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MSU COLLEGE OF NURSING PLACEMENT APPLICATION November 15, 2017: page 1

MSU- College of Nursing Application for Placement

Fall 2018 Sophomore Level Nursing Courses

Spring 2019 J1 Upper Division Nursing Course

Eligibility for Application: Correlates to C-16 Placement Policy and Procedure found at

http://www.montana.edu/nursing/facstaff/policies.html

Applications who do not meet MSU CON C-16 eligibility requirements by the application deadline will

not be processed

Applicants must have completed the following:

3/5 required pre-requisite sciences-one of which is BIOH 201 or equivalent

o Ability to complete remaining nursing pre-requisite courses by the start of sophomore

nursing courses FALL 2018

Nursing pre-requisite GPA at least 3.0

Complete GPA calculation worksheet in APPENDIX A

No more than two (2) retakes in the required nursing pre-requisites

All nursing pre-requisites courses must be successfully completed with a “C” or better (C-, D,

W, F are failed attempts)

Clinical Compliance Tracking through Castle Branch®

Official Transcripts from all Universities/Colleges mailed directly to the College of Nursing

Clinical Compliance Tracking: You may not start your CastleBranch account until December 15th, but you have until

January 10th to complete all requirements. You may be in process of your Hep B compliance until

complete.

The College of Nursing utilizes Castle Branch®, an accredited member of the National Association of

Professional Background Screeners (NAPBS) for clinical compliance tracking.

o Please use this link to get started:

https://portal.castlebranch.com/MV83/spif/MV84/MV84spring

o The cost is $168.00

Required through Castle Branch at application deadline (January 3rd , 2018)

o Urine Drug Screen

o Background Check

o E-Learning

o Policy Acknowledgments/Consents signed and posted

o Evidence of Health Insurance

Required to be in process at application and must be complete by January 10, 2018

http://www.montana.edu/nursing/


https://portal.castlebranch.com/MV83/spif/MV84/MV84spring


o Immunization evidence and 2-step TB test. See APPENDIX B

o American Heart Association Basic Life Support CPR for infants children adult and AED

Only American Heart Association CPR is accepted

Transcript Requirements:

Official Transcripts must be received by January 15th and mailed to:

College of Nursing Montana State University

ATTN: Debbie McCray P.O. Box 173560

Bozeman, MT 59717-3560

Do not send transcripts to the Registrar or Admissions office

CURRENT or FORMER MSU BOZEMAN STUDENT:

It is not necessary for you to submit a MSU transcript with your application (The College of

Nursing has access to your grades through the MSU Registrar’s Office)

However, if you have attended any other MSU colleges or universities including:

o MSU Billings, MSU Great Falls and MSU Northern you must provide official

transcripts

TRANSFER STUDENT:

Official transcripts for all schools attended/attending should be sent to the College of Nursing

Transcripts previously sent to the Registrar or Admission office are not automatically sent to

the College of Nursing and must be sent as described above

Pre-Requisite Course Evaluation: MSU transfer course equivalents, as determined by the MSU Admission’s Office and the College

of Nursing, are used for evaluating transfer course work

The number of credits used for grade point calculations are those associated with MSU courses (e.g., CHMY 121IN, 4 crs.), regardless of the number of credits for an equivalent course at a transfer institution

Laboratory grades for equivalents to BIOH 201, BIOH 211, CHMY 121IN and CHMY 123 are included in the calculation of grade point averages.

PLEASE NOTE: Students who are completing the nursing prerequisites at MSU-Bozeman, the lab grade in CHMY 121, CHMY 123, BIOH 201, and BIOH 211 is the same grade as the grade listed on your transcript



Grade point averages (GPAs) are calculated using the most recent grade earned in any required prerequisite or sophomore level nursing course regardless of where or when the course was taken.

Unusual grades found on transcripts will be interpreted according to the transcript key provided

by the grade granting institution

Any grades that are equivalent to an “F” grade (including “WF” grades) will be calculated as an

“F” grade

All courses completed by the end of the Fall 2017 semester will be calculated in the GPA

There are no calculations on, or penalties for, courses that have not been completed

College Writing and University Seminar requirements are waived for Post Baccalaureate (PB)

students.

