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Health Science Applications User Manual

1. CONFIRMATION OF APPLICATION Please read the following information carefully and INITIAL each line to verify that you have read understand and agree to each term amp LE amp LE A amp B amp UE 1 1 understand that all correspondence regarding this application will be sent to my Delta College student email address 2 understand that it is MY RESPONSIBILITY to review and respond to requests for information in a timely manner and within prescribed timelines 1 further understand that failure to review and respond to information within prescribed timelines may result in my disqualification from this filing period 3 understand that the information submit in my application is used to determine my eligibility for the program 4 understand that if am invited to submit documentation e g transcript and course descriptions that must provide documentation to support the information included in my application Failure to submit all required documentation AND inconsistent information between the documentation and application will result in disqualification for the filing period 5 have reviewed the admission criteria and read the FREQUENTLY ASKED QUESTIONS an the Nursing webpage 6 understand that it is my responsibility to review my application information before I submit this application REVIEW MY APPLICATION 7 1 understand that once SUBMIT this application for processing that no changes
2. These costs responsibility for participating in the program 5pecific instructions are provided by the Health 5cience Division Office once the student has been accepted into the program If yOu try to submit your understand that the performance of my duties as 51 student at San Joaquin Delta College shall hold ALL application without initialing client information confidential understand that any violation of client confidentiality will result in dismissal from the that you agree and under 51 students must be able to demonstrate the following ESSENTIAL PHYSICAL REQUIREMENTS to successfully meet stood the statement you will the clinical objectives 1 Operate a computer terminal and other office equipment a be directed to an error 2 Lift atleast 25 pounds m 3 Sit or stand for extended periods of time page 4 Verbally communicate with patients students t m 5 Complete visual assessments of patients students m 6 Ability to see pictures read words and distinguish colors on therapy materials with or without visual aids m 7 Have hearing acuity sufficient to understand speech at normal classroom therapy room levels and to distinguish correct speech sound productions BEB BBB PRP RRR eee eee eee Initial Date Print this page for your records Sele LAAN l D A DELTA ID Thank you Your application has been submitte
3. student at anJoaquin Delta College atleast 17 years of age and have satisfied the College s assessment placement test requirements Read the San Joaquin Delta College Catalog sections pertaining to academic regulations and graduation requirements understand that this program consists of coursework and also clinical practice Clinical classes require time in the field at off campus locations and students in the SLPA program must provide their own transportation to these sites The Speech Language Pathology Assistant Program at SanJoaquin Delta College does not guarantee practicum placement opportunities Opportunities are offered as available determined by number of students and site availability To maintain compliance with regulatory agencies Clinical fieldwork sites may require background clearance prior ta admittance to the facility PEP o o Students who are unable to be placed will be withdrawn from the program due to the inability to meet the program Bl You must initial below at the requirements bottom of the statement understand that the following are required costs associated with general public health and safety and these costs order for the system to Tuberculosis test Annual Physical Examination mark your application as Current Immunizations m Professional Liability Insurance complete lt Background check B Drugtest
4. Admission to the VN and PT program is based on a lottery process The following are the minimum requirements applicants must satisfy in order to be eligible for lottery random drawing into the VN and PT programs l All prerequisite courses Human Anatomy Human Development Introduction to Psychology and Medical Terminology must be completed with a grade of C or better 2 2 5 minimum cumulatively for prerequisite courses Human Anatomy Human Development Introduction to Psychology and Medical Terminology 3 Have graduated from high school or equivalent Applicants will be notified via their Delta College email address of their status based on the random drawing lottery a few weeks after the application period Health Science Programs Page 23 Vocational Nursing amp Psychiatric Technician Application Step 1 Login T oy E wi T ro Fr A fa T Er E NURSING AND HEALTH SCIENCE APPLICATION To apply to the following programs Associate Degree in Nursing Vocational Nursing Psychiatric Technician please login here 1 Enter your Delta ID IT Valli V DETTA COT T EGE Your Delta ID is a nine digit number pec AND HEALTH SCIENCE APPLICATION starting with 98 t is assigned to you by the college when you submit your admission ERROR application If you do not know your Delta ID you can retrieve your ID information by clicking http register deltacolle
5. San Joaquin Delta College Health Sciences Division The San Joaquin Delta College s Health Science Program applications are now available as online forms This user guide contains screen shots of the online application and information related to how to fill out the online applications IMPORTANT NOTES REGARDING THE ONLINE APPLICATIONS 1 All health science program applications require that you login using your Delta College student ID number and date of birth 2 You must be a currently registered student at the College and must have a Delta College student email address on file 3 All applicants must be in good standing with the College e g no academic holds on file 4 All applicants must have a valid social security card required for background clearance 5 Before you begin the application have copies of your transcripts available so that you can correctly enter your prerequisite course information 6 The online application saves the information on your application every time you click on the NEXT button 7 f you are unable to finish your application you may click on the SAVE AND FINISH LATER button to come back to your application at a later time 8 Before you submit your application please make sure to review all the information entered for accuracy 9 Once you submit your application you will NOT be able to access it again 10 If you have any questions related to the application please send an em
6. Other Asian Cambodian LJ Other Hispanic Central American LJ Other Pacific Islander thinese LJ Other Unknown Filipino LJ Samoan Guamanian LJ South American Hawaiian LJ Vietnamese iL Japanese White Gender Health Science Programs Speech Language Pathology Assistant Application Step 4 Academic Information SAN JOAQUIN DELTA COLLEGE SPEECH LANGUAGE PATHOLOGY ASSISTANT APPLICATION The information collected on this page is for reporting purposes only Please complete the following information to complete your application If a question does not apply please leave it blank 1 Please check the course s you will be enrolling in Fall 2011 2 Highest College Degree Earned 3 College Degree Earned At 4 Degree Major 5 Term Year Degree was Earned LJ Comm Dis 003 LJ Comm Dis 005 Comm Dis 007 Comm Dis 009 AA AS LJ None of the above L BA BS LI MA MS LJ Doctorate pd po ERROR Missing information You must answer Questions 1 and 2 Questions 3 5 require a response if you checked any other option other than Mone of the above Page 39 A response is re quired for Ques tions 1 and 2 If you are missing information you s will be directed to the following error page Health Science Programs Page 40 Speech Language Pathology Assistant Application Step 5 Statement of Understanding must
