HEALTH CAREERS ● PORTERVILLE COLLEGE ● 100 East College Avenue ● PORTERVILLE ● CA ● 93257

(559) 791-2321 FAX (559) 791-2417

https://www.portervillecollege.edu/health-careers/health-careers Revised 06/08/2017

PORTERVIILE COLLEGE

HEALTH CAREERS

NURSING PROGRAM

APPLICATION REQUIREMENTS/ INSTRUCTIONS

APPLICATION PERIOD

February 1 - February 28 for the program/courses scheduled to start in the FALL semester.

The application period for previous RN students transferring to 2nd or 4th semester is September 1 - September 30

for courses scheduled to start in the SPRING semester.

REQUEST FOR TRANSCRIPT EVALUATION DEADLINE Deadline for courses taken from any college other than Porterville College

October 15 – for program/courses scheduled to start in FALL semester

The Request for Transcript Evaluation Deadline for previous RN students transferring to 2nd or 4th semester is June

15th for courses scheduled to start in the SPRING semester.

APPLICATION PROCEDURES Read these guidelines carefully to ensure your application experience runs smoothly. It is the applicant’s responsibility

to complete ALL application requirements/procedures. FAILURE TO MEET ALL APPLICATION

REQUIREMENTS/PROCEDURES WILL RESULT IN AN INCOMPLETE APPLICATION AND WILL

NOT BE CONSIDERED FOR SELECTION.

1. COMPLETE ALL PREREQUISITE COURSES BEFORE YOU SUBMIT YOUR PORTERVILLE

COLLEGE NURSING APPLICATION. Courses in progress will not be accepted.

2. APPLY TO PORTERVILLE COLLEGE BY SUBMITTING AN ONLINE APPLICATION

A. Students who have never attended Porterville College must submit an online application.

https://www.portervillecollege.edu/node/4114

B. First time students to Porterville College will be issued a Student ID number and Gmail address. The

ID is to be used for all college transactions and Gmail is the mode of communication used by the

college to students.

3. GET YOUR STUDENT ID NUMBER and LOGIN TO YOUR PORTERVILLE COLLEGE GMAIL

ACCOUNT

4. COURSES FROM ANY COLLEGE OTHER THAN PORTERVILLE COLLEGE.

A. Pre-requisites taken from colleges other than Porterville College need to be evaluated by Admissions and

Records. (Please note, it takes about 18 weeks for this evaluation process to be completed by Porterville

College Admissions and Records Office.)

B. Complete Request for Transcript Evaluation form. Form can be obtained from Admissions and Records

or the Porterville College Health Careers webpage

https://www.portervillecollege.edu/health-careers/our-programs

2

C. Submit OFFICIAL transcripts and Request for Transcript Evaluation form to Admissions and Records

prior to the deadline.

D. Bakersfield College and Cerro Coso Community College official transcripts DO NOT need to be

submitted to Admissions and Records however, a Request for Transcript Evaluation form DOES need to

be submitted to Porterville College Admissions and Records Office prior to the deadline.

E. Once your transcripts have been evaluated and posted to your Porterville College transcripts, print your

unofficial Porterville College transcripts.

5. PROOF OF HIGH SCHOOL GRADUATION OR EQUIVALENT OR HIGHER DEGREE

Attach to the application official high school transcripts or official GED scores or higher degree official

transcripts.

6. UNOFFICIAL PORTERVILLE COLLEGE TRANSCRIPTS – print and attach to application

7. NURSING PROGRAM APPLICATION

Print and complete the Associate Degree Nursing Program application from

https://www.portervillecollege.edu/health-careers/health-careers.

8. MULTICRITERION SELECTION PROCESS FORM

Print and complete the multi-criterion #1-8. Calculate your subtotal. Attach supporting documentation.

Submit with ADN application.

9. SUBMITTING YOUR APPLICATION

Submit completed checklist and application with unofficial Porterville College transcripts, Multi Criteria

from and all supporting documentation to the Health Careers office during the appropriate application period.

Remember to sign and date your application.

APPLICATION STATUS 1. APPLICATION SUBMITTED

2. DO NOT CALL the Health Careers office to inquire about the status of your application, as verification will

not be given over the phone. With over hundreds of applications to carefully review, we will update you on

your status as soon as possible. We appreciate your patience. You will be notified regarding the results

approximately EIGHT (8) WEEKS AFTER THE CLOSING DATE.

3. APPLICATION QUALIFIED

We have reviewed your application and have determined that you meet all program requirements. You will

receive an invitation to take the ATI TEAS at Porterville College.

