Practicum 4 .............................................................2

Total Hours ............................................................................7

Third Semester Sem. Hours.ADN-405 Maternal Child Health Care ................................................6ADN-407 Clinical Practicum 3 .............................................................2ENG-105 Composition 1 .......................................................................3BIO-186 Microbiology w/lab ...............................................................4

Total Hours ......................................................................... 15

Fourth Semester Sem. Hours.ADN-511 Adult Health Care ............................................................. 8.5ADN-512 Clinical Practicum 5 .............................................................4SOC-110 Introduction to Sociology.....................................................3

Total Hours ......................................................................15.5

Summer Session (6 wks) Sem. HoursADN-805 Management in Health Care ..............................................1ADN-806 Clinical Practicum 6 ......................................................... 2.5

Total Hours ........................................................................ 3.5

Iowa Central Community CollegeNursing Programs of Study

It is the policy of Iowa Central Community College not to discriminate on the basis of race, color, national origin, sex, disability, age (employment), sexual ori-entation, gender identity, creed, religion, and actual or potential parental, family or marital status in its programs, activities, or employment practices as required by the Iowa Code §§ 216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681 – 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), Age Discrimination Act of 1975 (34 CFR Part 110), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact Kim Whitmore, Director of Human Resources, phone number 515-574-1138, whitmore@iowacentral.edu; or the Director of the Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number 312-730-1560, fax 312-730-1576

Personal Reference Form Pursuant to Public Law 93-380, all letters of recommendation written after January 1, 1975 are not considered confidential unless the applicant waives right of access. The signature below constitutes a waiver of the applicant’s right of access to this recommendation should he/she be accepted into the Nursing program. Applicants Signature Date If not signed, this recommendation can be available to the applicant upon their request. It is the policy of Iowa Central Community College not to discriminate on the basis of race, color, national origin, sex, disability, age (employment), sexual orientation, gender identity, creed, religion, and actual or potential parental, family or marital status in its programs, activities, or employment practices as required by the Iowa Code §§ 216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681 – 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), Age Discrimination Act of 1975 (34 CFR Part 110), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact Kim Whitmore, Director of Human Resources, phone number 515-574-1138, whitmore@iowacentral.edu; or the Director of the Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number 312-730-1560, fax 312-730-1576.

_____________________________________________________________________________________

The applicant named below has requested admission to the Nursing program at Iowa Central Community College. Your response to this inquiry will assist the Admissions Committee in assessing the applicant. The program’s faculty believes these are important items to be considered along with other data in predicting the potential professional success of persons in health care clinical settings. Your candid appraisal of the applicant’s characteristics is vital to our evaluation and subsequent decisions. Your assistance is appreciated.

Applicant’s Name (please print): __________________________________________________________

How long have you known the applicant? ___________________________________________________

In what capacity do you know the applicant (supervisor, instructor, etc.)? _____________________

Please complete the following table by marking in the appropriate box.

Exceptional top 2%

Above Average top 1/3

Average 50%

Below Average

Poor Below 1/3

Unable to Judge

Responsibility: Ability and willingness to accept responsibility; complete tasks; honor commitments.

Attitude: Displays positive actions and behaviors.

Problem-Solving: Takes initiative and has the ability to identify, confront, and solve problem situations.

Honesty: Extent to which the candidate displays an ethical code of integrity.

Motivation: Degree to which candidate applies self without prompting

Appearance: Extent to which professional standards of neatness or cleanliness are met.

Stress/Anxiety Response: Ability to handle or cope with stressful/anxious situations.

Interpersonal Relationships: Ability to interact & communicate in a positive manner with co-workers, peers, etc.

Respect Demonstrates respect for self and others.

Constructive Criticism: Ability to accept and handle positive and constructive criticism.

Verbal/Writing Skills: Ability to clearly express oneself.

Attendance Reliability:

Organizational Skills: Uses time wisely and prepares for upcoming events

Please feel free to make comments explaining selections made in the previous table, as well as present additional information you believe would be relevant to this applicant’s pursuit of admission. _____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Please check one of the following categories that best describes your overall rating of the candidate: _____ Recommend with enthusiasm _____ Recommend with confidence _____ Recommend with reservations _____ Do not recommend ________________________________________ _______________________________________ Name of Evaluator (Please Print) Signature of Evaluator (date) ________________________________________ _______________________________________ Title/Position Agency or Business of Evaluator ________________________________________ _______________________________________ Address Phone number can be reached at. Thank you for your cooperation in evaluating this applicant. When completed with the evaluation, return it to the applicant in a sealed and signed envelope or send it to the student’s primary choice at the address below. Fort Dodge Storm Lake Webster City