7. Page last modified 8 26 11 Health Science Programs ADN Statements of Understanding Step 15 READ SIGN REVIEW SUBMIT SAN TOAOTIIN DEITA COLLEGE NURSING AND HEALTH SCIENCE APPLICATION a CONFIRMATION OF APPLICATION Please read the following information carefully and INITIAL each line to verify that you have read understand and agree to each term 1 1 understand that all correspondence regarding this application will be sent to my Delta College student email address 2 l understand that it is MY RESPONSIBILITY to review and respond to requests for information in a timely manner and within prescribed timelines 1 further understand that failure to review and respond to information within prescribed timelines may result in my disqualification from this filing period 3 1 understand that the information submit in my application is used to determine my eligibility for the program 4 1 understand that if am invited to submit documentation e g transcript and course descriptions that must provide documentation to support the information included in my application Failure to submit all required documentation AND inconsistent information between the documentation and application will result in disqualification for the filing period 5 have reviewed the admission criteria and read the FREQUENTLY ASKED QUESTIONS on the Nursing webpage 6 1 understand that it is my responsibility to review my application info
8. can be made amp verify that my application is accurate and complete to the best of my knowledge 9 further understand that the submission of inaccurate information may will result in disqualification of my application for the filing period NURSING AND HEALTH SCIENCE APPLICATION APPLICATION COMPLETE Thank you for applying Your application is now complete You will receive an email confirming receipt of your application Please remember to check your Delta College Student email address for notifications about the program FORCE Prior to submitting this application applicants will need to read and initial each of the statements indicating their agreement and their understanding to each of the a terms stated IT IS THE APPLICANT S RESPONSIBILITY TO REVIEW ALL INFORMATION PRI OR TO SUBMISSION APPLICANTS WILL HAVE AN OPPORTUNITY TO REVIEW THEIR APPLICATION BY CLICKING ON THE REVIEW MY APPLICATION WwW c 2 After the application is reviewed for accuracy click the SUBMIT button to submit the application PLEASE REMEMBER Once the application is s submitted you will be not be able to access the application again Health Science Programs Page 32 Nurse Assistant Training Program Application Information CAN DETTA Nurse Assistant Training Program Application This application will be available
9. esed in Section 26246 of the Unemployment Ineurcnce Code Low family income Bi gibility for or receipt af Financial aid ender a pro gran that may inclede bet not limited to a fee waiver IAT A CYXTTTAT DETT A COT NURSING AND HEALTH SCIENCE APPLICATION Delta ID Application for Term CRITERIA 3 LIFE CIRCUMSTANCES AND SPECIAL EXPERIENCES Maximum Points 2 5 Please check ALL life experiences special circumstances that apply for which you can provide supporting documentation for IF NONE OF THESE APPLY TO YOU PLEASE CHECK None of the above Disability Low Family Income L First generation of family to attend college Need to work at least part time Disadvantaged social or educational environment Difficult personal or family situations or circumstances O Veteran or Refugee Status None of the above Documented disability from college Learning Disability Program or Disability support Programs amp Services root of eligibility or proot af receipt Cal Grant Pell Grantor other federal grant CalWORKs front the Board of Governors He Cal Grant Program the federa Pell Grant program Col VV ORK First generation to attend college Fire generation college dedens are defined by the U 5 Department of Education as Meither parent hod more than a hi ah school edecation Meed ta work Need Ao work means stedent is working af least pant Hine while completing aca
10. points for any work experience related to the li cense you possess 2 If you answered Yes above do you have 1000 hours of experience or work experience for your licenses Oye N A If YES please list current former employer If you have previous work experience in license s you currently possess you may enter that information here receive points you must possess CURRENT license Pending licenses will not be accepted SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION Part 1 Licensed Vocational Nursing Psychiatric Technician Radiologic Technician Respiratory Therapist or Paramedic requires a copy of current license with license number issue date and expiration date Part 2 Work Letter from your current former employer verifying employment The letter must be on organization letterhead with an original signature and must include applicant s name start date and end date employee status full time part time total number of hours worked job title department if appli cable and examples of duties including direct patient care Health Science Programs Page 11 ADN Criterion 1C Step 8 Certificated HealthCare and Work Experience There are two parts to Criterion 1C A Part 1 The following are approved certificates that CRITERION 1C CERTIFIED HEALTH CARE AND WORK EXPERIENCE Maximum points 5 Points will only be awarded to o
11. to provide accurate information could disqualify you 3 This online application automatically saves your information whenever you finish a page If you are in the middle of completing a page in the application and wish to complete the application later just dick on the SAVE AND FINISH LATER button You will be able to return and finish the application at alater time 4 f you submitted an application from this system in a previous application period the information you entered will appear Please review this information to ensure that itis correct and current 3 BEFORE you SUBMIT your completed application please review your application Once the application has been submitted you will not be able to make changes to your application information Upon completion you will receive an email confirming receipt of your application It is imperative that you follow all directions on the application and ensure all the information submitted is correct Please be aware that incorrect information or information that can not be verified will result in disqualification PLEASE MAKE SURE TO READ THE INFORMATION ON THIS PAGE Click NEXT once you have read the information on the Welcome Page Page 4 Health Science Programs Page 5 ADN Application Step 2 Log into the application d TDICT TA NURSING AND HEALTH SCIENCE APPLICATION To apply to the following programs Associate Degree in Nursing
12. Attendance MAATTI DICETTA MTEL NURSING AND HEALTH SCIENCE APPLICATION Delta ID Applicatian far Term ECNRWETENWENNMNNNNNMNNEMTENNNNNM Please list ALL regionally accred COLLEGE UNIVERSITY ATTENDANCE ited United States colleges Please list all the regionally accredited United States colleges universities you have s Universities you have attended enrolled in courses where you received a letter grade Use pull down lists to record DO NOT ABBREVIATE THE PLEASE DO NOT ABBREVIATE THE OF THE INSTITUTIOM type out the entire NAME OF COLLEGE name m mplete th To add more colleges universities just press the TAB key on your keyboard past the You must also co TERM TYPE column following information for all Previously used colleges universities you First and Last Names MAMIE COLLEGE CITY STATE TERM attended College City State AND s the College s term type 2 e g semester or quarter system Back SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION Official transcripts from all colleges universities listed above Note Students with a degree from a college university outside the United States must have transcripts eval uated by a National Association of Credential Evaluation Services NACES approved independent agency the evaluation must be in a sealed envelope from the agency demonstrating equivalency to
13. In order to be eligible for admittance into the Nurse Assistant Training Program you must be Atleast 16 years of age Be aregistered student at Delta College Have a valid social security number required for background dearance Effective Spring 2010 admission into the Nursing Assistant Training Program will be based on a RANDOM DRAWING Upon completion of this application you will be assigned an APPLICATION NUMBER that will be put into a random drawing during the week of CONTINUE PENHEHEHEHNHEEHEEEHEEHEEHEHEHHEEEHEEHEEHEEHEHEHEHEEHEEHENHEEHEHEHHEHEHEEHEEHEEHEEHEEHEHEHEEHEHEEHEEHEEHEHEHEEHEEHEHEEHEHEHEHHEEHENHEHEHEHEEHEHEHEHENHEEHEEHEHEEHEHHEEHEHEEHEHEHEEHEHEHEHEEHEEHEHEEHEEHENHEEHEEHEEHEEHEEHEEHN The Nurse Assistant Training program is a 6 week course that based on a lottery admission process Applicants are eligible for the program if they meet the minimum requirements listed on above Applicants will be notified via their Delta College email address of their status based on the random drawing a few weeks after the application period Health Science Programs Page 33 Nurse Assistant Training Program Application Step 1 LOGIN TOAOTIIN DEITA COLLEGE Nurse Assistant Training Program Application To complete an application for the Nurse Assistant Training Program please log in here YAOUIN DEITA COLLEGE 1 Enter your Delta 1 Your Delta ID is a nine digit nu