University Admission Requirements: Application/Acceptance into the College of Nursing curriculum is not the same as

application/admission into Montana State University-Bozeman

Former Montana State University-Bozeman students who are not currently attending MSU must file an Intent to Register 30 days prior to registering for classes

o Go to MYINFO at https://atlas.montana.edu:9000/pls/bzagent/twbkwbis.P_WWWLogin

o Navigate to the STUDENT SERVICES TAB o select MSU-BOZEMAN online intent to register form

Transfer students who have never attended Montana State University will need to apply for undergraduate admission

o Go to this link: http://www.montana.edu/admissions/apply.html to apply

ALL Applicants: Email or mail your completed Nursing Application to the College of Nursing by January 3rd, 2018 to [email protected] or:

College of Nursing Montana State University

ATTN: Debbie McCray P.O. Box 173560

Bozeman, MT 59717-3560

TRANSFER STUDENTS: IN ADDITION-DO NOT DELAY IN APPLYING TO MSU (these are two separate application processes for transfer students). University Application deadlines are:

Fall semester – July 1


https://atlas.montana.edu:9000/pls/bzagent/twbkwbis.P_WWWLogin

http://www.montana.edu/admissions/apply.html

mailto:[email protected]


Spring semester – December 1 Summer semester – May 1

Application Sophomore Nursing Program: Fall 2018/J1 Spring 2019 A. PLEASE PRINT LEGIBLY APPLICATION DEADLINE: January 3, 2018

NAME:

Last

First

Middle

MSU Student ID#

(OR)

SS #

Permanent Mailing Address:

Street/POB:

City:

State/ZIP:

Current Mailing Address:

Street/POB:

City:

State/ZIP:

Telephone number: E -mail address:

Are you currently an LPN in MT? Y/N Are you a post-baccalaureate student

Y/N

Are you Native American? Y/N If you answered yes, are you interested in receiving information Nursing Program regarding the CO-OP (Caring for Our Own Program)? Y/N

Are you an Honors student? Y/N

Are you in ROTC? Y/N

Are you a Student athlete? Y/N

Are you a Music student? Y/N

B. Rank your preference for placement campus (1 through 5, with 1 being your first choice and 5 being

your last choice):

CAMPUS RANK (1-5)

CAMPUS RANK (1-5)

Bozeman: J1 Upper Division Spring Semester, 2019

Kalispell: J1 Upper Division Spring Semester, 2019

Billings: J1 Upper Division Spring Semester, 2018 Missoula: J1 Upper Division Spring Semester, 2019

Great Falls: J1 Upper Division Spring Semester, 2019

C. List all colleges/universities you have attended (including MSU): Name of Institution Dates of

Attendance Degree Earned



We are asking applicants to answer the following questions as we gather data for

applicant demographics, scholarships, and academics. These answers do not

impact your application status. This information is protected by FERPA and will

be utilized in aggregate reporting without identifiers. High school ACT _______ or SAT________

Gender: ___Male ___Female ___Other ___Prefer not to identify

Are you the first, in the household in which you were raised, to attend college? YES NO

Do you plan to apply for financial aid? YES NO

Is English the primary language spoken in the home in which you were raised? YES NO

Are you eligible to participate in Federal Programs such as the: Scholarships for Disadvantaged Students, Loans to Disadvantaged Students, or the Nursing Workforce Diversity Grant Program? YES NO

Are you from a school district where 50% or less of graduates go to college or where college education is not encouraged? YES NO UNKNOWN

Are you from a family that receives public assistance (e.g., Aid to Families with Dependent Children, food stamps, Medicaid, public housing)? YES NO

Please indicate: ___American Indian or Alaskan Native ___Asian* (not of Hispanic origin) ___Black or African American (not of Hispanic origin) ___Hispanic or Latino ___Native Hawaiian or Other Pacific Islander ___White (Not of Hispanic Origin) ___Two or More Races ___Race/Ethnicity Unknown



Application Checklist/Policy Acknowledgement: Please carefully read the following information

Initial each box

Providing full name date at the end of the document

□ I have evaluated my transcript(s) and academic standing and am confident that I can successfully complete all of the required prerequisite courses for upper division placement (including the Sophomore level nursing courses at MSU and any correspondence/on-line courses or CLEP exams) by Spring 2019. See Appendix C

□ I am a currently enrolled MSU -Bozeman student, OR I know that I must apply for admission to MSU through the

Office of Admissions. □ I have made the necessary arrangements to have my transcript(s) available to the MSU College of Nursing.

□ I WAS ENROLLED in courses Fall 2017 semester. Therefore, the Fall 2017 official transcript(s) will be

received in the College of Nursing no later than January 15, 2018.

