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Associate of Applied Science Degree
Full-Time Nursing Application
Fall 2016 / Winter 2017
Open date: Monday, November 2, 2015 | Applicants can begin submitting program applications.
Close date: Monday, February 15, 2016 | All required documentation listed on the application checklist must be received by the
Admissions, Registration and Records office no later than 5 p.m. No postmark date allowed, no exceptions.
Please note: This application is for a restricted entry program, and must be filled out by hand and submitted, along with supporting
documents and payment to Mt. Hood Community College’s Admissions, Registration and Records Office, 26000 SE Stark St, Gresham
OR 97030.
If you need assistance with filling out this application or require accommodations, please contact at AR@mhcc.edu or 503-491-7393.
Full-Time Nursing Program
Associate of Applied Science
2016/2017
Thank you for your interest in applying to Mt. Hood Community College’s Full-Time Nursing program! Our program offers students
award winning faculty, state-of-the-art training, cutting edge technology, and a challenging curriculum. After graduation, our
graduates are expected to manage and care for groups of patients in complex nursing situations, including acute care, long term
care, and in a variety of other health care settings. Please use the following information and the nursing website as a resource in
answering any questions that arise.
Helpful Hints:
 Go to an information session. Information sessions are a great way to learn more about the program, admissions process, meet
other applicants, and ask questions. Nursing information sessions are typically offered at the beginning of every month. Check
the schedule here: mhcc.edu/Nursing/
 Read the Nursing FAQ: mhcc.edu/NursingFAQ/
 All communication with applicants is done via email—always make sure the Admissions Evaluator has your current email address.
The Admissions Evaluator will always use the email address written on the applicant’s application form (even if you change it
with Admissions) unless told otherwise. Make sure you add MHCC.edu to your “safe senders” list.
 If you are ready to turn in your application, but have some questions about the process, or a piece of the application, come talk
with the Nursing Admissions Evaluator during open hours: mhcc.edu/LRQA/
Additional Resources:
 Oregon Consortium for Nursing Education: ocne.org
 Oregon Health & Science University Nursing School Program: ohsu.edu/son
 Oregon State Board of Nursing: osbn.state.or.us
 Nursing programs in the US: allnursingschools.com
 National Student Nurses Association: nsna.org
 Oregon Center for Nursing: oregoncenterfornursing.org
We Ask That You:
 Do not submit your application in double-sided format. Double sided applications are more time consuming and difficult to
process.
 Follow the directions carefully and ask questions if need be.
 Do not submit this page or the front cover with your application.
 Do not submit paperwork we do not ask for (i.e. letters of recommendation, awards, etc.). Anything that is not asked for will be
shredded.
 Only submit a work experience form if it applies to you—we don’t need a blank work experience form.
Full-Time RN Application (102615)
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Full-Time Nursing Program
Associate of Applied Science
2016/2017
APPLICATION PACKET CHECKLIST
Applicant Name: ___________________________________ Date: __________________________ MHCC ID#__________________
Every item on this checklist needs to be submitted by the application deadline—February 15, 2016 by 5 p.m. Only completed
applications containing all the required documents will be considered for review. You will not be given notification if items are
missing. It is the responsibility of the applicant to make sure everything was received by the deadline.
Item
1. Online General Admissions Form (only required if you are new to MHCC or have not attended in 4 terms. Do not print and
turn in with your application) -my.mhcc.edu/ics/Admissions
2. Application Checklist—Page 3
3. Health Professions Division Application—Page 4
4. Prerequisite Course Planning Sheet—Page 5
5. Work Experience Form (optional)—Page 6
6. $75 Non-Refundable Application Fee— Make check payable to MHCC. Bank card/cash is only payable in person in Student
Services (AC2253).
7. Official (in a sealed envelope) College Transcript(s) from EVERY COLLEGE EVER ATTENDED (do not include an MHCC transcript).
1. MHCC’s Admissions, Registration and Records office will send all application notification by email. It is my responsibility to set my
“spam filter” system to accept email addresses containing @mhcc.edu – even if I am currently receiving emails from MHCC. MHCC
cannot be responsible for notices which are not received due to spam or junk mail handling. I will make sure to add MHCC to my
“safe senders list”. MHCC recommends applicants to check their email on a computer and NOT on a smart phone.
2. I have read, completed, and fully understand the admission criteria as listed on the nursing website for the Nursing program at Mt.
Hood Community College and OCNE. I understand that it is my responsibility to meet all program and application criteria. I verify
that all statements on this application are complete and true; and I understand that falsification of any information may lead to
disqualification or dismissal from the program. I give my permission for release of pertinent application information to the OCNE
partner schools, including Oregon Health and Science University, and the State Board of Nursing, as necessary to facilitate my
program of study and to enhance the application process for future applicants.
3. I understand it is my responsibility to ensure all items are received by the application deadline and only complete applications will
be evaluated for admission. Furthermore, I have read and understand the admission requirements and procedures for applying. I
understand that withholding information or giving untruthful answers to questions on this application could be cause for nonacceptance or dismissal from the program. By signing below, I am confirming each item above is included with my application or I
have confirmed they are already on file at MHCC. I understand it is my sole responsibility to submit the required documents, and I
will not be given notice if my application is incomplete until after the deadline, at which time it will be too late to submit missing
documents.
Signature
Date
For Office Use Only:
Received Date:
Received By:
Full-Time RN Application (102615)
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Full-Time Nursing Program
Associate of Applied Science
2016/2017
HEALTH PROFESSIONS DIVISION APPLICATION
Please print and complete fully, do not leave blank. Attach extra paper if needed.
Name:
SSN or MHCC ID:
Previous Last Name(s):
Email:
ALL notifications will go out via email to this address
Current Mailing Address:
Street
Phone Number and Alternate Phone: (
City
)
State
(
Zip
)
Education Record: List ALL colleges EVER attended (including MHCC). Omission of any college transcript will result in non-admittance
or dismissal from the program. We will need an official copy of each transcript regardless of program length, course of study, or
program applicability. Failure to submit these transcripts will result in an immediate incomplete application.
College:
Major:
Degree earned, if applicable:
Previous Applications: List all Health Profession programs you have previously applied to (including MHCC). If you have previously
been admitted into a Health Profession program but did not finish, you must get a letter from the department at your prior
institution stating you left in good standing and are eligible to reapply.
College:
Program Title:
Application year(s):
Were you accepted?
Full-Time RN Application (102615)
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Full-Time Nursing Program
Associate of Applied Science
2016/2017
PREREQUISITE COURSE PLANNING SHEET
Applicant Name: ________________________________ Date: ______________________MHCC ID#: ________________________




