Approved by MANE Steering Committee - PDF document

1 Approved by MANE Steering Committee –
Approved by MANE Steering Committee – September 2012 Approved by Inver Hills Community College Academic Council – November 2012 Page | 1 Information & Application Package Spring 20 20 Start Date: Spring 20 20 Inver Hills Commu nity College is a member of Minnesota State Colleges and Universities and an affirmative action, equal opportunity employer and educator. This information is available in an alternate format by calling 651 - 450 - 3508 or TTY/Minnesota Relay at 1 - 800 - 627 - 3529. Approved by MANE Steering Committee – September 2012 Approved by Inver Hills Community College Academic Council – November 2012 Page | 2 Table of Contents MANE Mission and Vision ................................ ................................ ................................ ............................. 3 Minnesota Alliance for Nursing Education (MANE) Program ................................ ................................ ....... 3 MANE Program Plan ................................ ................................ ................................ ................................ ...... 3 Criteria for Application to th e Inver Hills Community College MANE Nursing Program .............................. 4 Selection Criteria for Acceptance/Admission to MANE Nursing Program ................................ .................... 5 After Acceptance/Admission to MANE Nursing Program ................................ ................................ ............. 5 Timelines for application and notification of admission status ................................ ................................ .... 6 Process for dual admission ................................ ................................ ................................ ........................... 6 A PPENDIX A – I n ver H ills N u r s i n g MANE C u rr ic u l u m P l a n ................................ ................................ ............ 8 NUR S I N G A PP L IC A TI ON C OVER P A GE & CH E CKL I ST – S T A R T D A T E : SPRING 20 20 ................................ ....... 9 APPENDIX B – Minnesota Alliance for Nursing Education ( M A N E) Program Application ............................... 10 APPENDIX C – Required Immunization Documentation -------------------------------------------------------------- 13 Approved by MANE Steering Committee – September 2012 Approved by Inver Hills Community College Academic Council – November 2012 Page | 3 MANE Mission and Vision The mission of the Minnesota Alliance for Nursing Education (MANE) is to increase baccalaureate prepared nurses through collaborative, and transformative educational strategies. Through increased access to B accalaureate nursing education MANE will prepare professional nurses to

2 promote health and meet the evolving
promote health and meet the evolving and complex healthcare needs of an increasingly diverse population in Minnesota. The purpose of the Minnesota Alliance for Nursing Education (MANE) is to improve access to baccalaureate education in Minnesota, closely aligning nursing edu cation with emerging health care needs and health care system changes. Students admitted to a MANE collaborating college or university will be enrolled in a four year (eight - semester) baccalaureate program, which will incorporate curriculum designed to fac ilitate deep, contextually grounded learning which prepares them for the rapidly changing health care environment upon graduation. Minnesota Alliance for Nursing Education (MANE) Program The MANE curriculum is transformative, moving away from independent silos of education to collaboration between universities, community colleges and practice. MANE is a collaboration between community college and university nursing programs to provide increased student access to a baccalaureate program and attainment of a Bachelor of Science in Nursing (BSN) degree. Students admitted to a community college MANE program will be dually admitted to Metropolitan State University. The program was built following a thorough analysis of national standards including AACN, CCNE, NLN , ACEN, PEW, OCNE, and QSEN from which ten program competencies have been developed. This 120 credit, eight semester program has