- or -

□ I WAS NOT ENROLLED in courses Fall 2017 semester. Therefore, the transcript(s) I requested sent to

the College of Nursing are complete to date.

□ I have completed the grade point average calculation worksheet. I have made a copy for my records. □ I understand that I will be notified after March 1, 2018 whether or not I have received placement for Fall 2018

Sophomore nursing courses and Spring 2019 Upper Division. □ I understand I may be required to attend sophomore level NRSG courses at my upper division

campus assignment in fall, 2018 (dependent upon resources at each campus). □ I understand students with minimum grade point average of 3.00 who have also completed clinical compliance

tracking, and who are not offered placement may request to be placed on the Waitlist. Waitlist students may be offered a placement as openings occur.

□ I have established my Castle Branch account, and I understand the deadline requirements for Clinical Compliance

Tracking as described in this application. □ I understand that if I am offered placement I will need to complete all required prerequisites and sophomore level

nursing courses with a minimum grade of C or better and have a MSU-Bozeman cumulative GPA of 3.00 or higher to progress to upper division. I understand that grades I have earned at other schools are not included in the MSU-Bozeman cumulative GPA.

□ I have read College of Nursing Placement Policy C-16 on the College of Nursing Web site at http://www.montana.edu/nursing/facstaff/policies.html (Policy C-16) AND I understand that placements are made

on available space, faculty and resources at each clinical site. □ I have read College of Nursing Abilities Required for Success in the BSN Degree Program Policy A-19 at

http://www.montana.edu/nursing/facstaff/policies.html □ I have completed the affidavit for policies: A-19, A-20, A-36, and A-38, found in APPENDIX D. It is included with

this application.





□ I have retained a copy of this application, grade point average calculation worksheet, and appendix ____ affidavit for

my records.

Printed Name__________________Signature______________________Date_________

APPENDICES: APPENDIX A-GPA Calculation and GPA SAMPLE

APPENDIX B-Immunization Table

APPENDIX C-Progression to J1 Upper Division and Sophomore Course Planning

APPENDIX D- Affidavits for Policies A-19, A-20, A-36, and A-38



APPENDIX A-GPA Calculation and GPA SAMPLE SAMPLE

GRADE POINT AVERAGE CALCULATION WORKSHEET

Course Name

Prerequisites

grade

points

credits

points X credits

CHMY 121IN

General Chemistry

Level 3 Math Placement Exam

B

3.0

3 9.0

Lab

B

3.0

1

3.0

CHMY 123

Organic & Biochem Principles

CHMY 121 or equivalent S’18

3

Lab S’18

1

BIOH 201

Anatomy & Physiology I

CHMY 121 or equivalent

B+ 3.3

3 9.9

Lab

B+ 3.3 2 6.6 BIOH 211

Anatomy & Physiology II BIOH 201 or equivalent

S’18

3

Lab

S’18 1

BIOM 250 Microbiology for Health Sciences

None

A 4.0

3 12.0

NUTR 221CS

Human Nutrition

None

B-

2.7

3 8.1

FCS 101

Individual and Family Development and Well-Being: Lifespan

None

F’17

3

PSYX 100IS

Introduction to Psychology

None

A

4.0

4

16.0

SOCI 101IS

Introduction to Sociology

None

Su 18

STAT 216Q

Elementary Statistics

C- or better in any 100 level or above MATH course, Level 3 MATH Placement Test or ACT & SAT scores

SU 18

3

WRIT 101W

College Writing I (Waived for Post Baccalaureate students) None A 4.0 3 12.0

CLS 101US

Knowledge & Community (Waived for Post Baccalaureate Students) None A- 3.7 3 11.1

NRSG 115 Nursing as a Profession None A 4.0 2 8.0 NRSG 220

Foundations of Ethical Nursing Practice None F’18 2

NRSG 225

Foundations for Planning and Providing Clinical Nursing Care

BIOH 201, BIOH 211, FCS 101 and BIOM 250

F’18 4

NRSG 258 Principles of Pathophysiology

BIOH 201, BIOH 211, CHMY 121 and CHMY 123

F’18 3

NRSG 238

Health Assessment Across the Lifespan

BIOH 201, BIOH 211, NRSG 225 (pre- or co-requisite)

F’18 4

TOTAL 27



AVERAGE CALCULATION WORKSHEET Please fill in the information requested below and calculate your own grade point average using the sample on the previous page for reference. If you are currently enrolled in prerequisite courses listed below, simply indicate the semester you are taking the course and do not fill in a grade.