4. ACCEPTED FOR CONDITIONAL ENROLLMENT

Congratulations! You have been selected for conditional enrollment to the Nursing Program. You will be

notified by email and/or phone and mailed further instructions.

5. ALTERNATE

You have been selected as an alternate. You will be notified by email and/or phone and mailed further

instructions.

6. NOT SELECTED

You are qualified and your application was not selected for this enrollment period. You are eligible to reapply

as a returning qualified applicant.

7. APPLICATION NOT QUALIFIED

We have reviewed your application, and based on program requirements, your application is not qualified.

You will be mailed further information.

PORTERVILLE COLLEGE

HEALTH CAREERS

Nursing Application Checklist

Revised 10/16/2017

Full Name: ______________________________________________________________________________________________________________

Last First Middle Initial

Please complete and submit this form. Initial each completed checkbox. If a box is not applicable place “N/A” in the checkbox.

Program Brochure: READ ALL PROGRAM POLICIES AND APPLICATION REQUIREMENTS

Completed REQUEST FOR TRANSCRIPT EVALUATION procedure by deadline, if applicable.

(Admissions and Records must evaluate courses taken from any college other than Porterville College)

Completed APPLICATION, signed, dated, and submitted by deadline (application packets received

after deadline will not be accepted)

Attached UNOFFICIAL PORTERVILLE COLLEGE TRANSCRIPTS

Attached official HIGH SCHOOL transcripts or official GED scores or HIGHER DEGREE official

transcripts (unofficial Kern Community College District transcripts accepted)

Completed MULTI-CRITRION FORM #1-8

Attached official transcript of PREVIOUS ACADEMIC DEGREES - #1 on Multi-Criteria Selection

Process, if applicable. (Degrees from other colleges will not be posted onto your Porterville College transcript;

unofficial Kern Community College District transcripts accepted with degree posted from Porterville College, Cerro Coso

College and Bakersfield College).

Documentation of RELEVANT HEALTH CARE CERTIFICATION, WORK OR VOLUNTEER

EXPERIENCE - #5 on Multi-Criteria Selection Process, if applicable.

Documentation of LIFE EXPERIENCES OR SPECIAL CIRCUMSTANCES - #6 on Multi-

Criteria Selection Process, if applicable.

Documentation of VETERAN STATUS - #7 on Multi-Criteria Selection Process, if applicable.

Documentation of LANGUAGE PROFICIENCY - #8 on Multi-Criteria Selection Process, if

applicable

Signature: ______________________________________________ Date: ___________________

NOTE: It is the applicant’s responsibility to complete ALL application

requirements/procedures. FAILURE TO MEET ALL APPLICATION

REQUIREMENTS/PROCEDURES WILL RESULT IN AN INCOMPLETE

APPLICATION AND WILL NOT BE CONSIDERED FOR SELECTION.

PORTERVILLE COLLEGE Associate Degree Nursing Program

Admission to: Fall Spring Year: _____________________ Semester: 1st 2nd 3rd 4th

Personal Information

Full Name: ________________________________________________________________________________________________________

Last First Middle Previous Last

Mailing Address: ________________________________________________________________________________________________

Street or P.O. Box

_________________________________________________________________________________________________________________

City State Zip Code

Home Phone: ( __ )___________________________ Cell Phone: ( ____ )______________________________________

Birth Date:___________________________________ Student ID# :_______________________________________________

Email:____________________________________________________________________________________________________________

Birth Date:___________________________________ Student ID# :_______________________________________________

Email:____________________________________________________________________________________________________________

U.S. Citizen: Yes No Served on active duty in the U.S. Armed Forces /are the spouse of an eligible veteran? Yes No

Do you have a valid Social Security Number or Tax Payer ID Number? Yes No

If previously enrolled in a RN program, please state where and when? ___________________________________________ N/A

Have you ever applied to the Porterville College RN Program? Yes No

Have you ever applied to any other Health Careers program? Yes No If yes, which program(s):_____________________________

If yes, under what name? ________________________________ When? __________________________________

Were you a RN alternate? Yes No Have you taken the TEAS? Yes No If yes, score 1st attempt_____ 2nd attempt_____

If required, have you completed all the steps of the TEAS remediation plan (attach proof)? Yes No N/A

Failure to meet all application requirements/procedures will result in an incomplete application and will NOT be considered for selection.

