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REGISTERED NURSING PROGRAMAPPLICATION FOR ENTRYOPTION “A”: ENTRY INTO FIRST SEMESTER(2020-2021 Application Cycle)STEP ONE: PREPARING TO TURN IN YOUR APPLICATION:You need to:1. Be sure that you have applied to Cerritos College (if not already a student) and obtain a student ID.You must be at least 18 years of age.2. Attend an Application Workshop with the Counseling Department to complete the preliminarytranscript evaluation.3. Applicants with International transcripts must make an individual counseling appointment.4. Complete your nursing application and sign it, confirming you have completed the applicationaccurately and to the best of your understanding.5. Attach high school graduation transcripts or GED results (graduation transcripts or GED results arenot needed if you have a college degree showing on your college transcripts).6. Attach OFFICIAL sealed transcripts from pertinent United States colleges/universities you haveattended: If the course was not completed in the state of California, include a copy of the coursedescription. International transcripts must be evaluated, an unofficial copy of the evaluation is tobe submitted (an official evaluation will be required if selected).7. Attach ATI TEAS (or HESI) results score sheet. Do NOT have ATI send your scores for yourapplication.8. Attach other supporting documentation for Multi-Selective Criteria.9. Submit your application, supporting documents, and transcripts to the HealthOccupations Office in person or by mail by the deadline of March 16th at the end of businessday.Applications will be accepted on the first day of Spring semester through March 16th at the end of thebusiness day. Incomplete applications or incomplete / inaccurate transcripts will not be accepted andthe application will be deemed ineligible.You are encouraged to make a copy of your application as it will not be returned. Your application mustbe completed and signed with all of the materials attached or your application will not be considered.Cerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25501

We will not check documents upon submission. We will not contact you if materials are missing. Youwill not be allowed to turn in additional documents after the application has been submitted.Therefore, please be sure that when you submit your application packet, ALL ITEMS are included.You can mail your application to the Nursing Department:CERRITOS COLLEGEc/o Nursing Department11110 Alondra Blvd., Norwalk, CA 90650If mailed, your application and documents must be postmarked by the deadline date.Cerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25502

STEP TWO: PREPARING TO TURN IN YOUR APPLICATION:NAME:STUDENT ID:APPLICATION CHECKLIST: A REQUIRED DOCUMENTThis Checklist is to assist you in gathering necessary paperwork. This will NOT be double checked by aCounselor nor an administrative assistant in the nursing department. It is your responsibility to assurethat all steps have been completed and all documents have been attached to the application forconsideration. INCLUDE THIS CHECKLIST WITH YOUR APPLICATION PACKET.Applied at Cerritos College to obtain a student IDI am at least 18 years of ageAttended an Application Workshop with a Counselor to have my transcripts evaluatedCompleted all prerequisites required for admission with a 2.5gpa or higherHave maintained an overall 2.5 or higher gpa in all college courseworkFully Completed Application with signature includedHigh School/GED TranscriptsOFFICIAL Colleges/Universities Transcripts (in a sealed, un-opened envelope) – please includeany pertinent schools attended. If you have a college degree showing on your collegetranscripts, then the high school/GED transcripts are not required. Unofficial evaluatedinternational transcripts must be included, if applicable.UNOFFICIAL Test of Essential Academic Skills (TEAS) Results (HESI will be accepted) – Do notneed to have official results sent from ATI to the department. Results need to have student’sname and result score clearly legible.Proof of relevant work experience (if applicable)Proof of relevant volunteer Hours (if applicable)Veteran status (if applicable)Statement of relevant life experience (if applicable)Proficiency in a second language (if applicable)I, have completed this checklist and am certain that I havefully completed the application for admission to the Nursing Program. I have gathered all necessarydocuments to support my application, as well. I have also attended an Application Workshop with aCounselor to have my transcripts evaluated. I understand that when I turn in my application packet tothe nursing department, it must be fully completed. I will not be able to add documents to it at a laterdate.Signature:Cerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25503

STEP THREE: APPLICATION FORM - REQUIRED DOCUMENTSTUDENT NUMBERCERRITOS COLLEGEHEALTH OCCUPATIONS DIVISIONAPPLICATION FOR ADMISSION TO NURSING PROGRAM – OPTION AWhen the application is completed, return application with official transcripts and required documents to:Cerritos College, Nursing Department, 11110 Alondra Blvd. Norwalk, CA 90650APPLICATION MUST BE SUBMITTED NO LATER THAN MARCH 16th at end of business dayI.GENERAL INFORMATION - Please PRINT clearly. Be sure to include Apartment and/or space or suite number.NAME:MAIDEN OR PREVIOUS NAMES USED:ADDRESS:CITY:STATE:PHONE #: HomeCell:ZIP:Email:II. MILITARYMilitary Service (Branch/Active/Discharged)Dates/YearsIII. COLLEGES ATTENDEDCOLLEGE NAMECity, StateOffice Use OnlyDegree AwardedGraduation DateUnitsAttempt/EarnedGrade PointsGPATotal:Total:Total GPA(College Work):This form must be completed and signed by a Cerritos College Counselor.Cerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25504