14. LL required documentation at one time will result in a disqualification from considered e disqualification letter if you are dis admission into the program for Spring 2014 Mailed documentation must be postmarked no later than 9 26 2013 documentation submitted in person must be submitted no later than the deadline of 4 00 P M on 9 26 2013 After all documentation has been verified and evaluated a final ranking will be prepared qualified from considered admission be cause you did not meet the minimum quali fications based on the information you Please DO NOT CALL the Health Science Office regarding the status of your application submitted in your a pplication webpage We expect to have the final rankings available 10 30 2013 Click on the pdf link to obtain your SUPPORTING DOCUMENTATION CHECKLIST GO TO EVALUATION STATUS If you are selected for admission into any of the programs IT IS YOUR RESPONSIBILITY TO SUBMIT THE APPROPRIATE FORMS OF SUPPORTING DOCUMENTATION AND MEET ANY ADDITIONAL REQUIREMENTS STATED BY THE PROGRAM BY THE DEADLINES POSTED ON THE WEBSITE 2 If you were invited to submit documentation you can access the status of your evaluation by clicking on the EVALUATION STATUS link Health Science Applications User Guide San Joaquin Delta College Health Sciences Division http www deltacollege edu div hs adnhome html CONTACT INFORMATION Health Sciences Division 209 954 5454 Associate Degre
15. T DATE OF BIRTH After logging in YOu will E E PLEASE COMPLETE THE FOLLOWING CONTACT INFORMATION be navigated to a page T to complete your contact PERSONAL EMAIL ADDRESS information MAILING STREET ADDRESS Tee ace ee T Sennen PEE 1 B a La m If you do not fill out Ee asa aE cc sone aaa address and contact im phone number you will HOMEPHONE CELLPHONES EMERGENCY CONTACT PHONE see the following E E igi E E igi SPEECH LANGUAGE PATHOLOGY ASSISTANT APPLICATION urrently for all students interested in taking C Comm Dis 3 or 9 you will need to complete an ap plication in order for the Health Science office to send you a course code to register for the class Please complete the fields for your address and home phone number This application should only be completed once Health Science Programs Page 38 Speech Language Pathology Assistant Application Step 3 Demographic Information SAN JOAQUIN DELTA COLLEGE SPEECH LANGUAGE PATHOLOGY ASSISTANT APPLICATION The information collected on this page is for reporting program planning purposes only It will not be used to determine your eligibility into the program Please all that apply L American Indian Alaskan Native Laotian O Asian Indian Mexican Black African American LJ
16. Vocational Nursing Psychiatric Technician LUCERE please log in here NURSING AND HEALTH SCIENCE APPLICATION ERROR invalid login due to or more of the following reasons 1 Enter your Delta ID Invalid Delta ID Invalid date of birth Your Delta ID is a nine digit number Ex Please make sure you enter all the information correctly and in the correct starting with 98 It is assigned to you by format the college when you submit your admission if you are still having trouble please send an email to e jhealthscienceapps deltacollege edu application If you do not know your Delta ID you can retrieve your ID information by clicking http register deltacolleze edu student login index cfm 2 Enter your Date of Birth FEE RBBB RRP RR RRR RRR Please enter your date of birth PLEASE NOTE in the following way Ex 01 01 2010 I x L TRETEN On each page if information is Bg L 3 Click Login s missing or invalid you will be B directed to a screen like the one above B L After you login into the server you will be required to log into the application itself Log into the application using your Delta College Student ID number and date of birth Enter your birth date in the following format MM DD YYYY f you are not currently a reg
17. YR vor UNITS GRADE The minimum cumulative GPA is 2 50 for prerequisite courses a If you completed multi term Human Anatomy Physiology combination course you must report all sections SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT For ALL PREREQUISITE COURSES Official transcripts for ALL lower and upper division courses completed at any and all regionally accredited U S institutions regardless of applicability to nursing requirements are required Official transcripts will not be required for courses completed at San Joaquin Delta College Prerequisite courses completed at other regionally accredited United States colleges or universities must be equiva lent to San Joaquin Delta College courses For determination of course equivalency official transcripts AND course descriptions for prerequisite courses will be required Course descriptions for prerequisite courses only must accompany the official transcript for the purpose of determining course equivalency Course descriptions must come from the specific catalog year in which the course was taken and may be obtained from the college catalog where courses were taken or may be available at http www collegesource or Health Science Programs Page 31 VN and PT Application Statements of Understanding Step 9 READ SIGN REVIEW SUBMIT Cant Bisnis COTT ECE NURSING AND HEALTH SCIENCE APPLICATION
18. a BA BS de s gree or higher from a U S regionally accredited college The NACES evaluation will be used ONLY to award points as part of ADN admission criteria Health Science Programs Page 9 ADN Criterion 1A Step 6 Previous Academic and Work Experiences TAa Arrar Tirra AMARE EE NURSING AND HEALTH SCIENCE AFFUCATION bid m Criterion 1A a lf you have earned a degree please indicate where and when you earned the degree Criteria 1 Academic degrees relevant health care license or certificates held by an applicant health care work experience in direct patient care or health care volunteer experience in direct patient care Maximum points 15 If you have not earned a college degree check NONE and click NEXT to continue SAVE AND FINISH LATER dux i PUT at i NURSING AND HEALTH SCIENCE APPLICATION _d Application for Term 2 SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION CRITERION 1 ACADEMIC DEGREES Maximum points 5 ed ie eS a Official transcript from regionally accredited all degrees that you have earned s U S colleges or universities with degree posted If you do nat have a college degree please check OR students with deg ree from a school outside the United States must have transcripts evaluated by a N
19. ail to healthscience apps deltacollege edu APPLICATION PERIODS FOR HEALTH SCIENCE PROGRAMS Please note that the following dates are typical timeframes when the applications are available For exact dates of the application periods for each program please check the program s website PROGRAM SUMMER Admission FALL Admission SPRING Admission Nursing Assistant Jun Jul Oct Nov Associated Degree in Nursing Jan Feb Aug Sept R N Speech Language Pathology Assistant Vocational Nursing Psychiatric Technician Health Science Applications User Manual Health Science Programs INSIDE THIS GUIDE TOPIC PAGE N General Login ADN 4 to 18 Application ADN Admission Criteria ADN Advanced Placement 3 2 ADN Transfer Option VN and PT 22 to 31 Application Nurse 32 to 35 Assistant Application SLPA 36 to 40 Application Submitting 4 Application Contact 42 Information INFORMATION IN THIS GUIDE IS SUBJECT TO CHANGE AT ANY TIME ALL INFORMATION ON THE HEALTH SCIENCES WEBSITE SUPERSEDES ANY INFORMATION LISTED HERE 2 9 1 1 LAST UPDATED SEPTEMBER 13 2013 zi Page 2 HEALTH SCIENCE APPLICATIONS USER GUIDE a GENERAL LOGIN INFORMATION Once you login into the server you will see links o the online Wer available Q ni Web Tolia ng Click on the online application you wish to complete TV NURS Health Science Applic