collaboratively developed prerequisites, admission processes, grading scales, and a Program Plan across all collaborating colle ges and universities. MANE Program Plan The MANE Program Plan content is taught within a concept - based curriculum which spirals concepts throughout the program. Nursing courses are sequential in nature due to the spiraled teaching/learning methodology. The MANE Program Plan is a baccalaureate curriculum based on The Essentials of Baccalaureate 9ducation (AACb, 2008) with trogram Student Learning hutcomes (tSLh’s) benchmarked at the fifth and eight semesters of the program. A student enrolled at a MANE commu nity college will receive an Associate of Science Degree in Nursing at the successful completion of the fifth semester. The student is expected to continue to the completion of the Bachelor of Science in Nursing degree. An applicant admitted to the MANE co llaborating college will be considered dually admitted to a collaborating university. Approved by MANE Steering Committee – September 2012 Approved by Inver Hills Community College Academic Council – November 2012 Page | 4 Criteria for Application to the Inver Hills Community College MANE Nursing Program 1. General admission to Inver Hills Community College. a. Applicants to Inver Hills Communi ty College must be in good academic and financial standing at all previously attended Minnesota State institutions or college admission may be denied. 2. Comp

3 leted MANE Nursing Application for Inver
leted MANE Nursing Application for Inver Hills Community College. 3. Submission of official transcript s from all institutions attended. a. See notes referenced on application checklist for directions 4. A minimum grade point average (GPA) of 2.75 based on the first semester of the MANE curriculum plan. (see Appendix A) a. Official transcripts will be used to calcu late GPA. b. The most recent course grade will be used for the GPA calculation, whether it is higher or lower than previous grade. c. Each course of the MANE curriculum plan must have been achieved with a letter grade of C or better. d. Full acceptance to the MANE collaborating college and university is dependent on successful completion of the second semester of the MANE curriculum plan, maintaining a minimum grade point average (GPA) of 2.75. 5. All applicants are required to complete the most current Assessment Tec hnologies Institute (ATI), standardized Test of Essential Academic Skills (TEAS) prior to application deadlines. a. Applicants are allowed to test as often as they choose. The highest score will be used for application submission per A TI. The fee for each exa m is $80 .00 (subject to change). b. The minimum accepted score for application is at the proficient level (58.7%). TEAS Testing Process: The TEAS exam will be administered via ATI, INC. at specified member MANE colleges/university. Registration and payment o f fees will be on - line via ATI. The student may opt to take the TEAS test at any of the listed member sites, and should register as a MANE nursing application candidate. The test will take approximately 3 - 4 hours and should not be scheduled unless adequate time is available by the tester.  Applicants will send a transcript report of TEAS results to the college/university(s) to which the applicant applied.  Applicants who opt to take the TEAS test at a non - MANE member site are required to purchase a transcript from ATI and have it sent to Enrollment Center at Inver Hills Community College. The fee paid by the student to ATI, INC. for a transcript is $ 27 .00 The student may access study materials at: http://www.atitesting.com/solutions/prenursingschool/teas/study - guide.aspx Approved by MANE Steering Committee – September 2012 Approved by Inver Hills Community College Academic Council – November 2012 Page | 5 6. Advanced standing applicants, Licensed Practical Nurses (Paramedics will be added when the c urriculum has been evaluated for appropriate advanced standing credit), must demonstrate: a. Licensed P ractical Nurses (LPN) must maintain unencumbered licensure from any state in the United States. b. When advanced standing credit is determined, paramedics mu st be certified as a Nationally Registered Emergency Medical Technician - Paramedic (NREMT - P), and/or state certified as an EMT - P (certifica