Course Name

Prerequisites

grade

points

credits

points X credits

CHMY 121IN

General Chemistry

Level 3 Math Placement Exam

3

Lab

1

CHMY 123

Organic & Biochem Principles


3

Lab

1

BIOH 201

Anatomy & Physiology I


3

Lab 2 BIOH 211

Anatomy & Physiology II BIOH 201 or equivalent

3

Lab 1

BIOM 250 Microbiology for Health Sciences

None

3

NUTR 221CS

Human Nutrition

None

3

FCS 101

Individual and Family Development and Well-Being: Lifespan

None

3

PSYX 100IS

Introduction to Psychology

None

4

SOCI 101IS

Introduction to Sociology

None

STAT 216Q

Elementary Statistics

C- or better in any 100 level or above MATH course, Level 3 MATH Placement Test or ACT & SAT scores

3

WRIT 101W

College Writing I (Waived for Post Baccalaureate students) None 3

CLS 101US

Knowledge & Community (Waived for Post Baccalaureate Students) None 3

NRSG 115 Nursing as a Profession None 2 NRSG 220

Foundations of Ethical Nursing Practice None 2

NRSG 225

Foundations for Planning and Providing Clinical Nursing Care

BIOH 201, BIOH 211, FCS 101 and BIOM 250

4

NRSG 258 Principles of Pathophysiology

BIOH 201, BIOH 211, CHMY 121 and CHMY 123

3

NRSG 238

Health Assessment Across the Lifespan

BIOH 201, BIOH 211, NRSG 225 (pre- or co-requisite)

4

TOTAL 27

C- = 1.7

B+

=

3.3 D+ = 1.3

B

=

3.0 D = 1.0

B-

=

2.7 D- = 0.7

C+

=

2.3 F = 0

Grade

Point

Averag

e =

3.544



Instructions for calculating grade point average: Grade Point Average = 1. Insert grade earned for classes taken through Fall 2017. 2. Enter points based on grade following chart at right. 3. Multiply points by credits for each class and enter in last column. 4. Total number of credits completed. 5. Total last column and divide by total credits to find grade point average.

Key A A-

4 3.7

B 3

B- 2.7

C+ 2.3

C 2



APPENDIX B-Immunization Table TABLE #1-MSU CON Immunization Requirements- Policy #A-20

REQUIREMENT PROCEDURE COMPLETION

DEADLINES

Tuberculosis:

All nursing students

are screened

annually for

tuberculosis (TB)*

*If the student has had no test, or no recent test (within 2 years), a two-step skin test must be done to provide a baseline. NEW APPLICANT OR NO EVIDENCE OF ANNUAL TB TESTS past 2 years*: If the student has had no test, or no recent test (within 2 years), a two-step skin test must be done to provide a baseline. STEP 1: A skin test is administered using Purified Protein Derivative (PPD) and must be read within 48-72 hours. STEP 2: If the first skin test is negative, a second PPD skin test is administered within 1-3 weeks after the first one and read within 48-72 hours. Students who interrupt the program of study and who are not able to produce evidence of annual testing while out of the program, must submit the 2 STEP TESTING. CONTINUING STUDENT: The Student has provided evidence annually of TB tests while in program. 1. One PPD skin test is administered and read within 48-72 hours. If the skin test is positive or converts to positive, a medical evaluation is required. This test must be completed within 10-12 months of the previous annual test.

STUDENTS with history of exposure to TB/BCG immunization/Sensitivity to PPD Testing:

1. QuantiFERON Gold blood test (lab report required) OR T-Spot blood test (lab report required)

POSITIVE TEST RESULTS TO ANY TESTING: If positive results to any of the above, the student MUST submit provider clearance documented on provider letterhead.

NEW APPLICANTS: Upon application as a 2 step test process—unless able to provide evidence of annual testing CONTINUING STUDENTS: Annually thereafter. And Upon return from travel outside the US—regardless of when the next annual TB test is due. **Students who have interrupted their placement for any reason must either show annual tests results while out of the program, or must submit to a new two-step testing process upon return.

Measles Mumps Applicants born in 1957 or later can be considered immune to Measles Mumps and Rubella (MMR) only if they Upon application



Rubella (MMR):

All students must

provide evidence of

adequate immunity

via proof of prior

vaccination for

MMR.

have one of the following: a. Documentation of laboratory confirmation of disease b. Proof of appropriate vaccination against MMR:

i. 2 doses of live measles and mumps vaccines given on or after the first birthday and separated by 28 days or more and at least one does of live rubella vaccine.