Refer to Application Requirements/Instructions

Job Information

Name of Employer: Position: _______________________________________

All Colleges Attended

College Name City, State Dates Attended Degree Awarded

I have read and understand the above regulations and certify that to the best of my knowledge, the information provided on this document is

complete and accurate. I understand that any misinformation, intentional or otherwise, may result in removal of consideration for the program.

Signature: Date:

05/25/17

Mail to: Porterville College Health Careers

100 E. College Ave. Porterville, CA 93257 Attn: Applications

[Type here]

Completion of this Page is Optional Demographic Information

Please complete the following survey:

Male Female Primary language spoken at home:

1. _________________________ Other language(s) spoken:

1. _________________________

2. _________________________

Your age: ______________________

Ethnic background (please mark one of the following) Black/African American

Native American/Alaskan Native

Asian/Pacific Islander Asian Indian

Filipino Native Hawaiian/ Non- Filipino Pacific Islander

Hispanic/Latino Mixed race

White/Caucasian Other race

(Please mark all that apply)

Autism/Asperger’s Spectrum

ADD/ADHD

Blind or Visually Impaired

Brain Injuries

Deaf/Hard-of-Hearing

Intellectual Disabilities

Learning Disabilities

Medical Disabilities/Chronic Illness

Physical Disabilities

Psychiatric Disabilities

Communication/Speech and Language

Disabilities

Other________________

(Please mark all that apply)

Academic Counseling

Disability- Related

Counseling/Referral

Adaptive Equipment/Physical

Space/Facilities

Interpreter and Captioning Services

Exam Accommodations

(modified/Extended

Time/Distraction Reduced Space)

Assistive technology/Alternative

Format

Note-Taking

Services/Reader/Audio

Recording/Smart Pen

Priority Registration

Reduced Course load

Transportations/Mobility Assistance

and Services/Parking

Other_______________________

It is the applicant’s responsibility to keep the Health Careers Office informed of any changes in personal information, including

telephone numbers or addresses.

2

Orig. Health Careers Division Sept 2016; rev April 2017 Education Code Section 78261-78261.5

Porterville College ADN Program – Multi Criteria Selection Process Name: Student ID #:

Application Semester: (Fall/Spring) ______________ Year: If REAPPLYING, has your criteria changed? Yes No

Criteria Circle Required Supporting Documents

1. Previous Academic Degrees – MAXIMUM 10 POINTS – Select one

BA/BS degree or higher Yes No

AA/AS degree Yes No

10

5

Attach official transcript from regionally accredited U.S. colleges or universities with degree posted.

Unofficial transcript accepted from Kern Community College District (PC, BC, CC) degrees.

IN PROGRESS DEGREES NOT ACCEPTED

STUDENTS WHO DO NOT HAVE AN AA/AS DEGREE OR HIGHER MUST PROVIDE PROOF

OF HIGH SCHOOL GRADUATION OR EQUIVALENT (Title 16, Division 14, Article 1, Section

1412 California Code of Regulation) – attach official transcripts.

Foreign High School & College Graduates: All transcripts from outside the U.S. must be evaluated

by a NACES independent agency.

2. Grade Point Average – Science – MAXIMUM 40 POINTS SEE APPLICATION GUIDELINES FOR THE NURSING PROGRAM

Attach unofficial Porterville College transcripts. GPA calculations will not be rounded.

Pre-requisites taken from colleges other than Porterville College must be evaluated by Admissions

and Records. Applicant transcripts must be on file and officially evaluated by the Porterville College

Admissions & Records office prior to application submission. Deadline for transcript evaluation is

October 15.

IN PROGRESS COURSES WILL NOT BE ACCEPTED

INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED

Grade point average in relevant course work Minimum 2.5

in Anatomy, Physiology, & Microbiology (ANAT P110,

PHYL P101, MICR P106)

GPA = 4.00 (40)

GPA = 3.50-3.99 (30)

GPA = 3.00-3.49 (20)

GPA = 2.50- 2.99 (10)

40

30

20

10

3. Grade Point Average – Non-Science MAXIMUM 10

POINTS

Grade point average in relevant course work Minimum 2.5

Non-science GPA in English (ENG P101A) & Math

(MATH P051 or MATH P122)

GPA = 4.00 (10)

GPA = 3.50-3.99 (7.5)

GPA = 3.00-3.49 (5)

GPA = 2.5- 2.99 (2.5)

10

7.5

5

2.5

3

Orig. Health Careers Division Sept 2016; rev April 2017 Education Code Section 78261-78261.5

4. Repeats (W, D, F, I) in Science Pre-requisites MAXIMUM PENATLY -10 POINTS

Repeated classes in any science pre-requisite (Anatomy,

Physiology, Microbiology)

Repeat 1 course (-2.5)

Repeat 2 courses (-5)

Repeat 3 courses (-7.5)

Repeat 4 or more courses (-10)

-2.5

-5.0

-7.5

-10

Courses with a passing grade that are repeated for a higher grade, are not penalized.

