Central Oregon Community College Nursing Department
2600 N.W. College Way; Bend, Oregon 97703
Instructions for Department Clearance and Registration
Winter 2016 Nursing Assistant
NUR 103 WI16 – CRN 13244
PRE-REGISTRATION AND DEPARTMENTAL CLEARANCE IS REQUIRED
EACH TIME YOU REGISTER FOR NURSING 103 (NURSING ASSISTANT CLASS)
Carefully read the information contained in this packet, sign the agreement page and return the signed
agreement page to the Nursing Department Administrative Assistant at least 3 business days prior to your
assigned registration date, for the term in which you are trying to register.
You must follow the instructions in this packet and meet the required deadlines. Any registered student who
does not meet the required deadlines will be withdrawn from class.
Departmental Approval will be given only after the signed agreement is received by Nursing Department
Administrative Assistant. This does not guarantee that you will be able to register as registration is on a first come
first serve basis. It is your responsibility to register for the class. We do not register you in the class.

It is important that you completely read this packet and understand the requirements of the NUR 103 class.

Initial each item on the “Agreement Page,” and sign it at the bottom. Return it to the Nursing Department
Administrative Assistant on the third floor of the Health Careers Center prior to the start of registration for
the term in which you are registering. Giving this packet to any other person may result in a delay in
preapproval beyond your registration date.

Make sure that you have advisor clearance, and confirm that Departmental Clearance for Nursing 103 is
visible on your “Can I Register Page.” NOTE: New students need to apply to the college, complete
placement testing or send in transcripts, and follow all Getting Started ( http://www.cocc.edu/getting-
started/) steps prior to registration for Nursing 103.

Register for NUR 103 at your scheduled time.
If you have questions, you may call the Nursing Department Secretary at (541) 383-7576.
All communication will be done through your college e-mail account; therefore, it is very important that you
check it often. We do not accept lack of communication, including checking your college e-mail, as an
excuse for lateness.
ORIGINAL TO NURSING DEPARTMENT ADMINISTRATIVE ASSISTANT
HEALTH CAREERS CENTER
MONDAY-FRIDAY 8-12 (HCC 257) AND 12:30-4:30 (HCC 357)
Office closed during summer and school breaks
Department Clearance Checklist to Register for NUR 095 / NUR 096
Step 1 – Oregon Health Authority and Oregon State Board of Nursing Requirements
The Oregon Health Authority and the Oregon State Board of Nursing requires all students in health occupations to
complete a criminal history check, 10 panel drug screen and to provide documentation of current immunizations
to attend any program with a clinical component that requires patient care. Individuals who have a positive urine
drug screen or who have been convicted of crimes that will disqualify them from clinical attendance and / or from
certification, will be denied admission to the Nursing Assistant Program [NUR 103].
You will receive information via your COLLEGE EMAIL with instructions and access codes for completing the
Oregon Health Authority required criminal history check, 10 panel drug screen and immunization upload. This
information will be sent at the end of the registration period.
The Oregon State Board of Nursing requires an American Heart Association, ILCOR compliant, HEALTH CARE
PROVIDER CPR cards that is current and valid through the end of the term for which you are enrolled. Pay
attention to the type of card issued by your CPR vendor. No other card will be accepted.

Criminal History Check: [Due Date: 12/04/2015]
_______ You DO have a history of arrest:
Check the ORS number on your court documents against the crimes listed on the DHS crimes list at
http://www.oregon.gov/dhs/chc/pages/index.aspx or the list provided in this packet. You will not be
approved to register for the Nursing Assistant Program [NUR 103] if the ORS number on your court records
match any of the crimes on the DHS crimes list. You may reapply for the Nursing Assistant Program when
your criminal record has been cleared of any listed crimes. Talk to the Nursing Assistant Program Director
prior to registering for NUR 103 if you are unsure of your status -OR_______ You DO NOT have an arrest history:
You will receive information via your college email with instructions and access codes for completing the
Oregon Health Authority required criminal history check, 10 panel drug screen and immunization upload.

10 PANEL URINE DRUG SCREEN [DUE DATE: 12/04/2015]
Registered students must submit to a urine drug screen, at the testing lab designated in your instruction
letter, no later than the indicated due date. Screening will be performed for the following drugs:
1.
Amphetamines including Methamphetamines
2.
Barbiturates
3.
Benzodiazepines
4.
Opioids
5.
Marijuana
6.
Heroin
7.
Methadone
8.
Phencyclidine
If you have a prescription from your health care provider for an amphetamine or benzodiazepine, to treat a
chronic disorder, you must present a letter from your health care provider, on clinic letterhead, stating the
need for the drug.

Immunizations [Due Date: 12/04/2015]
Registered students must provide copies of all required immunizations to the Nursing Department
Administrative Assistant no later than the indicated due date.

Hepatitis B Vaccine:
_______Provide official documentation of THREE Hepatitis B vaccinations given at 0, 1 and 6
months.
– OR _______Hepatitis B Vaccine series in progress: First dose must be completed no later than the
indicated due date and second dose received one month after first dose.
-OR_______If due, the third Hepatitis B vaccine dose or the Hepatitis B titer must be done prior to
clinical attendance.
-OR_______ Provide results of Hepatitis B surface antibody test (titer) completed 1 – 2 months after
the third dose showing immunity.
-OR –
_______ If the Hepatitis B surface antibody test [titer] is negative 1 – 2 months after completing
the series of three hepatitis B vaccinations the vaccination series must be repeated with a
titer drawn 1 – 2 months after completing the third vaccination. If the titer remains negative
after 6 doses the vaccine is considered a “non-responder”.