Iowa Central Community College Attn: Nursing applicant reference One Triton Circle Fort Dodge, IA 50501

Iowa Central Community College Attn: Nursing applicant reference 916 Russell St Storm Lake, IA 50588

Iowa Central Community College Attn: Nursing applicant reference 1725 Beach St Webster City, IA 50595

Form adopted from the University of Iowa

Personal Reference Form Pursuant to Public Law 93-380, all letters of recommendation written after January 1, 1975 are not considered confidential unless the applicant waives right of access. The signature below constitutes a waiver of the applicant’s right of access to this recommendation should he/she be accepted into the Nursing program. Applicants Signature Date If not signed, this recommendation can be available to the applicant upon their request. It is the policy of Iowa Central Community College not to discriminate on the basis of race, color, national origin, sex, disability, age (employment), sexual orientation, gender identity, creed, religion, and actual or potential parental, family or marital status in its programs, activities, or employment practices as required by the Iowa Code §§ 216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681 – 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), Age Discrimination Act of 1975 (34 CFR Part 110), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact Kim Whitmore, Director of Human Resources, phone number 515-574-1138, whitmore@iowacentral.edu; or the Director of the Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number 312-730-1560, fax 312-730-1576.

_____________________________________________________________________________________

The applicant named below has requested admission to the Nursing program at Iowa Central Community College. Your response to this inquiry will assist the Admissions Committee in assessing the applicant. The program’s faculty believes these are important items to be considered along with other data in predicting the potential professional success of persons in health care clinical settings. Your candid appraisal of the applicant’s characteristics is vital to our evaluation and subsequent decisions. Your assistance is appreciated.

Applicant’s Name (please print): __________________________________________________________

How long have you known the applicant? ___________________________________________________

In what capacity do you know the applicant (supervisor, instructor, etc.)? _____________________

Please complete the following table by marking in the appropriate box.

Exceptional top 2%

Above Average top 1/3

Average 50%

Below Average

Poor Below 1/3

Unable to Judge

Responsibility: Ability and willingness to accept responsibility; complete tasks; honor commitments.

Attitude: Displays positive actions and behaviors.

Problem-Solving: Takes initiative and has the ability to identify, confront, and solve problem situations.

Honesty: Extent to which the candidate displays an ethical code of integrity.

Motivation: Degree to which candidate applies self without prompting

Appearance: Extent to which professional standards of neatness or cleanliness are met.

Stress/Anxiety Response: Ability to handle or cope with stressful/anxious situations.

Interpersonal Relationships: Ability to interact & communicate in a positive manner with co-workers, peers, etc.

Respect Demonstrates respect for self and others.

Constructive Criticism: Ability to accept and handle positive and constructive criticism.

Verbal/Writing Skills: Ability to clearly express oneself.

Attendance Reliability:

Organizational Skills: Uses time wisely and prepares for upcoming events

Please feel free to make comments explaining selections made in the previous table, as well as present additional information you believe would be relevant to this applicant’s pursuit of admission. _____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Please check one of the following categories that best describes your overall rating of the candidate: _____ Recommend with enthusiasm _____ Recommend with confidence _____ Recommend with reservations _____ Do not recommend ________________________________________ _______________________________________ Name of Evaluator (Please Print) Signature of Evaluator (date) ________________________________________ _______________________________________ Title/Position Agency or Business of Evaluator ________________________________________ _______________________________________ Address Phone number can be reached at. Thank you for your cooperation in evaluating this applicant. When completed with the evaluation, return it to the applicant in a sealed and signed envelope or send it to the student’s primary choice at the address below. Fort Dodge Storm Lake Webster City

Iowa Central Community College Attn: Nursing applicant reference One Triton Circle Fort Dodge, IA 50501

Iowa Central Community College Attn: Nursing applicant reference 916 Russell St Storm Lake, IA 50588

Iowa Central Community College Attn: Nursing applicant reference 1725 Beach St Webster City, IA 50595

Form adopted from the University of Iowa

Iowa Core Performance Standards for

Health Care Career Programs

Iowa Community colleges have developed the following Core Performance Standards for all applicants to Health Care Career Programs. These standards are based upon required abilities that are compatible with effective performance in health care careers. Applicants unable to meet the Core Performance Standards are responsible for discussing the possibility of reasonable accommodations with the designated institutional office. Before final admission into a health career program, applicants are responsible for providing medical and other documentation related to any disability and the appropriate accommodations needed to meet the Core Performance Standards. These materials must be submitted in accordance with the institution’s ADA Policy.