Criteria Circle Required Supporting Documents

5. Relevant Health Care Certification, work or volunteer experience – MAXIMUM 5 POINTS – Select Only One

Currently licensed LVN, Psychiatric Technician,

Respiratory Therapist, Physical Therapy Assistant,

Certified CNA, EMT-B, Medical Assistant,

relevant work or volunteer experience.

Yes No

current license/certification (5)

work or volunteer experience > 500 hours (2)

5

2

Copy of current license or certification with license number, date of issue, and date of expiration.

Items listed are examples only and not an exhaustive list of certifications/licenses that MAY be

accepted.

Recent work or volunteer experience with direct human patient care within the past 5 years > 500

hours. Must have verification from human resources or employer verifying the number of hours

worked and job title.

All information must be submitted by the student along with the application. The admissions

committee will make the final determination of acceptance of work or volunteer experience.

6. Life Experiences or Special Circumstances MAXIUMU 5 POINTS – Select Only One

6.a Disabilities 5 Proof of receiving college disability services from Disability Resource Center.

6.b Low family income 5 Proof of eligibility or proof of financial aid, e.g. Board of Governors Fee Waiver (BOGW), Cal Grant

or other federal grant, CalWORKS. (DO NOT SUBMIT FAFSA applications or tax returns).

6.c First generation to attend college 5 Submit Life Experiences or Special Circumstances Supporting Documentation form.

6.d Need to work 5 One (1) paycheck stub during period enrolled in prerequisite course or letter from employer on

letterhead stationary verifying employment at least part-time while completing prerequisites.

6.e Disadvantaged social or educational environment 5 Participation or eligibility for Extended Opportunity Programs and Services

6.f Difficult personal or family situation/environment 5 Submit Life Experiences or Special Circumstances Supporting form.

6.g Refugee status 5 Documentation of United States Citizens Immigration Service (e.g. I-94 card with Refugee Asylum

Stamps or I-797 Notice of Action).

4

Orig. Health Careers Division Sept 2016; rev April 2017 Education Code Section 78261-78261.5

7. Veteran Status – MAXIMUM 3 POINTS

Veteran Status or eligible spouse status

Yes No

3 Submit copy of Defense Form DD-214 Honorable Discharge or alternate documentation per Veterans

and Eligible Spouses.

8. Language Proficiency – MAXIMUM 2 POINTS

Proficiency in a language other than English.

Yes No

2 Proof must be provided by student (of spoken language proficiency) by ONE of the following:

a) Submit Language Proficiency Verification form completed by a professor, clergy or supervisor, if

it is the native language (must speak, read, and write in the language).

b) Transcripts showing completion of 3 years of high school in same language with a “C” or better,

or 2 years in college through the intermediate level.

c) AP or SAT Subject test scores in the language.

SUBTOTAL POINTS

Maximum Subtotal Points 75

Total Your Circle Points for ADN Program Prescreening Criteria 1 through 8

Submit this prescreening criteria form and student checklist with application and transcripts.

9. Approved Diagnostic Assessment Tool, Test of Essential Academic Skills ATI TEAS – MAXIMUM 25 POINTS

Porterville College utilizes the Test of Essential

Academic Skills (ATI TEAS). The minimum

adjusted individual score required for applications

is 62%.

ATI TEAS Score:

90 – 100 (25)

85 – 89 (20)

80 – 84 (15)

75 – 79 (10)

69 – 74 (5)

62 – 68 (2)

25

20

15

10

5

2

ATI TEAS will be offered by Porterville College on an invitation-only basis to qualified applicants.

The dates for the exam follow the application period year and will be posted on the Nursing

Department website. All TEAS scores must be received by the Health Careers Division by the final

testing date in order to be considered.

Students must rank at or above the average composite percentage of 62% to be eligible for enrollment

into the program. PC will accept the highest ATI TEAS score of the first two attempts. There must be

45 days or more between attempts and evidence of remediation for the second score to be accepted.

Students who do not meet the 62% minimum score on the first attempt will be required to complete

an ATI TEAS remediation program. Only one repeat of the ATI TEAS will be allowed.