4 tion may be in any state in the United S
tion may be in any state in the United States, but must be to a level equivalent to a nationally registered EMT - P). S election Criteria for Acceptance/Admission to MANE Nursing Program Ranking of applicants will be based on the following criteria: 1. TEAS composite score divided by a factor of 10. (Ex: Composite score of 72% = 7.2) 2. First semester GPA of MANE Program Plan. (E x: 2.75) 3. The combined total TEAS and GPA score will be utilized to rank applicants for order of acceptance. (Ex: 7.20 + 2.75 = 9.95 ranking score) 4. In the event of a tied combined total TEAS and GPA score, the applicant with the highest TEAS science sub - sco re will advance in rank order for acceptance. If a further tie exists, the applicant with the highest TEAS math sub - score will advance in rank order for acceptance. 5. All applicants, regardless of LPN (or Paramedic/EMT when applicable) status, will be placed into a common applicant pool based on numeric sco re as identified in criteria 1 - 3. 6. Full acceptance to the MANE collaborating college and university is dependent on successful completion of the second semester of the MANE curriculum plan, maintaining a min imum grade point average (GPA) of 2.75, including obtaining a grade of C or greater in all required courses. After Acceptance/Admission to MANE Nursing Program Evidence of having completed the following criteria will be required prior to the start of MANE nursing courses and must remain current throughout the program. Requirements include, but may not be limited to: 1. Documentation of current CPR Healthcare Provider. 2. Completion of current Minnesota Department of Human Services Net Study 2.0 Background Study.  The Net Study 2.0 process includes supplying a picture ID and being fingerprinted.  If an applicant has been arrested, charged or convicted of any criminal offense, he or she should investigate the impact that the charge or conviction may have on his or her chances of employment or licensure as a registered nurse and the student’s chances to obtain federal, state and other hi gher education financial aid ( by Minnesota Statute 135A. 157).  If the applicant refuses, or is disqualified as a result of the backg round study, the applicant will be unable to successfully complete the requirements of the MANE program. Note: Involuntary termination from a healthcare institution may prohibit an applicant from completing this program. Approved by MANE Steering Committee – September 2012 Approved by Inver Hills Community College Academic Council – November 2012 Page | 6 3. Completed health and immunization r ecord, including proof of current immunizations and tuberculosis testing, and/or other requirements as defined by the clinical agency. Please see the complete list of requirements in Appendix C . Timelines for application and notification of admission s

5 tatu s Applications, transcripts and
tatu s Applications, transcripts and TEAS exam results may be submitted separately but all must be received by close of business on the deadline date. 1. Universal application deadlines for all MANE schools: a. Fall semester start: Application deadline is February 1 . b. Spring semester start: Application deadline is June 1. 2. Notification to applicants by the college or university applicant applied to: a. Fall semester start: i. March 15 applicant notification of accept, deny or waitlist status. ii. April 1 notification deadline by applicant to respond to the college or university to accept or deny admission to the program. b. Spring semester start: i. July 15 applicant notification of accept, deny or waitlist status. ii. August 1 notification deadline by applicant to respond to the college o r university to accept or deny admission to the program. 