Practical Nursing Program Application

Pre-Admission Requirements

• Completed application and admission packet
• High school diploma or GED
• Official transcripts (high school and college, if applicable)
• Background check and drug screening
• Immunization records
• Other requirements as detailed in the program handbook

Post-Acceptance Requirements

• Health examination and immunizations
• CPR certification
• Purchase of uniforms and supplies
• Attendance at orientation
• Payment of tuition and fees

Performance Standards for Admission & Progression

Critical Thinking & Clinical Judgment
☐ Prioritize information and recognize cause-and-effect relationships.
☐ Participate in planning and revising nursing care within the practical nurse scope.
☐ Use logic, reasoning, and nursing standards to make safe decisions.
☐ Perform basic mathematical calculations used in medication administration and measurement.

Interpersonal Skills
☐ Interact respectfully with patients, families, peers, faculty, and healthcare team members.
☐ Establish rapport and communicate effectively in individual and group settings.
☐ Recognize changes or urgent situations and respond appropriately within the student role.

Communication
☐ Communicate clearly and effectively in spoken and written English as required for safe care.
☐ Document patient information accurately and convey critical information in a timely manner.

Physical Mobility & Strength
☐ Move through classrooms and clinical environments and maneuver in confined spaces.
☐ Stand and walk for extended portions of clinical shifts.
☐ Bend, reach, squat, push, pull, lift, position, and transfer patients with appropriate assistance and equipment.
☐ Perform CPR and respond promptly in emergency situations.

Gross & Fine Motor Skills
☐ Use hands and fingers to safely manipulate equipment, syringes, vials, switches, and other clinical supplies.
☐ Perform procedures requiring coordinated use of both hands and maintain aseptic/sterile technique when required.

Auditory, Visual & Tactile Abilities
☐ Detect alarms, emergency signals, and relevant patient sounds.
☐ Read printed and electronic information, gauges, labels, measuring devices, and equipment displays.
☐ Observe changes in patient condition and environmental hazards.
☐ Use touch as needed for nursing assessment and care.

Signature _____________________________________________
Date ______________________________

Students participating in direct patient care may be required by Professional Allied Health LLC and affiliated clinical agencies to complete criminal background screening and satisfy clinical clearance requirements. A criminal history or other background finding may affect clinical placement, program progression, eligibility for licensure, or employment. Clinical agencies and licensing authorities make their own eligibility determinations.

I understand that I must complete required background screening and provide any additional information requested for clinical clearance. I understand that inability to obtain required clinical placement may prevent completion of the Practical Nursing Program.

Use this checklist to confirm that your application packet is complete. Requirements and deadlines are subject to the official admission instructions issued by Professional Allied Health LLC.

☐ Completed Practical Nursing Program application form.
☐ Official high school transcript or recognized equivalency documentation.
☐ Official transcript(s) from each college/postsecondary institution attended, if applicable.
☐ Required pre-admission assessment/testing documentation, if applicable.
☐ Signed Performance Standards for Admission & Progression form.
☐ Signed Background Check & Clinical Clearance Acknowledgment.
☐ Signed Drug & Alcohol Screening Acknowledgment.
☐ Copy of government-issued identification or other identification requested by the school.
☐ Any additional documents identified in the current admission instructions.

For Applicants Requesting Readmission
☐ Written request for readmission.
☐ Explanation of the reason(s) the student did not complete the program.
☐ Completed Action Plan for Success.

A complete packet must be received by the deadline established by Professional Allied Health LLC. Submission of an application does not guarantee admission or readmission.

Required for applicants requesting readmission.

I understand that the Practical Nursing Program is an academically and clinically rigorous program. I have reviewed this application packet and understand that I am responsible for meeting all admission, academic, attendance, health, financial, clinical, and graduation requirements established by Professional Allied Health LLC.

I understand that program requirements may also be affected by clinical agency standards and applicable regulatory requirements. I understand that acceptance into or completion of the program does not itself guarantee eligibility for licensure, certification, clinical placement, or employment.

Printed Name __________________________________________________
Signature _____________________________________________
Date ______________________________

☐ Application received
☐ Transcripts received/verified
☐ Pre-admission testing complete
☐ Performance standards signed
☐ Background acknowledgment signed
☐ Drug policy acknowledgment signed
☐ Additional requirements complete
☐ Admission decision entered

Reviewed by _____________________________________________
Date ______________________________
Notes _________________________________________________________________