The applicant should plan to attend an Application Workshop OR make an individualappointment with a Counselor in order to fulfill this page.PRELIMINARY TRANSCRIPT EVALUATION - OPTION A APPLICATION:NAME:DATE:High School Graduate or Equivalent: Yes NoDateEnglish Clearance Yes No Test Score/Clearance Code CourseAlgebra Clearance Yes No Test Score/Clearance Code CourseReading Clearance Yes No Test Score/Clearance Code CourseTEAS / HESI EXAM: Date: Score:For “Office Use llege s AdditionalCommentsTotal:Prerequisite GPA:(grade x units)A&P 150(Anatomy)A&P 151(Physiology)MICR 200(Microbiology)ENGL 100Total:For Office Use:TOTALGENERAL EDUCATIONSPEECH 100, 120, 130, 132, or 150EquivalentCourseTermCompletedGradeCollege Where TakenUS HISTORY (101, 102, or 103) ORPol 101 or 201Psychology 251**Sociology 101 (Phil 104 advised)*Humanities (Phil 104 advised) ORFine ArtsCerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25505

*PHIL 104 satisfies BOTH the Board of Registered Nursing SOCIOLOGY and the HUMANITIESrequirement for the Cerritos College Associate Degree Nursing program only.** The following courses may be completed instead of Sociology 101 for the Cerritos College Nursingprogram: ANTH 100, 101, SOC 201, 210, 215, or PHIL 104.Date:Counselor’s Signature:The following was verified from OfficialDate:or UnofficialTranscriptsNOTES / COMMENTS:MULTISELECTIVE CRITERION – OPTION A ADMISSION ONLYApplicant is to initial the criterion for which the student is providing supporting documents. Student will also place theirpoints as they tally them in each box and then total at the end. The applicant is responsible for submitting ALLsupporting documents with the application and the checklist at one time. Late documents will not be accepted.Cerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25506

Admission CriteriaTotal PointsPossiblePoint DistributionRequired SupportingDocumentationGrade Point AverageOverall CollegeCourseworkAll eligible applicants mustcarry an overall 2.5gpa orhigher to be eligible foradmission20 Points4.0 20 points3.5 – 3.99 15 points3.0 – 3.49 10 points2.75- 2.99 7 points2.5 – 2.74 5 point 2.5 unqualifiedOfficial, sealed transcripts to beenclosed. Failure to provide thesewill disqualify the applicant. Submitall required transcripts to reflect gpaand only transcripts that arerelevant to required coursework fornursing program and for degree.Grade Point AverageNursing PrerequisitesMicrobiology, Anatomy,Physiology, English20 Points4.0 20 points3.5 – 3.99 15 points3.0 - 3.49 10 points2.75 – 2.99 7 points2.5 – 2.74 5 points 2.5 unqualifiedOfficial, sealed transcripts to beenclosed. Submit all requiredtranscripts. Failure to provide thesewill disqualify the applicant.Previous Academic DegreeOnly one degree / highestdegree will be counted10 PointsMS/MA/Doctorate 10 pointsBS/BA 10 pointsAS/AA 5 pointsHealthcare RelatedCertificate 2 pointsTranscript to show completion ofdegree OR copy of the degreecertificate. Must be from a USregionally accredited institution orWASC accredited college. Degreeposting / completion must be clearlyidentified. Do not simply submittranscripts that are not clear.Recency of SciencePrerequisites:A&P 150, A&P 151 andMICR 200 are recommendedto be completed within six (6)years of admission.5PointsIf all science prerequisitescompleted within:3 years 5 points4 years 3 points5 – 6 years 1 point 6 years 0 pointsOfficial, sealed transcripts to beenclosed. Submit all requiredtranscripts. Failure to provide thesewill disqualify the applicant.TEAS ScoreAll students need to passTEAS test with a 62%composite score to beeligible for admission30 PointsComposite Score: 90-100% 30points 85-89.9% 25points 80-84.9% 20points 75-79.9% 15points 70-74.9% 10points 66-69.9% 8points 62-65.9% 5 pointATI TEAS Student Report to besent to the nursing department fromATI via the student’s account orresults page submitted withapplication.Composite Score: 95-100% 30points 90-94.9% 25points 85-89.9% 20points 80-84.9% 15points 75-79.9% 10points 70-74.9% 5pointsHESI Student Report to be sent tothe nursing department from thestudent’s HESI account or resultspage submitted with the application.Must be able to show 500hours worked in healthcareLetter from a current / formeremployer verifying employment.The letter must be on organizationletterhead, include the applicant’sname, start date, end date,employment status, number ofhours worked, job title.HESI Score(If TEAS not taken)All students need to pass theHESI Exam with a 70% Composite Score to beeligible for admissionRelevant HealthcareExperienceHealthcare experienceincludes paid work in ahealthcare environment,including, but not limited toCNA, MA, phlebotomy, RCP,PT, Radiology Tech, SurgicalTech, Unit Clerk, EMT, etc.Relevant work will bedetermined on case-by-casebasis.Must have been in the past 3years.5PointsStudent’sInitials andPointsOffice Use Only:*HIGHLY recommended to havethe TEAS test completed prior tothe application cycle. The nursingprogram does conduct one TEAStesting session per year; however,limited spaces are available.*The nursing department does notconduct HESI testing.Cerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25507