3. Applications of students not accepted to MANE will remain on file through the next admission cycle. If a student chooses to reapply for the next admission cycle, the student must: a. Complete a new appl ication form. b. Update any materials needed to maintain currency of admission requirements. c. For any successive applications, complete and submit all required information and documents as if applying to MANE for the first time. Process for dual admission 1. Students who receive confirmation of acceptance to the program will be required to return the following materials prior to the deadline specified in the acceptance letter: a. Applicant Agreement Form acknowledging acceptance of seat in the MANE Program. b. Dual Admission Form to complete the BSN Degree  Dual Admission Form stimulates dual admission with Metropolitan State and gives permission for student data to be shared. 2. Metropolitan State University will send the student written acknowledgement of participatio n in the MANE Program and Admit Packet for a future term of enrollment at Metropolitan State University based on the following criteria: a. Acceptance to a MANE nursing program. b. Submission of all admission materials. Approved by MANE Steering Committee – September 2012 Approved by Inver Hills Community College Academic Council – November 2012 Page | 7 c. Submission of a n electronic “5ual Admissio n Corm” to complete the .Sb degree at Metropolitan State University. 3. A Metropolitan State University nursing representative will connect with MANE students on the community college campuses in the 4 th and 5 th semesters of the program to advise the student on the dual admission process and continuation to the Bachelor of Science in Nursing degree. Metropolitan State (new student orientation) will take place in the 5 th semester of the program. Metropolitan State will begin teaching in the 6 th semester of the program. 4. Continuing at Metr

6 opolitan State University after completi
opolitan State University after completion of five semesters of the MANE Program Plan : Students must meet the academic performance criteria of both institutions, and the MANE program, in order to continue to the baccalaureate degree. Students that do not will be denied continuing to completion of the baccalaureate degree at Metropolitan State University. In addition, students will be reviewed for any other performance criteria that may prohibit continuing at Metropolitan State University (i.e. code of conduct issues, probation status). Page | 8 A PPENDIX A – I n ver H ills N u r s i n g MANE C u rr ic u l u m P l a n Year Semester 1 Credits Total Semester 2 Credits Total 1 • ENG 1108 - Writing and Research Skills 4 15 • BIOL 2201 - Anatomy & Physiology I 4 15 • BIOL 1120 - Exploring Biology 4 • BIOL 2205 - Microbiology 4 or BIOL 1154 - Biology: From Cell to Organism • PSYC 1210 - Lifespan Development 4 • PSYC 1101 or 1201 – Introduction to Psych (with or without lab) 4 • MNTC General Elective from Goal 6 3 • COMM 1100 - Interpersonal Communication 3 or COMM 2230 - Small Group Communication Must have Semester 2 coursework in progress or complete at or COMM 2240 - Intercultural Communication time of application and must maintain a cumulative G.P.A. of Must have Semester 1 coursework complete with a 2.75 G.P.A. 2.75 in semester 1 and 2 coursework with no letter grade less in order to apply. (G.P.A. calculated using courses from Semester 1 only) than a C in order to be fully admitted to the program. 2 • Traditional Only: NURS 2700: Health Promotion & The Role of the Professional Nurse (9 credits) 9 15 • NURS 2820 Pharmacology and the Role of the Professional Nurse 3 15 or **Mobility Only: NURS 2720: Transition to the Role of the • NURS 2850 Applied Pathophysiology for Nursing I 2 Professional Nurse (4 credits plus 5 advanced standing credits). • NURS 2800 - Chronic & Palliative Care 7 • NURSE 2750: Nutrition and the Role of the Professional Nurse 2 * ANTH 1130 - Introduction to Biological Anthropology 3 • *BIOL 2202 - Anatomy & Physiology II 4 or *ANTH 1110 - Cultural Anthropology or *SOC 1127 - Social Inequalities or *ANTH 2130 - Medical Anthropology 3 • *NURSE 2900 - Acute & Complex Care 7 15 METRO STATE: CONTINUED COURSEWORK FOR 15 • *NURSE 2920 - Applied Pathophysiology for Nursing II 2 BACHELOR'S DEGREE • *NURS 2950 - Nursing Leadership I

7 3 • NURS: Family Health Nursing