CAPABILITY STANDARD SOME EXAMPLES OF NECESSARY ACTIVITIES

(NOT ALL INCLUSIVE) Cognitive-Perception The ability to gather and

interpret data and events, to think clearly and rationally, and to respond appropriately in routine and stressful situations.

• Identify changes in patient/client health status

• Handle multiple priorities in stressful situations

Critical Thinking Utilize critical thinking to analyze the problem and devise effective plans to address the problem.

• Identify cause-effect relationships in clinical situations

• Develop plans of care as required

Interpersonal Have interpersonal and collaborative abilities to interact appropriately with members of the healthcare team as well as individuals, families and groups. Demonstrate the ability to avoid barriers to positive interaction in relation to cultural and/or diversity differences.

• Establish rapport with patients/clients and members of the healthcare team

• Demonstrate a high level of patience and respect

• Respond to a variety of behaviors (anger, fear, hostility) in a calm manner

• Nonjudgmental behavior

Communication Utilize communication strategies in English to communicate health information accurately and with legal and regulatory guidelines, upholding the strictest standards of confidentiality.

• Read, understand, write and speak English competently

• Communicate thoughts, ideas and action plans with clarity, using written, verbal and/or visual methods

• Explain treatment procedures • Initiate health teaching • Document patient/client responses • Validate responses/messages with

others

CAPABILITY STANDARD SOME EXAMPLES OF NECESSARY ACTIVITIES

(NOT ALL INCLUSIVE) Technology Literacy Demonstrate the ability to

perform a variety of technological skills that are essential for providing safe patient care.

• Retrieve and document patient information using a variety of methods

• Employ communication technologies to coordinate confidential patient care

Mobility Ambulatory capability to sufficiently maintain a center of gravity when met with an opposing force as in lifting, supporting, and/or transferring a patient/client.

• The ability to propel wheelchairs, stretchers, etc. alone or with assistance as available

Motor Skills Gross and fine motor abilities to provide safe and effective care and documentation

• Position patients/clients • Reach, manipulate, and operate

equipment, instruments and supplies • Electronic documentation/ keyboarding • Lift, carry, push and pull (50 lbs.

minimum) • Perform CPR

Hearing Auditory ability to monitor and assess, or document health needs

• Hears monitor alarms, emergency signals, ausculatory sounds, cries for help

Visual Visual ability sufficient for observations and assessment necessary in patient/client care, accurate color discrimination

• Observes patient/client responses • Discriminates color changes • Accurately reads measurement on

patient client related equipment

Tactile Tactile ability sufficient for physical assessment, inclusive of size, shape, temperature and texture

• Performs palpation • Performs functions of physical

examination and/or those related to therapeutic intervention

Activity Tolerance The ability to tolerate lengthy periods of physical activity

• Move quickly and/or continuously • Tolerate long periods of standing

and/or sitting as required Environmental Ability to tolerate

environmental stressors • Adapt to rotating shifts • Work with chemicals and detergents • Tolerate exposure to fumes and odors • Work in areas that are close and

crowded • Work in areas of potential physical

violence • Work with patients with communicable

diseases or conditions 9/2013

Admissions Iowa Central Community College is a comprehensive college with an open admissions policy. Students who have not graduated from high school, or who are attending high school, may also enroll in programs for which they qualify. The academic skills of all students will be assessed. The specific program for which an applicant may be accepted will depend upon such factors as the quality of his/her high school work and test scores.

To complete admission procedures, the following requirements are necessary:

1. Complete an Iowa Central application form.2. Provide a high school transcript or equivalent, plus official transcripts from any colleges

previously attended.3. Submit ACT, COMPASS, ASSET, or ALEKS math test scores (scores need to be within the

last 3 years to be accepted).4. Non-native speakers of English must prove an adequate level of English language proficiency

for admission into the nursing program. Non-native speakers of English will need to submitresults of the TOEFL examination (scores need to be within the last two years to beaccepted). Please refer to the English Language Proficiency Policy.

5. Submit a nursing application packet.5. A personal interview with the program coordinator may be requested.6. Nursing application packets are reviewed and ranked by an Admissions Committee including

Nursing faculty, Health Sciences Associate, and/or Dean of Health Sciences.It is highly recommended the following courses be taken prior to entrance into the program: high school biology, chemistry, and algebra.

All nursing students are required to have a current American Heart or Advanced Red Cross Basic Cardiac Life Support Certificate (Healthcare Provider) and a current Child and Adult Mandatory Reporter Certificate prior to the start of classes. Students must submit proof of BCLS certification and proof of class completion of the written and skills portions of the Nurse Aide or equivalent course prior to the start of class.