20. althCare Work Experience For applicants with other types of licenses or certificates see ese applicants may earn points if MS 1 Application for Term they have the following experiences Other current license or CRITERION 1D HEALTHCARE WORK EXPERIENCE NOT COVERED UNDER CRITERION 1B OR 1C Maximum points Z certificate Work or volunteer hours If you currently have alicense or certificate that was not covered under Criteria 1B or Criteria 1C but have either of the following experiences you may earn points here with direct patient care LEASE NOTE Direct patient are is defined as experience If you do not please check NONE PLEASE MOTE Direct patient care is defined as experience providing and assisting human clients roviding and assisting human with hands on healthcare needs not including clerical and administrative type of work lients with hands on C None healthcare needs not including O Other current license or certificate Total Work experience in direct patient care gt 1000 hours C Total Volunteer with direct patient gt 200 hours clerical and administrative type of work If none of the experiences ee eee apply check None BACK NEXT SAVE AND FINISH LATER SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION Work Letter from current former employer s ve
21. are proficient in is not listed below check Other and enter languages you are proficient the language i In If you ARE NOT proficient in ANY of the following languages please check None of the above ENGLISH does not qualify as another language American Sign Language Arabic Chinese including its various dialects Farsi _ Russian C Other Please Specify None of the above SAVE AND FINISH LATER SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION Official transcript from a U S regionally accredited college or university verifying four 4 semesters of the same foreign language with a C or better for each semester Official transcript from U S high school verifying four 4 years of the same foreign language completed with C or better Complete ADN Criterion 4 Supporting Documentation Form Foreign Language Certification The form be found at http www deltacollege edu div hs adnhome html Health Science Programs Page 18 ADN Criterion 5 Step 14 TEAS San Joaquin Delta College a Uses the Test of Essential Aca demic Skills TEAS Delta ID Delta ID Effective Spring 2012 nly TEAS Version 5 test cores will be accepted CRITERIA 5 Test of Essential Academic Skills TEAS Score Maximum Points 30 o All students applying for the 5JDC ADM program must meet the minimum passing score on
22. are required Official transcripts will not be required for courses completed at San Joaquin Delta College Prerequisite courses completed at other regionally accredited United States colleges or universities must be equivalent to San Joaquin Delta College courses For determination of course equivalency official transcripts AND course descriptions for prerequisite courses will be required Course descriptions for prerequisite courses only must accompany the official transcript for the purpose of determining course equivalency Course descriptions must come from the specific catalog year in which the course was taken and may be obtained from the college catalog where courses were taken or may be available at www collegesource org San Joaquin Delta College does not evaluate foreign transcripts nor is credit granted for foreign coursework Health Science Programs ADN Criterion 3 Page 16 Step 12 Life experiences or special circumstances Applicants can earn up to 2 5 points for specific life circumstances and special experiences Education Code Section 78261 5 Using the checklist shown check ALL circumstances experiences that apply If you select an option other than None of the above you will only earn 2 5 points regardless of how many apply to you experiences or circum stance Maximum Points for Criterion 3 2 5 points Disabilities Sone meaning
23. ational Association of Creden Where When Month Year tial Evaluation Services NACES approved inde Onore LLL LLLI Bachelor s Degree or Higher 8 pendent agency evaluation must be a sealed LL AA AS Degree la ooo envelope from the agency demonstrating Lo m equivalency to a BA BS degree or higher from U S regionally accredited college The NACES evaluation will be used ONLY to award points as part of ADN admission criteria Health Science Programs Page 10 ADN Criterion 1B Step 7 Licensed Health Care and Work Experience There are two parts to Criterion 1B i m Cn COE NURSING AND HEALTH SCIENCE APPLICATION Delta ID Application far Term Part 1 The following are approved licenses that applicants can earn points for CRITERION 1B LICENSED HEALTH CARE AND WORK EXPERIENCE Maximum points 10 If you have a license in any of the listed Points will only be awarded for one current license areas complete license and expiration 1 Do you have any of the following current licenses below No date information for that license s If Yes please enter information for the license s you have l E ti Date id VDD Y f mw Psychiatric Technician Radiologic Technologist Respiratory Therapist Paramedic ess Part 2 If you answered YES to part 1 you may receive additional
24. ations Logout of FileMaker Server zi Page 3 HEALTH SCIENCE APPLICATIONS USER GUIDE a ASSOCIATE DEGREE IN NURSING ADMISSION REQUIREMENTS Admission to the ADN program is based on a multi criteria screening process The following are the criteria used to determine eligibility for ADN admission 1 Previous experience related to academic degrees relevant licenses or certificates held by applicant and health care experience in direct patient care Maximum Points 15 GPA in Science Non Science prerequisite coursework and science repeats Maximum Points 50 Life experiences or special circumstances Maximum Points 2 5 2 3 4 Foreign language proficiency Maximum Points 2 5 5 Test of Essential Academic Skills TEAS Test Scores Maximum Points 30 6 Completion of Math 82 Intermediate Algebra or higher Points O Applicants can earn up to 100 total points All applicants will be rank ordered with the highest ranking applicants being offered the available spaces in the program for the current application period In addition to selecting applicants for available spaces there will be an Alternate list where students who meet the minimum requirements earning enough points on the application but not enough to be offered an available space will be provided with an opportunity to be on a wait list in the event a space does become available Please note that Alternates are not guaranteed a
25. ciences Division website http www deltacollege edu div hs ApplicationProcess and Must meet all minimum ADN requirements to be considered see Section Ill Part C in ADN Student Handbook Applicants who are eligible for advanced placement will be accepted on a space available basis Page 20 Advanced Placement Option Vocational Nurses VN and Psychiatric Technicians PT may elect to apply to the ADN Program for Advanced Place ment and waive some courses based upon their prior education VNs and PTs who ap ply for advanced placement must 1 Complete all ADN prerequisite courses prior to application and 2 Comply with online application directions found on the Health Health Science Programs ADN Transfer Option C IAT F T A Eish NURSING AND HEALTH SCIENCE APPLICATION This application is available from September 10 2010 8 00 a m to September 20 2010 5 00 p m Important information regarding the ADN Transfer Option Please note that admittance into the 5an Joaquin Delta College ADN program is based on space availability Applicants are essentially on call until a space is available for the transfer student Please be advised that in order to be admitted as a transfer student you must meet the following criteria 1 Meet all of Delta College s minimum program requirements 2 Be a currently registered student at Delta College 3 Complete the D
26. d at You will be receive additional information regarding the program via your Delta College email address by the end of the term Health Science Programs Page 41 HEALTH SCIENCE APPLICATIONS ONCE APPLICATION IS SUBMITTED Upon submitting your application you will receive a confirmation email with information on how to access information concerning the status of your application APPLICATION STATUS INFORMATION Associate Degree in Nursing Spring 2014 Psychiatric Technician ee 1 The Application Status Information page DELTA ID APPLICATION PERIOD will display the status of your application NAME for the program s you applied for ADN Completed Application pdf PT Completed Application pdf On this page you will be able to down PTSupporting Documentation Checklist pdf ADN Disqualification Letter pdf load a copy of ASSOCIATE DEGREE IN NURSING Thank you for applying to the Associated Degree in Nursing ADN Program at San Joaquin Delta College Unfortunately based on your application you have been disqualified your completed application supporting documentation checklist if Click on the pdf link to obtain a copy of your DISQUALIFICATION LETTER you are invited to submit documentation PSYCHIATRIC TECHNICIAN Based on your online application to the PT Program we are inviting you to submit all required documentation in support of your application information Please be advised that failure to submit A