3 • NURS: Family Health Nursing 4 • *PHIL 1112 - Ethics or 3 • NURS: Epidemiology for Nursing 3 • *BIOL 1114 - Critical Issues in Human Biology • M ATH 1103 - Introduction to Stati stics (Inver Hills) or 4 . STAT 201 (Metro State) BENCHMARK - eligible for NCLEX - RN/licensure and Associate of • General Education - Writing in your Major (Must be at the 4 Science in Nursing degree the Upper Division level. 4 • NURS: Population Based Care 7 16 • NURS: Integrative Seminar & Practicum 7 14 • NURS: Nursing Leadership II 4 • NURS: Global Health perspectives for Nursing 3 • NURS: Nursing Info r matics 2 • Upper Division General Education - elective 4 • Upper Division General Education - elective 3 Eligible for Bachelor of Science in Nursing • All nursing courses must be taken concurrently in the semester listed and must be successfully completed in order to progress to the next semester. • *General education courses can be taken earlier but not later than the identified semester. • **Traditional students take NURS 2700, Mobility students take NURS 2720 (Mobility track available to students who hold an une ncumbered LP license) • Credits in AD Degree: 35 Nursing; 40 prerequisites= 75 total • Credits after licensure eligibility to BSN: 30 Nursing; 15 general education credits (10 general education credits must be upper division; 5 credits may be taken at lower division level and transferred). • Total Program Credits: 65 nursing; 55 pre - requisites/general education = 120 © Minnesota Alliance for Nursing Education and Inver Hills Community College Page | 9 NUR S I N G A PP L IC A TI ON C OVER P A GE & CH E CKL I ST – S T A R T D A T E : SPRING 20 20 S U B M I T W I T H A P P L I C A T I ON (pages 9, 10, 11, 12 ) All m a t eri a l s mu s t b e s u b m i t t ed w i t h y o ur appl i c a t ion u n l e s s n o t ed o t her w i s e S u b m it o r m ail a pp li c a t i o n m a t e rials t o I n v er H ills E n r o ll m e n t C e n ter, 2 nd f l oo r o f t h e C o lle g e C e n t er B u il d i n g , 2 5 0 0 Ea s t 80th S tr e et, I n v er G r ov e H e i gh t s, M N 5 5 0 7 6 ☐ A cc e p ted to I n v er H ill s C om m un i t y Co l l e ge , I H CC St udent I D ☐ Nu rs i n g A pp li c at i o n : p l e a s e i n cl u de t he f o ll o w i ng 3 pa ges w h en s ub m it t i ng th i s ap p l i c a t i on ☐ T EA S te s t r e s u l ts ☐ Co p y i n c l u d ed w i th Nu rsi n g a p p li

8 c at i o n (if tested at a MANE site)
c at i o n (if tested at a MANE site) ☐ Official TEAS transcript requested from ATI on __________________ (if tested at a Non - MANE m e m ber s i te ) ☐ Minimum score of 58.7% ☐ P r o o f o f c u rr e n t , une n c u m be r ed L P N li c en s u r e f r om a n y s t a t e i n the U n i t e d S t a t es ☐ Not app li c ab l e ☐ O f f i c i al c o ll e g e t r an s c r i p t s f r o m a l l non - Minnesota State sc h o o l s L i s t a l l Minnesota State sc hoo l s w h ic h y o u h a v e a t te n ded ( off i ci al t r an s c r i pts f r om Minnesota State sc hoo l s do n o t h a v e be i n c l uded i n t h i s app li c a t i on) L i s t a l l non - Minnesota State sc ho o l s i n w h i c h y o u h a v e at te nded and i n c l uded a t r a n scr i p t ( If y ou s ubm i t t ed a n of f i c i al t r an s cr i pt (s ) f r o m a n on - Minnesota State sc hoo l (s ) at t h e t i me o f app li c at i on to In v e r H ill s , y ou d o n o t ha v e t o r e s ubm i t th e m un l e s s add i t i on a l c ou rs e w o r k h a s been ta k en after th e y we r e s ubm i tt e d . ) ☐ p r e v i ou sl y s ub m i t t ed ☐ i n c l uded w i t h Nu rs i n g a p p l i c a t i on ☐ p r e v i ou sl y s ub m i t t ed ☐ i n c l uded w i t h Nu rs i n g a p p l i c a t i on ☐ p r e v i ou sl y s ub m i t t ed ☐ i n c l uded w i t h Nu rs i n g a p p l i c a t i on ☐ p r e v i ou sl y s ub m i t t ed ☐ i n c l uded w i t h Nu rs i n g a p p l i c a t i on ☐ p r e v i ou sl y s ub m i t t ed ☐ i n c l uded w i t h Nu rs i n g a p p l i c a t i on ☐ A pp r o v e d Cou rs e S ub s t i t u t i o n / Wa i ve r Re q ue s t or S tu d ent A pp e al F o r m * (If Applicable) * Cou rs e S ub s t i tu t i o n / W a iv er Reque s t and S t ud e nt A p p eal f o r m s m u s t be r e c e i v e d b y t he E n r o ll m ent Ce n ter 2 1 d a y s p ri or to the a p p li c a t i on d e ad l i n e. F a il u r e to d o s o w i l l r e s u l t i n a n i n c o m p l ete a p p l i c at i on. ☐ Int e r n a t i o n al T r an s c r i pt - ap p r o v ed b y W o r l d E d u c at i on S e r v i c es or E du c at i o n C r ede n t i al E v a l u a to r s ☐ Not app li c ab l e I ha v e r e a d and und e rs t a nd the i n f o r m at i on p r o v i ded i n t he M A NE Nu rs i ng A pp li c a t i on P a c k a g e Na m e ( p r i nte d ) Si g natu r e Date Updated Mar