MMR Vaccine (measles, mumps, rubella):
_______ Official documentation of two doses of live measles and mumps vaccines separated by
at least 28 days –AND- at least one dose of live rubella vaccine
-OR_______Vaccine series in progress: Provide documentation of first dose prior to indicated due
date; second dose at one month and completed prior to clinical component of program. –
OR_______Laboratory confirmation of disease or immunity: Dated copy of measles, mumps and
rubella titer report with results must be included in documentation.

Varicella (Chickenpox):
_______Provide documentation of 2 doses of Varicella vaccine, at least 28 days apart.
-OR_______ Laboratory confirmation or evidence of immunity (titer) to Varicella.
-OR-
_______ Diagnosis or verification by a health care provider of a history of varicella or herpes
zoster [shingles].
-OR_______Documentation of the first vaccine by the established due date followed by
documentation of the second dose within the first 4 weeks of the term.

Tetanus, Diphtheria, Pertussis:
_______ Provide documentation of a one-time dose of Tdap as an adult.
–OR_______Documentation of Td booster every 10 years after Tdap dose as an adult.

Two Step TB Testing (PPD):
Please note: A TB test [PPD] cannot be placed within 28 days of receiving a live virus vaccine.
_______ Documentation of two negative TB tests, administered 14 days apart [21 days if you
receive the MMR vaccine concurrent with the 1 TB test], and read within 48 hours of
st
placement by the administering agency. If both are negative, nothing further needs to be
done.
–OR_______Documentation of a negative blood test, either Quantiferon Gold or T-Spot, within the
past the past 12 months.
–OR_______ If either test is positive, provide documentation of the TB tests, a chest x-ray and an
evaluation by a physician.
–OR_______ Students with a past positive TB test must provide documentation of the positive TB test
and, if not already completed, provide documentation of a baseline chest x-ray prior to the
deadline.
–AND_______All follow up care related to a past, positive TB test must be completed prior to the first
day of class.

Influenza vaccine:
_______ An annual influenza vaccine is required for students who will be attending clinical
between September 01 and March 31.

Medical Exemption: [Due Date: 12/04/2015]
_______If you have had a life-threatening allergic reaction to a vaccine or any component of a
vaccine, you must provide documentation, on letterhead, from your health care provider. See the
Nursing Department Administrative Assistant for immunization exemption for medical reasons.
Please Note: You may NOT waive tuberculin screening.

Healthcare Provider CPR: [Due Date: 12/04/2015]
Please Note: CPR cards must comply with Oregon State Board of Nursing rules. The Oregon State
Board of Nursing requires an American Heart Association, ILCOR compliant, Health Care Provider
CPR cards that is current and valid through the end of the term for which you are enrolled. WE
CANNOT ACCEPT ANY OTHER CPR CARD.
_______ Copy of both sides of a signed, current American Heart Association, ILCOR compliant,
Healthcare Provider CPR card.

Step 2 - Class Attendance:
_______ Attend mandatory orientation on the first day of class and arrive on time to retain your
seat in NUR 103.
_______ You will be withdrawn from class if your required paperwork is not turned in to the
Nursing Department Administrative Assistant by indicated due dates. The instructor will
NOT accept your required paperwork on the first day of class. This is not negotiable.
Letter of Agreement for Departmental Approval:
_______ I understand that I must initiate my criminal history check, 10-panel drug screen and provide
documentation of all required immunizations on or before the established due date. Failure to provide the
required documents by the due date will result in administrative withdrawal from NUR 103.
_______ I understand that I must have an American Heart Association, ILCOR compliant, Healthcare Provider CPR
card valid through the completion of the term in which I am enrolled and that I must provide a photocopy of both
sides of the signed card to the Nursing Department Administrative Assistant in HCC 357 on or before the
indicated due date.
_______ If I am on the wait list I understand that I must have all the listed immunizations, titers, and tests and bring
copies of documentation of immunizations, titers and x-rays and appropriate CPR card to the Nursing Department
Administrative Assistant on or before the deadline scheduled by the Program Director.
_______I understand that the nursing department will not accept document originals and copies cannot be made
in the department office.
_______I understand that the classroom instructor will not accept my required documents on the first day of class.
_______ I understand that I will be administratively withdrawn from the course, if I do not meet all pre-registration
requirements and turn in photocopies of all required documents to the Nursing Department Administrative
Assistant in HCC 357 on or before the indicated due dates.
_______I understand that I must attend the mandatory orientation on the first day of class to retain my seat in the
program or if I am waitlisted, to be considered for an open seat.
My initials and signature indicate that I have read, understand and will comply with the requirements for the
Nursing Assistant Class AFTER registration for NUR 103. I also understand that I will be administratively withdrawn
from the class if I do not meet the outlined requirements for class attendance by the due date listed.
__________________________________________________________[Student Signature] _________________[Date]
____________________________________________________[Print Name] ___________________[Student COCC ID]