Transforming Lives | Building Communities
Associate of Applied Science Degree
Full-Time Nursing Application
Fall 2017 / Winter 2018
Open date: Tuesday, November 1, 2016 | Applicants can begin submitting program applications.
Close date: Wednesday, February 15, 2017 | 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.
People requiring accommodations due to disability should contact the Disability Services Office at 503-491-6923 or
[email protected]
Full-Time Nursing Program
Associate of Applied Science
2017/2018
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.
Important Note: Some external links may be inaccessible. People requiring accommodations due to disability should
contact the Disability Services Office at 503-491-6923 or [email protected].
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.
Mt. Hood Community College
Full-Time RN Application (110116)
Page 2 of 6
Full-Time Nursing Program
Associate of Applied Science
2017/2018
APPLICATION PACKET CHECKLIST
Applicant Name: ___________________________________ Date: ___________________ MHCC ID#______________
Every item on this checklist needs to be submitted by the application deadline—February 15, 2017 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. General Admission Application, Online Form (only required if you are new to MHCC or have not attended within
the last 4 terms. Do not print and turn in with your application) — Apply at 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 (room AC2253).
7. Official (in a sealed envelope) College Transcript(s) from EVERY COLLEGE EVER ATTENDED — Do not
include an MHCC transcript. If an up-to-date transcript is on file (showing most recently completed coursework with
nothing in progress) applicants do not need to submit another copy.)
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 non-acceptance 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:
Mt. Hood Community College
Full-Time RN Application (110116)
Page 3 of 6
Full-Time Nursing Program
Associate of Applied Science
2017/2018
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:
Mt. Hood Community College
Program Title:
Application year(s):
Full-Time RN Application (110116)
Were you accepted?
Page 4 of 6
Full-Time Nursing Program
Associate of Applied Science
2017/2018
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
transcript. 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 (CPT) into
MTH105/111) and must be completed by the application deadline date of February 15, 2017. If the math requirement
is met by CPT into MTH105 or higher, students must select from any other prerequisite courses to obtain the
minimum 30 credits required to apply.
For point assessment, only courses completed by the end of Fall term 2016 with a letter grade of “C” or better will be
used. If selected into the program, ALL courses below must be completed by the end of Summer term 2017.
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 by the application deadline 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
INSTITUTION
EXAMPLE
BI231
FA14
A (4.0)
4
MHCC
ANATOMY AND PHYSIOLOGY I, II, III - cannot be completed prior to Winter 2010
BI231 Anatomy & Physiology I
BI232 Anatomy & Physiology II
BI233 Anatomy & Physiology III
|
|
|
MATHEMATICS: 0–5 credits— test scores cannot be older than 02/15/2012; coursework cannot be completed
prior to Winter 2010
MTH095 Intermediate Algebra or higher
|
OR CPT into MTH105/111
ENGLISH COMPOSITION - 8 credits*
WR121 English Composition I
|
WR122 English Composition II OR
WR123 English Composition: Research
OR
WR227 Technical Report Writing
|
NUTRITION - cannot be completed prior to Winter term 2010
|
FN225
BIOLOGY WITH GENETICS
BI102/BI112/BI212
|
MICROBIOLOGY - cannot be completed prior to Winter term 2010
|
BI234
HUMAN DEVELOPMENT
PSY237
|
GENERAL EDUCATION
Humanities Elective (3+ credits)
|
*Applicants will need to have 8 credits of writing (which must include WR121) by the end of summer 2017 to start the program. A bachelor’s degree
completed by the application deadline will satisfy WR122 or WR123/227. Enter “BA/BS” for the course. Students must select from any of the other
prerequisite courses or microbiology to attain the minimum 30 credit hours required to apply.
REMINDER – Applicants MUST have at least a 3.0 GPA in their prerequisite courses to apply!
Mt. Hood Community College
Full-Time RN Application (110116)
Page 5 of 6
Full-Time Nursing Program
Associate of Applied Science
2017/2018
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. Date stamp this form with office
name/credentials and attach to it a signed business card (or a signed letterhead in lieu of a business card).
 Seal it in an office envelope and sign across the seal.
 The sealed envelope must be received no later than February 15, 2017 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. If you have less than
1,000 hours, do not submit the work
experience form.


LPN (License Practical Nurse)
CNA (Certified Nursing Assistant)
For the above, if you have less than 601 work hours do not
submit this form, just submit a copy of your current LPN or CNA
license.

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
Printed Name of Human Resources Associate
___________________________________________________________________________________________
Human Resources phone number
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.
Mt. Hood Community College
Full-Time RN Application (110116)
Page 6 of 6