9 ch 2019 Page | 10
ch 2019 Page | 10 APPENDIX B – Minnesota Alliance for Nursing Education ( M A N E) Program Application Sta r t D a t e: Spring 20 20 T he M i n ne s o t a A l li an c e f or Nu rs i ng E du c a t i o n ( M A N E ) i s c omp r i s e d o f m em b er c o m m un i ty c o l l e g es and M e t r op o li t a n S tate Un i v e r s i ty w ho c o ll a bo r a t i v e l y of f er a B a c h e l or of S c i e n c e i n N u r s i n g ( B S N) d eg r e e, w i th d u a l a d m i t tan c e t o I n v er H i ll s Co m m u n i ty C o ll eg e a n d M et r op o li t an S ta te U n i v e r s i ty for deg r ee c o m p l e t i on. T h i s oppo r t u n i ty p r o v i d es nu r s i ng s t u dents f l e x i b ili ty i n t he i r edu c a t i ona l an d c a r eer p l an n i n g. Co m p l et i o n of th i s s i n g l e ap p li c a t i on p r o vi d es the i n f o r m at i on ne c e s s a r y t o be c on s i de r ed f or f u l l a d m i ss i on to a M A N E c o ll a bo r a t i n g c o ll e ge and / or u n i v e r s i t y nu rs i n g p r o g r a m . A s e pa r a t e a pp li c a t i on f o r m m u s t be c o m p l eted f or e a c h M A N E Nu rs i ng p r o g r am to w h i c h y ou a pp l y . A pp l ic a t i o n d ea d l i nes a r e F eb r ua r y 1 and J u ne 1 of e a c h y e ar f or p r og r a m s a d m i tt i n g fa l l a nd s p r i ng s e m e s ter c oho r ts a nd F eb r ua r y 1 f or p r og r a m s ad m i tt i ng f a l l s e m e s ter c oho r t s on l y . A l l r e qu i r e m ents f or ap p li c a t i o n m u s t be c o m p l eted or s u b m i tted b y t he ap p li c a t i o n dea d li ne. L a st n a m e : F i r st na me: MI: _______ P r e vi o u s n a m e s u s e d : S o c i a l S ec ur i t y # _____________________ I n ver Hil l s C ommun i t y C o lle g e S t u d e nt ID # (r e qu i r e d) : ( M u st be an ad m i tted I H CC s tud e nt t o ap p l y ) S t r eet a dd r e ss : C i t y : S t ate: ________ Z i p: ___________ P r e f e rr e d e m a il : _ Ho m e P hone # ( ) Ce l l P h o ne # ( ) W o r k P hone# ( ) M A NE A p p l i c a ti o n P r e r e qui s it e C o ur se C h e ck li s t In o r d e r to p r o c e ss a pp lica t i o n , t h e c o u rs e s list e d b e l o w M U S T b e c o m p l e t e prior to application w i t h a m i n i m u m combined GPA of 2 . 7 5 with n o l e tt e r g ra d e less t h an a ‘C’. P lea s e i nd i c ate t h e n a m e

10 o f t h e c o u rs e , w h e r e
o f t h e c o u rs e , w h e r e it was take n , t h e y ear a n d s e m este r , a n d g ra d e earned . C ou rs e N a me College /Name of Course Y ea r & Se m e s t er Gr ade 1) E N G 1 1 0 8 W ri t i n g an d R e s ea rc h S k i l l s o r E q u iv a l ent 2) C OM M 1 1 0 0 I n t e r pe rs ona l C o mm uni c a t i o n o r C OM M 2 2 3 0 S m a l l G r ou p C o mm u n ic a t i o n o r C OM M 2 2 4 0 I n t e rc u l t u r a l C o m m un ic a t io n o r E qu iv a l ent 3) P S Y C 1 1 0 1 o r 1 2 0 1 Introduction to Psychology (with lab) o r E qu iv a l ent 4) BI O L 1 1 2 0 E x p l o ri n g B i o l o g y o r B I O L 1 1 5 4 G ene r a l Bi o l o g y o r E qui v a l ent Updated March 2019 Page | 11 Students MUST have the following courses in - progress during summer and/or fall semester or have already completed the courses in order to apply to the program for the June 1 st deadline. C ou rs e N a me College /Name of Course Grade Earned In Progress or Semester Course Will be Taken 1) BIOL 2201 Anatomy & Physiology I or Equivalent 2) BIOL 2205 Microbiology or Equivalent 3) PSYC 1210 Lifespan Development or Equivalent 4) Minnesota Transfer Curriculum General Elective from Goal 6 or Equivalent If you are a current IHCC student, please refer to your degree audit report (DARS) to help you fill in the tables. If you are a transfer student and have questions about course transfer, please use www.transferology.com . If you need further assistance, please contact Counseling & Advising at 651 - 450 - 3508. For your application to be processed, the following is required (if applicable): 1. All applicants are required to have taken the most current Assessment Technologies Institute (ATI), standardized Test of Essential Academic Skills (TEAS) prior to application deadlines. 