27. d to determine your eligibility a information on this page is a e If you need to correct anything please click in the field and make the appropriate not used to determine changes a your eligibility for the program but is used for _ aAa DELTA ID FIRST NAME LAST NAME reporting purposes only a a GENDER OF OM errr rT rr ETHNICITY MBB RRR RRR RRR RRR en Indian Alaskan Native Den IMPORTANT INFORMATION O Asian Indian O Mexican O Black African American Q Other Asian Q Cambodian Q Other Hispanic Once you click NEXT on this Q Central American Q Other Pacific Islander page the system will do a O Chinese O Other Unknown Filipino Samoan Search for your application for Guamanian O South American the application period If you O Hawaiian Q Vietnamese Japanese white have completed an application O Korean for the CURRENT application period you will not be able to navigate any further in the ADNE OND system Click exit to log out of the system NURSING AND HEALTH SCIENCE APPLICATION ERROR According to our records you have a completed application on file We are not able to log you back in at this time Health Science Programs Page 27 Vocational Nursing amp Psychiatric Technician Application Step 5 College Attendance MAATTI DICETTA MTEL NURSING AND HEALTH SCIENCE APPLICATION Delta ID Applicatian far T
28. demic work that is prerequisite for the Complete the ADH Criterion 3 Supporting Documentation form explaining situation or circumstances The form can be found at http wv ww deltacallegae edu div hs adnhome html Paycheck stub during period of time enrolled in prerequisite courses or letter from employer must be on organization letterhead verifying employment was at least par t time while completing prerequisite courses Hersam Ano oot Disadvantaged social or educational environment Difficult personal and family situation circumstances situation or circumstances The form can be found at http www deltacallege edu div hs adnhame html Refuges status Documentation or letter fram United States Citizens and Immigration Services LISCIS Vermeran stow af Defense Department Form DD 2 14 Honorable Discharge required Health Science Programs Page 17 ADN Criterion 4 Step 13 Foreign Language Proficiency Applicants can earn up to 2 5 points for being proficient in a language other than English Education Code Section 78261 5 f you select an option other Delta ID Delta JR 2 Application for Term Applicati CRITERIA 4 FOREIGN LANGUAGE PROFICIENCY Maximum Points 2 5 than None of the above yOU E will only earn 2 5 points re If you are proficient in more than one of the following languages check all that y P apply gardless of how many If the language you
29. e in Nursing hs adn deltacollege edu Vocational Nursing Psychiatric Technician hs vnpt deltacollege edu For questions about the application please send an email to healthscienceapps deltacollege edu Dean of Health Sciences Division Laurie Jensen Ph D ABD
30. elta College ADM application 4 Submit all required documentation for the Delta College application 3 Submit all Nursing course transcripts and course descriptions 6 Submit a Letter of Recommendation from your previous Nursing program dean director Must be in good standing in your previous Nursing program If you are able to meet ALL of these Transfer In requirements please check Yes and then dick Next Yes Applicants who are eligible for transfer will be accepted on a space available basis and Must meet all minimum ADN requirements to be considered see Section Part B in ADN Student Handbook Page 21 HEREEEEEEEEHEEHRHHHHHHNHNNENEN Transfer credit shall be given for related or previous nursing education completed within the last five years and found to be equivalent to current course curriculum Courses may include state accredited nursing courses leading to licensure as a Registered Nurse or Armed Services nursing courses Only students who leave a nursing program in good standing will be considered for transfer Good standing is defined as a student who has earned passing grades in all nursing courses and is eligible to continue or reenter that program Students who left their program due to academic failure and or clinical failure will not be accepted as a transfer student Health Science Programs Page 22 Vocational Nursing amp Psychiatric Technician Admission Information
31. equired for reporting to the Program s governing agencies and PLEASE NOTE The will not in any way be used to determine your eligibility z information on this page is m m E e If you need to correct anything please dick in the field and make the appropriate not used to determine changes a your eligibility into the program but is used for igi DELTA ID FIRST NAME LAST NAME reporting purposes only a a GENDER OF OM l American Indian Alaskan Native Laotian IMPORTANT INFORMATION O Asian Indian O Mexican O Black African American CQ Other Asian z Q Cambodian Q Other Hispanic s Once you click NEXT on this z Q Central American Q Other Pacific Islander page the system will do a Q Chinese O Other Unknown ME m Filipino C Samoan search for your application for Guamanian South American the application period If you O Hawaiian Vietnamese Japanese white have completed an application Korean for the CURRENT application m s period you will not be able to z navigate any further the z a E System Click Exit log out of 5 E the system NURSING AND HEALTH SCIENCE APPLICATION ERROR According to our records you have a completed application on file We are not able to log you back in at this time Health Science Programs Page 8 ADN Application Step 5 College
32. erm Please list ALL regionally accred COLLEGE UNIVERSITY ATTENDANCE ited United States colleges Please list all the regionally accredited United States colleges universities you have universities you have attended enrolled in courses where you received a letter grade Use pull down lists to record DO NOT ABBREVIATE THE PLEASE DO NOT ABBREVIATE THE OF THE INSTITUTIOM type out the entire NAME OF COLLEGE name e To add more colleges universities just press the TAB key on your keyboard past the For all colleges and universities TERM TYPE column you attended you must also Previously used complete the following infor First and Last Mames a mation MAMIE COLLEGE CITY STATE TERM E College City State AND the College s term type e g semester or quarter system Back SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION Official transcripts from all colleges universities listed above Note Students with a degree from a college university outside the United States must have transcripts eval uated by a National Association of Credential Evaluation Services NACES approved independent agency evaluation must be in a sealed envelope from the agency demonstrating equivalency to a U S degree s from a U S regionally accredited college Health Science Programs Page 28 Vocatio
33. ge edu student lozin index cfm 2 Enter your Date of Birth Please enter your date of birth o ERREERREERERERERERREREREREREERE in the following way eo09 20 PLEASE NOTE NM DD YYYY each page if information is 3 Click Login missing or invalid you will be directed to a screen like the one After you log in into the server you will be required to log into the application itself Log into the application using your Delta College Student ID number and date of birth Enter your birth date in the following format MM DD YYYY Health Science Programs Page 24 Vocational Nursing amp Psychiatric Technician Application Step 2 Choose program s applying for laf C OTTECE NUKOINC AND HEALTH SCIENCE APPLICATION What program s are you applying for Please CHECK ALL that apply NOTE Associate D in Nursi n For VN and PT applicants if Psychiatric Technician you choose to apply for the ADN program please see Pages 4 through 20 of this manual for information on how to fill out the application During the fall terms applicants have the opportunity to apply for any or all of the three 3 programs open for admissions in one application VN and PT applicants that also apply for the ADN program will be navigated to the ADN application first Upon completion applicants will then be navigated to