Fill out each section accurately and in its entirety. No points will be awarded if the class is not documented or fully documented
below or is listed in the wrong category.
Submit one official (unopened) transcript from every college or university ever attended. Do not include MHCC transcripts. From
these transcripts, list a minimum of 30 credit hours from the prerequisite courses listed below. The 30 credit hours must include
BI231 and MTH095 (or competency through the College Placement Test) and must be completed by the application deadline
date of February 15, 2016. If the math requirement is met by CPT placement into MTH105 or higher, students must select from
any other prerequisite courses to obtain the minimum 30 credits.
For point assessment, only courses completed by the end of Fall term 2015 with a letter grade of “C” or better will be used.
List the courses as they appear on your transcript. For course not taken at MHCC, do not use the MHCC equivalency, convert to
quarter credits, or include +/- on your grades (i.e. B- = B). If the class is in progress for Fall term, put “IP” in the term/year box.
Submit updated transcripts documenting your grade once the class is completed. Do not list courses you are planning to take
Winter or Spring term. “Pass” or “Satisfactory” grade(s) will be counted as a “C” grade.
PREREQUISITE COURSES
COURSE
TERM|YEAR GRADE
CREDITS
EXAMPLE
BI231
FA13
A (4.0)
4
ANATOMY AND PHYSIOLOGY I, II, III: 12 credits – cannot be completed prior to Winter 2009
BI231 Anatomy & Physiology I
|
BI232 Anatomy & Physiology II
|
BI233 Anatomy & Physiology III
|
INSTITUTION
MHCC
MATHEMATICS: 0–5 credits— test scores cannot be older than 02/15/2014; coursework cannot be completed prior to Winter 2009
MTH095 Intermediate Algebra or higher
OR College Placement Test
ENGLISH COMPOSITION: 8 credits
WR121 English Composition I*
|
|
WR122 English Composition II OR
|
WR227 Technical Report Writing
NUTRITION: 4 credits - cannot be completed prior to Winter term 2009
FN225
|
BIOLOGY WITH GENETICS: 4-5 credits
BI102/BI112/BI212
|
MICROBIOLOGY: 4 credits - cannot be completed prior to Winter term 2009
BI234
|
HUMAN DEVELOPMENT: 4 credits
PSY237
|
GENERAL EDUCATION: 6+ CREDITS
Social Science Elective (3+ credits)
|
Humanities Elective (3+ credits)
|
*Applicants will need to have 8 credits of writing (which must include WR121) by the end of summer 2016 to start the program.
REMINDER – Applicants MUST have at least a 3.0 GPA in their prerequisite courses to apply!
Full-Time RN Application (102615)
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Full-Time Nursing Program
Associate of Applied Science
2016/2017
WORK EXPERIENCE FORM
Student’s Name: _________________________ Date: _____/____/______ MHCC Student ID #:__________
Dear Human Resources Associate:
The above individual is planning to apply to the MHCC Nursing program and can earn points in the selection process with proof of
work experience in the healthcare field. In order to receive those points, each applicant must provide official documentation. We are
asking you to assist this applicant with the process. Please do the following:




Fill out the appropriate information below as it pertains to the employee
Seal it in an envelope and sign across the seal.
The sealed envelope must be received no later than February 15, 2016 by 5 p.m. to earn points, no exceptions.
Applicants may submit the paperwork with their application materials, or it can be mailed directly to us at:
Mt. Hood Community College
Admissions, Registration and Records
Full-Time Nursing Program Application
26000 SE Stark St.
Gresham, OR 97030
The applicant held the following position:
 EMT (Emergency Medical Technician)
 CST (Certified Surgical Technician)


Applicants must have 1,000+ hours of work
experience as an EMT or CST to earn
additional points.

LPN (License Practical Nurse)
CNA (Certified Nursing Assistant) - if you have less than 601 work hours
do not submit this form, just submit your CNA credentials off the OSBN
website.
CMA (Certified Medical Assistant) – applicants must have 601+ hours of
work experience as a CMA to earn additional points.
The employee has worked a total of ____________ hours.
Employment begin date:_______/_______/______
Employment end date: _______/________/______
Please note: Applicants that were/are employed as an LPN or CNA must have been performing authorized duties as defined by
the OSBN and must have received ongoing or regular supervision by a licensed nurse, and must have been in a position that
required a CNA certification or LPN license.
Signature of Human Resources Associate/Title
Human Resources phone number
_______ ______________
Printed Name of Human Resources Associate
__________________________________________________________
Facility
APPLICANTS—you must submit BOTH this work experience form and your current, state-issued credentials (credentials can be from
outside the state of Oregon). Submitting just this form will result in zero points.
Full-Time RN Application (102615)
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