Admission CriteriaTotal PointsPossiblePoint DistributionRequired SupportingDocumentationHealthcare VolunteerHoursMust have been in the past 3years.5Points50 – 100 hours 1 point100 – 200 hours 2 points200 – 400 hours 3 points400 – 500hours 4 points 500 hours 5 pointsLetter from current / formerorganization verifying volunteerservices. The letter must be onorganization letterhead, include theapplicant’s name, start date, enddate, number of hours volunteered,and examples of duties includingpatient interaction.Max2 Points Healthcare work experience(above) will not be doublecounted as volunteerexperience. However, astudent may have hourseligible for work experienceand other hours /experiences eligible forvolunteer points.Life ExperiencesApplicants may have one ormore in this category,however maximum pointsawarded are 2 points Low family incomeFirst Generation collegestudentDisadvantaged social oreducationalcircumstancesRefugee statusNeed to work at least PTDisability Student’sInitials andPointsOffice Use Only:STUDENT’SPOINTS –according tostudent’stalliesSTUDENT’SPOINTS –DepartmentVerifiedPertains to: single parent,deployed spouse, familycaregiver, death of familymember within 6 months,medical problem, financialissue. Written statement fromapplicant.Documented copy of eligibilityof Financial Aid, Cal Works,BOGFW-B, Federal Pell Grantor EOPS.Copy of the card indicatingrefugee status.Copy of DD214Letter from Physiciandocumenting disabilityDocumentation from employeron company letterheadverifying dates of employmentOR recent paycheck stub ORW-2Written bio statement fromapplicant.Veteran Status2PointsSubmit copy of Defense FormDD-214 Honorable DischargeDD-214 showing above adishonorable discharge ordocument showing AD statusSecond Language1PointProficiency in the followinglanguages:American Sign language;Arabic; Farsi; Spanish;Tagalog; Chinese; Russian;Indian subcontinentAmerican Sign Language, Arabic,Chinese, Farsi, French, Russian,Spanish, Tagalog, and the variouslanguages of the Indiansubcontinent and Southeast Asia. Letter stating fluent inspeaking, reading, and writinglanguage and explaining howfluency was obtained isrequired OR transcript showing 3 years ofHS completion of foreignlanguage OR transcript showing 2semesters of college levelforeign language (up throughintermediate) AP or SAT Subject test scorein the languageTOTALPOSSIBLEPOINTS100I certify that my answers are true and complete to the best of my knowledge for all pages of this application. If thisapplication leads to enrollment, I understand that false or misleading information in my application may result in denialof admission and/or dismissal from the nursing program.Cerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25508

Applicant’s Signature:Date:*Applicant to turn in PAGES 3-9 of this application packet, along with supporting documents and officialtranscripts to the Nursing Office by March 16th, 2020.STEP FOUR: SELECTION AND ACCEPTANCEThe nursing department takes applications once a year, from January to March 16th, 2020. Thatapplication cycle is to secure the new nursing student admissions for the following fall and spring terms(2020-2021).OPTION A Applicants are evaluated according to the number of points accrued in the areas designatedin the Multi-Selective Criterion. Applicants are ranked accordingly. The nursing program will fill thefirst 50% of admission seats with the top point scorers. In case of a tie, a lottery draw will be utilizedfor selection. The remaining applicants will be placed into a Random Selection (Lottery) process andthe next 50% of admission seats will be filled through the lottery. The nursing program will thenmaintain a list of Alternates who will be utilized to fill admission seats, as needed, for Fall or Springapplicants/admissions who do not end up enrolling.*Please Note: The Nursing Department will first fill any vacancies with qualified ongoing students whowithdrew from the first semester and who are returning to complete the program.Applicants who are selected are notified in writing.Note: Any change to your contact information must be submitted in writing through email [email protected] or submitted to the Health Science Building, Nursing Office. If we are unable tocontact you at the information provided, and you do not respond to our mail, email, or phonecontact, your application may be disqualified.There is no “Waitlist” maintained. Applicants who do not gain enrollment in this application cyclemust reapply the following application cycle. Instructions on how to proceed with this will be providedfrom the Nursing Department with the regret letter.Cerritos College, Health Occupations Division, Health Science Building11110 Alondra Blvd., Norwalk, CA 90650562-860-2451, ext. 25509