2. A p p li c an t s , w h o a r e li c e n s e d as a P r a c t i c a l Nu r s e ( L P N ) , m u s t s up p l y p r oof of c u rr ent, un en c u m be r ed l i c e n s u r e f r o m a n y s ta te i n t he U n i t e d S t a t e s . ( ) Che c k he r e i f y o u a r e a L P N and h a v e i n c l u ded a c o p y of y o ur u n en c u m be r ed li c en s e . E du ca t i on : Ap p li c ants m u s t s up pl y o ff i c i al t r an scr i pts f or a l l po s t - s e c o nda r y i n s t i t u t i ons at w h i c h th e y p r e v i o u sl y e n r o ll e d ( e v en i f no c r ed i t or c l o c k hou r s we r e e a r n e d ) , a n d o f f i c i al t r a n s c r i pts f or a l l po s t - s e c onda r y c r e d i ts ( i n c l u d i n g m ili ta r y a nd a d v an c ed p l a c e m ent ) . A n

11 o f f i c i al t r a n scr i p t
o f f i c i al t r a n scr i p t d o es not n e ed to b e s u b m i tted f or Minnesota State sc ho o l s . If y o u s u b m i tt e d an o ff i c i al t r an scr i pt (s ) f r o m n on - Minnesota State sc h o o l (s ) at t h e t i m e of ap p li c a t i on t o In v er H i l ls , y o u do not h a v e t o r e s ub m i t t hem un l e s s ad d i t i o n a l c o u r s e wo r k has been ta k en a f ter t h e y we r e s u b m i tted. Re m i n d e r : T r a n scr i pts m u s t i n c l u de g r a des f or a l l c ou rs es c o m p l et e d at t i m e of dead l i ne a nd c u rr ent r e g i s t r a t i o n . Inte r n a t i on a l c o ll eg e c r ed i t s m u s t be e v a l ua te d b y W o r l d E du c a t i on S e rv i c es ( ww w . w e s .o r g ) or E CE E d u c a t i on al C r ed en t i a l Ev a l u a t o r s ( ww w .e c e. o r g ) . A c o p y of the u n o ff i c i al t r an scr i pts m u s t be s ent i n c on j un c t i o n w i t h e v a l u a t i o n . C r e d i ts ea r n ed m u s t be f r o m a Reg i on a l l y A ccr ed i t e d i n s t i t u t i on ( s) . List names of colleges and/or universities you previously attended. 1. ________________________________________ 4. ______________________________________ 2. ________________________________________ 5. ______________________________________ 3. ________________________________________ 6. ______________________________________ Have you filed an Academic Petition form? Yes_____ No _____ If yes, you must attach the signed and approved copy to this application. Updated March 2019 Page | 12 If y o u a r e an In t e r na t i o n a l S tu d ent d i d y o u ap p l y f or a W o r l d E du c a t i on S e r vi c es o r E C E E du c a t i o n a l C r e de n t i a l E v a l ua t o r s t r an scr i pt e v a l u a t i o n ? Y e s No F or m o r e i n f o r m at i on go to www.wes.org or www.e c e . o r g M i sr ep r e s e nta t i on of a pp li c at i o n i n f o r m at i on i s g r ou n d s f or c an c e li n g ap p li c a t i o n. I c e r t i f y the i n f o r m at i on I ha v e p r o v i d ed o n th i s a p p li c a t i o n f o r m and a l l ot her a d m i ss i on app li c at i o n m ate r i a l s a r e c o m p l ete, a cc u r a t e and t r u e to the be s t of my k no w l e dg e . I n i t i a l ________________ SE N D C O M P L E T E D A P P L I C A T I O N S T O : A T T N: I n v er Hil l s C ommun i t y C o lle g e Enrollment Center 2500 E a s t 8 0 t h S t r e et In v er G r o v e H e i g h t s , MN 5 5076 S I G N A T U R E R E

12 Q U I R E D: _________________________
Q U I R E D: ____________________________________ D a t e : ___________________ Y ou a r e e n c ou r a ged t o m a k e a c o p y of th i s ap p li c a t i o n. M A N E Ap p li c a t i o n q u e s t i on s c an be d i r e c te d to t he D i r e c tor of Nu r s i n g : Diane Elifrits at delifrits @ i n v e r h i ll s . edu A dm i ss i o n i s g r an t e d w i t hou t r ega rd t o r ace , c r e e d , colo r , s e x , age , na t i o na l o r i g i n o r ha n dicap . T hi s ins t i t u t io n abi d e s b y t h e p r o v is i on s o f T i t l e I X , f ede r a l l e g i sla t io n f o r b idd i n g d i sc r imi n a t io n o n t h e b a s i s o f s e x an d b y al l o t he r f e de r a l la w s r ega r d in g equ a l o p po r t uni t y . N o t e : F ede r a l a n d s t a te le g i s l a t io n r eq u i r e s t h a t t h e c o n t e n t s o f s t u d en t f i l e s b e o p e n t o r e v ie w b y t h e s t ud e n t. A pp l ic a t i o n f o r ms , hi g h sc h oo l tr a n sc r ip t s , t es t d a t e , l e tt e r s , an d r ecommen d a t ion s th a t a re se n t a s pa rt o f an y ap p l i ca t io n f o r a d m i ss i o n w il l b e o p e n to t h e s t u d en t 's r e v i e w upo n r e q u e s t. N o t e : T h i s ap p lica t i o n i s a v a i l a bl e i n a l t e r n a t i v e f o r ma t s f o r p eopl e w i th d i sab i li t ie s b y c a ll i n g 651 . 