Students retaking or remediating can review the suggested strategies on the nursing website, “ATI

TEAS Preparation and/or Remediation Plan.”

ATI TEAS taken at Porterville College – Applicants do not need to submit their results; the results

will be accessible.

ATI TEAS taken at any other location – you must go to the www.atitesting.com online store and

request that your official TEAS results are sent to Porterville College.

See Assessment Testing (ATI TEAS) Required for Nursing Program.

TOTAL POINTS

Maximum Total Points 100

Selection Process: Each incoming class will be randomly selected from the top third of candidates

who apply during the application cycle.

PORTERVILLE COLLEGE

LIFE EXPERIENCES OR SPECIAL CIRCUMSTANCES

SUPPORTING DOCUMENTATION

(To Be Completed for Prescreening Criteria 6.c or 6.f)

If applicable, complete your Life Experiences or Special Circumstances below. Please print or type.

I , acknowledge by my signature below, that the

information on this form is correct and true.

Signature: Student ID #: _______

First generation to attend college. Briefly explain your situation or circumstances.

Difficult personal or family situation/environment.

PORTERVILLE COLLEGE

HEALTH CAREERS

Veterans and Eligible Spouses

Original 08/30/16

Veteran: a person who served in the active military, naval, or service who was discharged or

released there from under conditions other than dishonorable, as specified in 38 U.S.C. 101(2).

Active service includes full-time duty in the National Guard or a Reserve component, other than

full-time duty for training purposes.

Eligible Spouse: as defined in section 2(a) of the JVA (38 U.S.C.) 4215(a) means the spouse of

any of the following:

1. Any veteran who died of a service-connected disability;

2. Any member of the Armed Forces serving on active duty who, at the time of

application for the priority, is listed in one or more of the flowing categories and had

been so listed for more than 90 days:

a. Missing in action

b. Captured in line of duty by a hostile force; or

c. Forcibly detained or interned in line of duty by a foreign government or

power;

3. Any veteran who has a total disability result from a service-connected disability, as

evaluated by the Department of Veterans Affairs;

4. Any veteran who died while a disability was in existence, as indicated in item (3) of

this section.

In order to be eligible for points under this selection criteria, documentation of veteran or eligible

spouse status must be submitted to Health Careers by the application closing date with the

nursing program application packet. This documentation may include, but is not limited to, the

following:

Veterans submit a copy of the DD Form 214 – Member 4.

Eligible spouses submit documentation confirming their status from an appropriate government

agency, for example the Department of Veterans Affairs or Department of Defense.

Department of Veterans Affairs

o Official notice veteran’s service-connected disability, total in nature

o Official notice establishing entitlement to compensation to the surviving spouse

based on the veteran’s death resulted from a service-connected disability

o Official notice veteran’s service-connected disability, total in nature, existed when

death occurred.

Department of Defense

o Official notice documenting the active duty spouse to be missing or detained

status for more than 90 days.

PORTERVILLE COLLEGE

HEALTH CAREERS

LANGUAGE PROFICIENCY VERIFICATION

(To Be Completed for Prescreening Criteria 8)

Applicant’s Name

(Last) (First) (Middle)

Student ID # :

Instructions to applicant: Proof must be provided by student (of spoken language proficiency) by one of the

following:

1. Submit transcripts showing completion of 3 years of high school in same language with a “C” or

better, or 2 years in college through the intermediate level OR

2. Submit AP or SAT Subject test scores in the language OR

3. Submit Language Proficiency Verification form completed by a professor, clergy, or supervisor.

The person completing this proficiency certification must be:

1. Proficient in the identified foreign language and

2. Have known the applicant and observed his/her language skills in the past year, and

3. Not be a close family member or friend.

Certification of proficiency in the language of

Contact information for Individual Verifying Language Proficiency

Name (print) Title

Organization Phone

Address Email

City, State, Zip

Please answer the following questions:

1. How long have you known the applicant and in what capacity (professor, clergy, supervisor)?

2. How often have you observed the applicant conversing/translating in this language?

Daily 2+ day a week 1 day a week Other

3. Is the applicant proficient in reading this language? Yes No

*Reading Definition: able to read standard newspaper items addressed to the general reader, routine

correspondence, reports, and technical materials in the individual’s special field.

4. Is the applicant proficient in speaking this language? Yes No

*Speaking Definition: Able to speak the language with sufficient structural accuracy and vocabulary to

participate effectively in most formal and informal conversations on practical, social, and professional

topics.

Signature: Date:

(professor, clergy, or supervisor)