34. ication in the following for s mat MM DD YYYY Student ID PEA id Ex 98XXXXXXX Date of Birth Pate Of Birth al Ex MM DD YYYY If you are not cur a rently a registered student or if you en tered your Delta ID or date of birth in correctly you will El ee SAN JOAQUIN DELTA COLLEGE g et an error SPEECH LANGUAGE amp PATHOLOGY ASSISTANT APPLICATION message E a ERROR The following error s occurred BEEBE E86 Invalid Delta ID Number and or Date of Birth Format or Incorrect Combination of Delta ID and Date of Birth You do not have an active and current application on file with the College Health Science Programs Page 37 Speech Language Pathology Assistant Application Step 2 Contact Information SAN JOAQUIN DELTA COLLEGE SPEECH LANGUAGE PATHOLOGY ASSISTANT APPLICATION Q T oo 1 DEITAID 7 DELTA ADDRESS DURS gH gm m mmm mmm mmm mmm mum RETE DRE ERE Hz eee 4 FIRST LAS
35. ingly DOCUMENTATION gt dvanced Placement Option copy of your current certificate including your certificate number issue ate and expiration date Transfer Option 1 The applicant must submit all course syllabi with detailed course information describing outlines and content for all completed VN PT courses and clinical evaluations for all VN PT courses directly to the Director of Health Sciences 2 Applicant must request a letter of recommendation from the director of pro gram from which the applicant is transferring which indicates 1 the status of the applicant at time of with drawal 2 dates of enrollment 3 conditions under which student withdrew Letter must be mailed directly from director of transferring program to the SJDC Director of Health Sciences ee ee eee CPP OOOO POPP eee Health Science Programs Page 30 Vocational Nursing amp Psychiatric Technician Application Step 8 Prerequisite Course Information SAN TOAOUIN DELTA COLLEGE This section is for Prerequisite NURSING AND HEALTH SCIENCE APPLICATION Course Information Delta ID iii Enter the information for the FIRST PASSING GRADE VOCATIONAL NURSING PSYCHIATRIC TECHNICIAN received in each prerequisite PREREQUISITE COURSE INFORMATION course section PASSING z LETTER GRADES include A B sor C HUMAN ANATOMY DELTA COURSE EQUIVALENT BIOL 31 OR BIOL 33 COLLEGE UNIVERSITY NAME COURSE ID TERM
36. ion and English course information Please record your FIRST passing grade A passing grade is any letter grade A B C You are not required to list all attempts for Nutrition or English Courses in progress WILL NOT BE ACCEPTED English Composition courses Eng 1A 1B 1D or equivalent Use pull down lists to record your information when possible a s Passing grades letter Any prerequisite courses taken at San Joaquin Delta College will be shown below d A B C If the courses below were not the EARLIEST passed courses you took in the area please update B graaes r D OT V the information to reflect the EARLIEST PASSED course you enrolled in SUPPORTING DOCS NEEDED IF INVITED NUTRITION DELTA COURSE EQUIVALENT FCS 006 NOTE The system is OLLEGE UNIVERSITY NAME COURSE ID TERM UNITS GRADE sensitive to data entry ivi ivi errors If you are unable to move on check each entered field to make ENGLISH COMPOSITION DELTA COURSE EQUIVALENT ENG 001A or 001B or 001D sure there are not extra TO SUBMIT lines spaces OLLEGE UNIVERSITY NAME COURSE ID TERM UNITS GRADE If there is delete the DOCUMENTATION lines spaces so that when ed you click in the field only For ALL PREREQUISITE COURSES the entered text is r present Official transcripts for ALL lower and upper division courses complet ed at any and all regionally ac credited U S ins
37. istered student or if you entered your Delta ID or date of birth incorrectly you will get an error message Health Science Programs Page 6 ADN Application Step 3 Verify Contact Information 74 T E Wi S Baal E Ty iat T f y L MIN AND HEALTH SCIENCE APPLICATION CONTACT INFORMATION This is the contact information we have on file for you Please review the information to make sure we have the most current information If you need to change anything please dick the field and make the appropriate changes DELTA ID DELTA EMAIL ADDRESS FIRST NAME LATNAME MIDDLE NAME STREET ADDRESS STATE ZIPCOE PHONE NUMBER After logging into the database the contact information we have on file for you will appear in this page Please be sure that the contact information is correct and current If there is missing or incorrect information please update this form Health Science Programs Page 7 ADN Application Step 4 Personal Information ii OAOTIIN DETTA COTTECE a Please verify the m information we have s NURSING AND HEALTH SCIENCE APPLICATION Rs file for you and make m s changes as appropriate a PERSONAL INFORMATION m Once verified click NEXT This is the demographic information we have on file for you Please review the information gt This information is r
38. lease review the contact information we have on file for you for accuracy If the information is incorrect or missing please update the information by clicking on the field that needs to be updated Once reviewed for accuracy click START APPLICATION to begin Health Science Programs Page 35 Nurse Assistant Training Program Application Step 3 Statements of Understanding SaN TOAOTTN DETTA Nurse Assistant Training Program Application The Nurse Assistant Training Program is designed to qualify the student for state certification Preparation includes classroom instruction and supervised clinical training within the guidelines set by the State Finally please Department of Health Services read and initial E STATEMENTS OF UNDERSTANDING s each statement to m You must initial after each of the following statements to show that you have complete TUE read and agreed to each of the terms written in each statement and then pplication dick SUBMIT APPLICATION to complete the application process Click submit once am applying to the Nursing Assistant Training you have read program at SJDC for the application period and initialed each B Item am at least 16 years of age am currently a registered student at San Joaquin Delta College understand that must have a valid Social Security Number understand that the Nurse Assistant Training Pr
39. mber starting with 98 It is assigned to you ERROR the college when you submit your admission application If you do not know your Delta ID you can retrieve your ID information by clicking http register deltacollege edu student lozin index cfm 2 Enter your Date of Birth a jT C m Please enter your date of birth in the following way j E z TES TE 3 Click Login On each page if information is e LOGIN missing or invalid you will be directed to a screen like the one above After you login into the server you will be required to log into the application itself Login into the application using your Delta College Student ID number and date of birth date Enter your birth date in the following format MM DD YYYY Health Science Programs Page 34 Nurse Assistant Training Program Application Step 2 Contact Information TOAMTITN DIETT TECE Health Sciences Division Nursing Assistant Program Application 5ystem This is the contact information we have on file for you Notifications by the Health Sciences Division regarding your application status will be mailed to your DELTA EMAIL ADDRESS below FIRST LAST NAME DATE OF BIRTH DELTA ID EMAIL ADDRESS To submit an application to the Nursing Assistant Program please click on START APPLICATION Once logged in p
40. nal Nursing amp Psychiatric Technician Application Step 6 Education and Background Application for Term Application P VOCATIONAL NURSING PSYCHIATRIC TECHNICIAN PROGRAM REQUIREMENTS L This is the application for the Psychiatric Technician Program At a minimum applicants must Delta ID Delta ID Application for Term Application Pe 1 Be a high school graduate or equivalent PSYCHIATRIC TECHNICIAN 2 Have taken and passed Passed grade is A B C EDUCATION AND BAC KGROUND Human Anatomy Medical Terminology Human Development Introduction to Psychology The PT program require that applicants be at least 18 years of age and have completed 12th grade with either by graduating from high school or earned an equivalent education e g 95 1 Are you at least 18 years of age AND have completed 12th grade with HESREHEEEEREEREERHEEEHEEREREEEEEEEREEREEEHNENE official high school records or an equivalent e g GED In order to be eligible for admission into the VN and PT programs applicants must shave a high school diploma or equivalent 2 Presently we have spaces reserved for veterans with honorable discharges who meet minimum program requirements Effective Spring 2014 the PT program will have a limited number of Are you a veteran reserved spaces available for veterans Please note that if you are selected for the program you will be required to Submit supporting doc