Admission Criteria Admission of students to either nursing program is based on the following program criteria:

1. High school GPA of 2.5 or higher and/or eight hours of college courses of 2.0 or above.2. High school transcripts - courses should include science classes (biology, chemistry, physics,

advanced biology), math (algebra I & II, geometry), and English classes.3. ACT scores of 18 and above in all areas of reading and writing, and 20 in math.4. ACT score of 18 or above in English, Reading, and 20 or above in Math; COMPASS scores

(Writing 65, Reading 80, Pre-Algebra 64 or Algebra 51), or ASSET scores (Writing 40,Reading 40, Numeric 46) or ALEK math.

5. GED scores of 550 and above (if no high school diploma).6. For students required to submit TOEFL scores, TOEFL scores of 17 or above in each section-

Reading, Listening, Speaking, and Writing. Please refer to English Language ProficiencyPolicy.

If a student does not meet criteria, it may be suggested that they take the EXTENDED program to help assure success in the program.

Advanced Standing The ladder concept initiated in the nursing program at Iowa Central Community College enables Licensed Practical Nurses to enter the Associate Degree Nursing Program at an advanced level. Licensed Practical Nurses are required to have completed Anatomy and Physiology (6-8 semester hours), Nutrition (3 semester hours), Microbiology (4 semester hours), Intro to Psychology (3 semester hours) and Developmental Psychology (3 semester hours) prior to beginning the second year nursing courses. Licensed Practical Nurses must meet the necessary pre-requisites for the second year nursing courses.

To be considered for acceptance into the sophomore nursing classes, the student must be a LPN with an active license (no probation) and will need to complete an Iowa Central Community College application and an Advanced Standing Application packet (effective January 2009). Both documents are located on the Iowa Central web page. The Iowa Central application needs to be sent to the admissions office. The Advanced Standing Application packet needs to be submitted to the Nursing Program at the center for which the student wants to attend. The Advanced Standing Packet must include a current copy of the applicant’s LPN license.

For students who have completed the PN management courses (PNN 311, 731 and 811) successfully and have remained an Iowa Central nursing student for consecutive semesters, they do not need to complete an Advanced Standing Application packet. Prior to starting any ADN courses, the student must submit a copy of their LPN license.

English Language Proficiency Requirement

A non-native speaker of English must prove an adequate level of English language proficiency for admission into the nursing program. Non-native speakers of English language will be required to submit TOEFL test results. The student must obtain a minimum of 17 or above in each of the sections (Reading, Listening, Speaking, Writing) to enter the nursing program. Please refer to the chart on English Language Proficiency below. TOEFL scores must be within two year time period to be accepted. The student will be allowed only two times to test to meet the requirements. In order to track the number of times a student takes the TOEFL exam, the student will be required to take the TOEFL exam only at Iowa Central Community College.

Please note that completion of an English Composition or English course in a US college does not satisfy the English proficiency requirement for Iowa Central’s nursing program.

If a student is unsuccessful in obtaining the required scores in any of the sections on the first test, the student will be required to complete a remediation through the ESL division. After the remediation, the student will be allowed to retest. If the student does not meet the scores on the second test, the student will not be allowed to enter the nursing program.

English Language Proficiency Nursing admission for Iowa Central Community College Nursing Program related to non-native English-speaking students taking the TOEFL for iBT:

Non-native English-speaking students must submit TOEFL iBT result with a minimum skill scores of:

• Reading component no less than 17 Level in the intermediate.

• Listening component no less than 17 Level in the intermediate.

• Speaking component no less than 17 High end level of limited

• Writing component no less than 17 low end of Fair level

Please note: There will be an opportunity to retake the TOEFL one more time prior to application to the nursing major in order to achieve the minimum TOEFL scores.

TOEFL iBT® Score Scales

Skill Score Range Level

Reading 0-30 score scale High (22-30) Intermediate (15-21) Low (0-14)

Listening 0-30 score scale High (22-30) Intermediate (15-21) Low (0-14)

Speaking 0-30 score scale

Good (26-30) Fair (18-25) Limited (10-17) Weak (0-9)

Writing 0-30 score scale Good (24-30) Fair (17-23) Limited (1-16)

There are many sites on the web and practice tests to prepare a student to take the TOEFL exam. Student may also contact the ESL department for assistance.

The TOEFL exam cost $190.00 each time a student tests. The student will only be allowed to test two times for entrance into the nursing program.

The TOEFL exam is given at 9:00 am on select Fridays at the Iowa Central Testing Center. Before you can schedule to take your exam, you will need to register and make a payment at the following site:

https://toefl-registration.ets.org/TOEFLWeb/extISERLogonPrompt.do

There is a required remediation if unable to meet the required scores. A student will not be able to retest for at least 12 days and will be required to demonstrate some form of remediation.