Hepatitis B

(HBV):

Students entering

undergraduate

clinical nursing

course work are

required to present

documentation of

serologic evidence of

immunity (either by

vaccination or

previous infection,

demonstrated by

positive titer) to

HBV.

A series of three vaccinations is given over 6 months to provide immunization. A titer level is drawn 6 weeks after the last injection to document immunity. If the previously vaccinated student does not have evidence of a responsive post vaccination titer: 1. Complete a booster or “challenge dose” and obtain a titer post booster

2 .If the student does not respond to the challenge dose, complete the series and obtain a final titer.

If the student has never been immunized or exposed to Hepatitis B: 1. Complete the Hep B series and provide evidence of a positive antibody titer post vaccination (lab report

required)

2 .If your series is in process, provide evidence of where you are in the series to CastleBranch.

Note: If the student declines these Hep B requirements, the student must sign the Declination Waiver form. The Declination Waiver is available to download on Castle Branch from this requirement.

Upon application



Varicella: Students are required to provide one of the following: 1. Documentation of adequate immunity through a positive varicella titer OR 2. Proof of 2 vaccinations OR 3. Medically documented history of disease (date of disease required) 4. If a student’s varicella titer level is negative, the student must receive 2 doses of vaccine at an interval of 4-8

weeks between doses. 5. Post vaccination titer after 2 doses of vaccine is not necessary or recommended.

Upon Application

Tetanus,

Diphtheria,

Acellular

Pertussis (Tdap)

One of the following is required: 1. Documentation of a Tetanus, Diphtheria & Pertussis (TDaP) vaccination from anytime AND a Td booster

administered within the past 10 years OR 2. Documentation of a Tetanus, Diphtheria & Pertussis (TDaP) vaccination, administered within the past 10

years.

Upon Application

FLU vaccination 1. Students should receive annual flu vaccination 2. If a student wishes to decline, he/she must sign a declination waiver and must comply with all clinical

agency requirements during flu season as an unvaccinated person.

Annually during flu season

Students without valid documentation will not be permitted to attend clinical (will be denied access to clients).



APPENDIX C-Progression to J1 Upper Division & Sophomore Course Planning

SOPHOMORE LEVEL NURSING COURSE PLANNING:

The College’s required sophomore level nursing courses have restricted entry, so students cannot automatically enroll in these courses. Instead, students are placed in these courses by the College of Nursing in Fall 2018, the semester prior to the students first semester of Junior 1 nursing courses in Spring 2019. In planning for your sophomore level nursing course work, please keep the following information in mind:

Students applying for Spring 2019 Upper Division, may be required to attend sophomore level nursing courses at their Upper Division campus (dependent upon resources).

All students are required to have completed clinical compliance tracking by January 3, 2019 deadline. This tracking includes a urine drug screen, a background check, e-learning, acknowledgements of policies, CPR, and immunization. Applications will not be processed unless all documentation has been uploaded to Castle Branch®. All compliance tracking is reviewed by the College of Nursing. If the results reveal any discrepancies, students will not be offered a placement until the results have been reviewed and approved by the College of Nursing Dean, Associate Dean, and Campus Directors.

All of the College’s required prerequisite courses must be completed with a minimum grade of C or better (C- is not acceptable), and no more than 2 of the required prerequisite courses may be repeated 1 time regardless of the grade received. If a student has repeated more than 2 of the required prerequisite courses more than 1 time and only if they have extraordinary circumstances (i.e. death in family), they may appeal to the Scholastic Committee requesting permission to apply for an upper division placement. Such appeals must be received in the College of Nursing by May 1, 2018.

NRSG 225 – prerequisites are: BIOH 201 & 211, FCS 101, and BIOM 250 (or equivalent courses), NRSG

238 is a required co-requisite. NRSG 238 – prerequisites are: BIOH 201 & 211 (or equivalent courses), NRSG 225 is a required co-

requisite NRSG 258 – prerequisites are: BIOH 201 & 211, CHMY 121IN, and CHMY 123 (or equivalent courses). NRSG 115 or NRSG 220 – no prerequisites, but must have upper division placement to be enrolled in

NRSG 220.

Students are strongly encouraged to take sequenced courses (such as the two Anatomy and Physiology courses) in their entirety at either their pre-nursing institution or at MSU to avoid difficulties related to having “parts or pieces” of equivalent courses in the transfer process.