41. ne current certificate If you have a certificate in any of applicants can earn points for 1 Do you have any of the following current certificates below Yes No the listed areas enter your If Yes please enter information for the certificate s you have certificate number and expiration Certificate Expiration Date wamom date information that certificate Part 2 If you answered YES to Part 1 you may receive additional points for any work experience related to the certificate you possess If you have previous work experience in the certificate s you currently possess you may enter that e SAVE AND FINISH LATER To receive points you must possess a CURRENT certificates Pending certificates will not be accepted SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION Part 1 Certified CNA HHA or EMT requires a copy of your current certificate including your certificate number issue date and expiration date Part 2 Work Letter from current former employer verifying employment The letter must be on organi zation letterhead with an original signature and must include applicant s name start date and end date B s employee status full time part time total number of hours worked job title department if applicable and examples of duties including direct patient care Health Science Programs Page 12 ADN Criterion 1D Step 9 Other He
42. ogram 15 now based random selection of my application number understand that all correspondence related to my application will be sent to my Delta College email and that it is MY RESPONSIBILITY to check my email and respond accordingly Nurse Assistant Training Program Application Thank you for applying to the Nurse Assistant Training Program at San Joaquin Delta College Your application is now complete and have been received Please remember to check your Delta College email address for notifications Health Science Programs Page 36 Speech Language Pathology Assistant Application Stepl1 Login a After you login into SAN JOAQUIN DELTA COLLEGE Hx SPEECH LANGUAGE PATHOLOGY ASSISTANT APPLICATION the server you will required to log into the application itself Welcome to the Speech Language and Pathology Assistant Program Application Application There are no prerequisite courses to be completed prior to applying to i the program at this time Log into the applica tion using your Delta College Student ID number and date of birth Enter your birth date Students interested in pursuing a SLPA degree need to complete a program application prior to enrolling in COMM DIS 003 Therapy Analysis and Fieldwork or higher courses in the program All applicants must be a current Delta College student in order to access the SLPA appl
43. r higher with a grade of C or better is a prerequisite a program Please note that this grade is not used to calculate your GPA or your requl rement for consl dered E NOTE The system is sensitive Courses in progress WILL NOT BE ACCEPTED to data entry errors If you 8 d mission nto th e p rog ram il are unable to move on check Use pull down lists to record your information when possible each entered field to make Please list the highest Math course you have completed with a grade of A or C P a S S in g g ra d e S a re lette r If there is delete the E Do not enter or signs in grades UNLESS it appears on your OFFICIAL TRANSCRIPTS lines spaces so that when you g ra d es A B or C Errors in entering grades will result in disqualification click in the field only the a entered text is present NUTRITION DELTA COURSE EQUIVALENT FCS 006 OLLEGE UNIVERSITY NAME COURSE ID TERM YRww UNITS GRADE The Math requireme nt is not viu iv a azea E n iM U sed to calculate application a points SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION For ALL PREREQUISITE COURSES Official transcripts for ALL lower and upper division courses com pleted at any and all regionally accredited U S institutions regardless of applicability to nursing requirements
44. rifying employment The letter must be on organization letterhead with an original signature and must include applicant s name start date and end date employee status full time part time total number of hours worked job title department if applicable and examples of duties including direct patient copy of current license or certificate Volunteer Letter from organization verifying volunteer service s The letter must be on organization m letterhead with an original signature and must include applicant s name start and end date total hours Health Science Programs Page 13 ADN Criterion 2A Step 10 Science Prerequisite Course Information Enter Science Prerequisite T T SW NM amt TT T I BrT Course Information on this NURSING AND HEALTH SCIENCE APPLICATION tage Delta iD Application for Term For combined Human Anatomy and Physiol that CRITERIA 2 SCIENCE PREREQUISITES and Physiology courses tha a Were 2 semester quarter clas Please list ALL OF YOUR ATTEMPTS to complete the ADH Science Prerequisites You must list every attempt for which you received a letter grade B C D F W MW IJ an your transcript Ses split the courses between Courses in progress WILL HOT BE ACCEPTED the Human Anatomy and Hu Use pull down lists to record your information when possible MAN Ej add more courses fust press the TAB key on ur ke
45. rmation before submit this application REVIEW MY APPLICATION 7 1 understand that once SUBMIT this application for processing that no changes can be made 8 verify that my application is accurate and complete to the best of my knowledge 9 further understand that the submission of inaccurate information may will result in dizqualification of my application for the filing period BACK SUBMIT SAVE AND FINISH LATER TA OAT TECE NURSING AND HEALTH SCIENCE APPLICATION APPLICATION COMPLETE Thank you for applying Your application is now complete In a few days you will receive an email confirming receipt of your application and a copy of your completed application Please remember to check your Delta College Student email address for a copy of your application and notifications about the program Page 19 Prior to submitting this application applicants will need to read and initial each of the statements indicating their agreement and their understanding to each of the terms stated IT IS THE APPLICANT S RESPONSIBILITY TO REVIEW ALL INFORMATION PRIOR TO SUBMISSION APPLICANTS WILL HAVE AN OPPORTUNITY TO REVIEW THEIR APPLICATION BY CLICKING ON THE REVIEW MY APPLICATION BUTTON After the application is reviewed for accuracy click the SUBMIT button to submit the application PLEASE REMEMBER Once the application is submitted you will be not be able
46. space this list is only used for the current application period The ADN application collects the criteria information in order to determine an applicant s eligibility Please see http www deltacollege edu div hs ApplicationProcess html for a detailed description of the the admission criteria See pages 4 through 18 for detailed information about the application and information on how to complete each section of the application PLEASE NOTE If you have submitted an application to the program since the Fall 2010 application period all of the information you previously submitted will be populated in the application for the current period s Please keep in mind that it is YOUR RESPONSIBILITY to review the information you previously submitted for completeness and accuracy To update your information simply click in the field Health Science Programs ADN Application Step 1 Read Welcome Page Information N DEITA NURSING AND HEALTH SCIENCE APPLICATION Welcome Before you start the application 1 You must have your Delta College student 1 0 number and your Delta College student e mail address All correspondence from the college regarding this application will be sent to your DELTA COLLEGE STUDENT E MAIL ADDRESS 2 M online cire on that 2 en mter detailed a related 15 apy icai The information you will be used to determi ne your eligibility for the program failure
47. ss a Nursing Assistant certification would you be interested in this option a five years and found to be equiva Oves Ono lent to current course curriculum err Only students who leave their Please enter your Certificated Nursing Assistant CNA information below PT program in good standing NOTE Your certificate must be current in order to be eligible for the PT Upgrade option 2 will be considered for transfer Pending certificates are not eligible for the PT Upgrade option Good standing is defined as stu Expiration Date MM DD YYYY J9 ent who has earned passing 2 PT applicants who have completed the Vocational Nursing or Psychiatric Technician program fully or partially are eligible to apply to the PT program as a TRANSFER Applicants may apply for this option only if they were in GOOD STANDING with the program Current PT VM Licenses are not required d grades in all VN PT courses and is eligible to continue or reenter that p rogram ccc eg ee ee tudents who left their program S For additional information please visit http www delcacollege edu div hs ptfag html due to academic failure and or clinical failure will not be accepted as a transfer student e Please note that these options SAVE AND FINISH LATER Will not always be available so this page may change SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT accord