779 . 33 5 4 ( v oice ) o r th r o ug h t h e M innes o ta R ela y S e r v ic e a t 1 . 80 0 . 62 7 . 3 5 29 . N o t e : If a n app l ic a n t h a s be e n a rr es t ed , cha r ge d o r con v ic t e d o f a n y c r imi n a l o ff e n se , h e o r sh e sh o ul d in v e s t i g a te t h e i m pac t t ha t t h e cha r g e o r con v i c t i o n ma y ha v e o n hi s o r he r ch a nc e s o f e mp l o y men t o r l i ce n su re a s a r eg i s t e r e d nu r s e an d t h e s t uden t ’ s cha n ce s to ob t ai n f ede r a l , s t a te an d o t he r hi ghe r educa t i o n f i na n ci a l a i d ( b y M i n nes o ta St a t u te 135 A. 157 ) . If t h e ap p lican t r e f use s , o r i s d i squ a li f ie d a s a r e sul t o f t h e b a ckg r oun d s t ud y , t h e ap p l i can t w il l b e u n abl e to s u cc e ss f ul ly comp l e te t h e r equi r eme nts t h e M ANE p r og r am . N o t e : I n v o l un t a ry t e r m i na t io n fr o m a he a l t hca re i n s t i t u t io n m a y p r ohi b i t y o u f r o m c o mp l e t i n g t h i s p r o g r a m . N o t e : A p p l i ca t io n r equi r em e n t s a re su b j e c t t

13 o c h ang e .
o c h ang e . Updated March 2019 Page | 13 APPENDIX C: Required Immunization Documentation IF Accepted to the Nursing Program 1. Measles, Mumps and Rubella (MMR) One of the following is required:  2 vaccinations OR  Positive antibody titer for all 3 components (lab reports required) . If any titer is negative or equivocal, you will need to receive one booster shot. 2. Varicella One of the following is required:  2 vaccinations OR  Positive antibody titer (lab report required) OR  Medically documented history of disease signed by medical provider. If titer is negative or equivocal, you will need to receive one booster shot. 3. Hepatitis B One of the following is required:  3 vaccinations (may be in progress) OR  Positive antibody titer (lab report required) OR  A si gn e d H e p atitis B ( H B V ) V a cci n e Wai v e r F o rm If titer is negative or equivocal, you will need to receive two booster shots. 4. Tuberculosis (TB) Documentation of ONE of the following within the past 12 months:  2 - step TB skin test (TST). Students who have not had a TST in the past 12 months will need a full 2 - step TST.  Two 1 - Step TB skin tests administered in the past 12 months  Students who have had a negative TST within the last 12 months need one additional TST (this will constitute the 2 - step TST).  QuantiFERON Gold blood test (QFT)  T - Spot blood test  Single TST with record of previous baseline TB screening (2 - step TST or QFT) and record of annual screening ev ery year since the baseline screening.  If your Tuberculosis test is positive, you will need to provide signed documentation from a clinic of a subsequent negative chest x - ray AND a negative annual symptom survey since your chest x - ray. Annual documentation of TB status is required. For renewal, one of the following is required:  1 - Step TB skin test OR  QuantiFERON Gold blood test OR  T - spot blood test OR  If PREVIOUS positive results, a completed annual symptom survey.  If NEWLY positive, signed documentation fr om a clinic of one subsequent negative chest x - ray AND a negative annual symptom survey since your chest x - ray. 5. Tetanus, Diphtheria & Pertussis (TDaP) Documentation of a TDaP booster within the past 10 years is required. If TDaP is older than 10 years, you will need to provide documentation of a TDaP along with a TD booster from within the last 10 years. According to the CDC a TDaP may be given as one of these boosters. 6. Influenza Vaccine  Documentation of a flu shot administered during the current flu s eason OR  Documentation of a medical contradiction or allergy from medical provider as to why flu shot cannot be received.