If you are in doubt as to whether or not you can successfully complete (grade of C or better) all of the required prerequisite course work and sophomore level nursing courses in time to be ready for your requested upper division placement assignment, please confer with your academic/pre-nursing advisor. If you are not working with an advisor, please feel free to contact Amanda Griswold, Student Services Coordinator, [email protected] for assistance well in advance of the January 3rd deadline.



GENERAL CRITERIA FOR ADMISSION TO UPPER DIVISION COURSE WORK:

Required Sophomore level nursing courses and all required prerequisite courses (see list on page 9)

must be completed with a minimum grade of C or better (C- is not acceptable), and no more than 2 of

the required prerequisite courses may be repeated 1 time regardless of the grade received.

A minimum cumulative overall grade point average of 3.00 or better, in all courses taken at MSU-

Bozeman, must be achieved. This is not in reference to your pre-requisite GPA, which was used for

application and admission to nursing. This cumulative GPA refers to ALL grades earned at MSU-

Bozeman

Students who have not achieved an MSU-Bozeman cumulative GPA of 3.00 or better will not be

permitted to begin upper division even if they have met all other requirements (e.g., C or better in

required prerequisite courses) and have an upper division placement.

o [Note: MSU-Bozeman cumulative GPA does not include grades from other MSU units (e.g.

MSU-Billings, MSU-Great Falls, or MSU-Northern).

o Students who have previously attended MSU-Bozeman and who have a cumulative GPA of less

than 3.00 should prepare for an appeal to the College of Nursing Scholastic Committee upon

completion of sophomore level nursing courses and prior to beginning the upper division

placement. This appeal is due by December 26th, 2018 to the College of Nursing. See Policy

A-8: http://www.montana.edu/nursing/facstaff/policies.html

Annual Clinical Compliance Tracking is required while enrolled in the nursing program at a cost of

$106.00 annually after the initial application compliance.




APPENDIX D- Affidavit for Policies A-19, A-20, A-36, A-38

Policy A-19, Abilities Required for Success in the BSN Degree Program Attachment #2 Affidavit I have read Policy A-19 (found on the College of Nursing website at http://www.montana.edu/nursing/facstaff/policies.html and understand the expectations. I have reviewed the list of required abilities in Policy A-19, Attachment #1, and I am able to or believe I have the potential to perform the required tasks/skills by the time of degree completion. Applicant’s Complete Legal Name _________________________________________

Date ___________________

By providing my name above, I certify the information given is complete and accurate.

OR I have read Policy A-19 Abilities required for success in the BSN degree program (found on the College of Nursing website at http://www.montana.edu/nursing/facstaff/policies.html and understand the expectations. I have reviewed the list of required abilities in Policy A-19, Attachment #1, and I am not able to or don’t believe I have the potential to perform some of the required tasks/skills by the time of degree completion. The tasks/skills that I do not believe I am able to or will be able to perform by the time of degree completion are: I understand that I may be referred to the Montana State University Office of Disability, Re-entry & Veterans Services to document and assess eligibility of a disability (which is determined case-by-case) and to discuss if reasonable accommodations can be provided to assist me in being able to accomplish the skills/tasks I have identified above. Applicant’s Complete Legal Name ________________________________________

Date ____________________


Policy A-20 Student Communicable Disease Prevention Policy

I have read Policy A-20 (found on the College of Nursing Website at: http://www.montana.edu/nursing/facstaff/policies.html and understand that I must complete required immunizations and have the Hepatitis B series in progress upon submission of my application. I understand that I will not be permitted to participate in clinical until my immunizations are complete and I have shown proof of completion. Applicant’s Complete Legal Name _____________________________________ Date __________________________ By providing my name above, I certify the information given is complete and accurate.






Policy A-36 Student Background Checks

I have read Policy A-36 (found on the College of Nursing Website at: http://www.montana.edu/nursing/facstaff/policies.htmland understand that I need to have a cleared background check upon submission of my application. Until my background check is cleared I will not be offered an upper division placement. Applicant’s Complete Legal Name _______________________________________

Date _______________________


Policy A-38 Student Urine Drug Testing

I have read Policy A-38 (found on the College of Nursing Website at: http://www.montana.edu/nursing/facstaff/policies.html and understand that I need to have a urine drug test completed upon submission of my application. Until my urine drug screening is cleared I will not be offered an upper division placement. Applicant’s Complete Legal Name _______________________________________

Date _______________________





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