48. the Test of Essential Academic Skills TEAS If vou have taken the TEAS test more than once please report the HIGHEST of the first three 3 passing When reporting your score scores do not round scores Enter Attention Spring 2012 Applicants Only TEAS Version 5 scores will be accepted exact score you received on the TEAS test TEAS Version V Students without TEAS scores or scores below 62 will be automatically disqualified from the current application periad Have you successfully passed the TEAS V test SUPPORTING DOCS TEAS Date Place Location TEAS was Taken Date Taken NEEDED IF INVITED MM DD YYYY k the TEAS te T TO SUBMIT DOCUMENTATION For the TEAS Score please list your exact adjusted Individual Total Score do not round up scores TEAS taken at San Joaquin Delta Col lege Applicants do not need sub mit any documentation your results will be on file sack SAVE AND FINISH LATER TEAS taken at any other location Do NOT send your official TEAS results x unless you are invited to submit documentation in support of your application If documentation is required you must go to www atitesting com online store and request that your official TEAS results be sent to the college Please make sure you request the scores to be sent to San Joaquin Delta College ADN there is another Delta College on the list There is a fee for this service
49. the VN and or PT application Health Science Programs Page 25 Vocational Nursing amp Psychiatric Technician Application Step 3 Verify Contact Information NUKSING AND HEALTH SCIENCE APPLICATION CONTACT INFORMATION This is the contact information we have on file for you Please review the information to make sure we have the most current information If you need to change anything please dick the field and make the appropriate changes DELTA ID DELTA EMAIL ADDRESS FIRST NAME LASTNAME MIDDLE NAME STREET ADDRESS STATE ZIPCOE PHONE NUMBER After logging into the database the contact information we have on file for you will appear on this page Please verify that the contact information is correct and current If there is missing or incorrect information please update this form Health Science Programs Page 26 Vocational Nursing amp Psychiatric Technician Application Step 4 Personal Information ii AAQTIIN DETTA COTTECE Please verify the infor a mation we have on file for you and make changes as m appropriate a a m m PERSONAL INFORMATION m Once verified click NEXT This is the demographic information we have on file for you Please review the information gt lel This information is required for reporting to the Program s governing agencies and PLEASE NOTE The will not in any way be use
50. titutions regardless of applicability to nursing requirements are required Official transcripts will not be required for courses completed at San Joaquin Delta College Prerequisite courses completed at other regionally accredited United States colleges or universities must be equivalent to San Joaquin Delta College courses For determination of course equivalency official transcripts AND course descriptions for prerequisite courses will be required B e o e o Course descriptions for prerequisite courses only must accompany the official transcript for the purpose of de termining course equivalency Course descriptions must come from the specific catalog year in which the course was taken and may be obtained from the college catalog where courses were taken or may be available at i http www collegesource org San Joaquin Delta College does not evaluate foreign transcripts nor is credit granted for foreign coursework Health Science Programs Page 15 ADN Criterion 2B Step 11b Non Science Prerequisite Course Information a e e igi 722 Can TOAQUIN DETTA COTTECE Effective 2011 12 completion a P L NURSING AND HEALTH SCIENCE APPLICATION of Math 82 Intermediate H e Detai Application for Tem Q Algebra or higher is a Bl a e e MATH PREREQUISITE COURSEWORK prerequisite course Completion of Math 82 Intermediate Algebra o
51. to access the application again Health Science Programs ADN Advanced Placement Option Delta ID Application for Term ADVANCED PLACEMENT OPTION Based on your previous response you may be eligible to also apply as an advanced placement into the ADM Program This option is available for qualified applicants who have a current license as a LVN or a Psychiatric Technician AND who have successfully passed HS 43 Nursing Synthesis This option gives a qualified applicant the opportunity to waive one semester of the ADN program should a space become available Applicants are admitted IF space becomes available in the program Space becomes available if a current student in the program withdraws or fails during the first year of the program PLEASE NOTE If you select YES you will only be considered for this option under 2 circumstances 1 You are selected in the regular pool and decline your space you get selected in the regular pool you are forgoing your opportunity to waive ane semester in the ADN program 2 You were not selected in the regular pool but meet all the minimum requirements AND there are spaces available Choosing this option does not guarantee that there will be advanced placement spaces available lf a space becomes available are you interested in Oves No being considered as an advanced placement ii HS 43 NURSING SYNTHESIS COLLEGE UNIVERSITY NAME COURSE ID TERM YR UNITS GRADE S
52. umentation to verify your education and background SAVE AND FINISH LATER SUPPORTING DOCS NEEDED IF INVITED TO SUBMIT DOCUMENTATION High School Education A copy high school transcripts with completion of 12th grade posted OR Copy of high school diploma or GED OR Students who graduated 12th grade from a school outside the United States must have transcripts evaluated by a National Association of Credential Evaluation Services NACES approved independent agency evaluation must be in a sealed envelope from the agency demonstrating equivalency to 12th grade Veteran Status Copy of Defense Department Form DD 214 only honorable discharge required Health Science Programs Page 29 Vocational Nursing amp Psychiatric Technician Application Step 7 Previous Education Experience Advanced placements shall be AAT AND HEALTH SCIENCE APPLICATION given the opportunity to waive some courses based upon their Detalo Application for Term 2 prior education E a 1 i PSYCHIATRIC TECHNICIAN Transfer credit shall be given for OPTIONS FOR PREVIOUS EXPERIENCE a relaten oF previous education from an accredited 1 All PT applicants who have a CURRENT nursing assistant certificate are eligible for institution completed within the last advanced placement into the PT program If you currently posse
53. ybaard t the fast GRADE entered m ET Physiology sections LUMAN ANATOMY DELTA COURSE EQUIVALENT BIOL 031 PRIOR TO FALL 99 001 Each section in the science prerequisites must have at least one 1 A v o information entered UMAN ANATOMY DELTA COURSE EQUIVALENT BIOL 031 PRIOR TO FALL 99 ANAT 001 OLLEGE UNIVERSIT Y NAME COURSE ID TERM YR UNITS GRADE American River College American River College SAVE AND FINISH LATER s NOTE College course ID term academic year units and grade information must be entered for all science prerequisite courses you earned a letter grade in Pull down lists are available for all fields in yellow The College University Name field is based on the information you entered in the College Attendance section Course ID should be entered the way the college publishes its courses on the class schedule For example Delta College s Human Anatomy Course ID is BIOL 31 BIOL 31 is what is entered in the Course ID field Health Science Programs Page 14 ADN Criterion 2B Step 11a Non Science Prerequisite Course Information Unlike the Science Prerequisite Cant fa Valise B Bind NURSING AND HEALTH SCIENCE APPLICATION courses enter the FIRST pemam application for Tem PASSING grade you received in Nutrition and ANY passing i e Please list your Nutrit

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