Successful completion of the program does not guarantee

Dear Applicant,

Thank you for your interest in the Moberly Area Community College’s Virtual/Hybrid

Accelerated Associate Degree of Nursing program. This one-year program is offered at the main

campus in Moberly, Missouri, the Kirksville Area Technical Center in Kirksville, Missouri and

the Advanced Technology Center in Mexico, Missouri. The virtual/hybrid program combines

the benefits of a web-based, real-time instructional delivery platform. This brings the education

to the students at one of our off-campus locations, along with the benefits of hands-on

classroom/lab experiences, face-to-face faculty engagement, experience with state-of-the-art

simulation equipment and real-life clinical experiences, predominantly in the students’ local

community.

Upon successful completion of the program, the student is eligible to apply to take the National

Council of Licensing Examination for Registered Nurses. The Missouri Nurse Practice Act,

Section 335.006, provides additional criteria for eligibility to apply for licensure to practice

nursing. Successful completion of the program does not guarantee eligibility to take the

licensing exam. Satisfactory performance on the examination will qualify the student for

licensure as a registered nurse.

To begin the application process the following admission packet must be completed and

submitted to the Director of Nursing and Allied Health at Moberly Area Community College by

the deadline stated on the Virtual/Hybrid Accelerated Associate Degree of Nursing Program

Application for Admission. Admission criteria can be located on the application for admission,

in the college catalog, and on the college website www.macc.edu. Applicants whose records

indicate the greatest potential for successful achievement in nursing will be selected for

admission into the program. An admissions committee process is utilized to select qualified

candidates for acceptance into the program.

All application materials must be received by the stated deadline. Only complete application

packets will be considered. If you have questions, please contact the Allied Health office at

660-263-4110 ext. 11250.

Submit application materials to:

Moberly Area Community College

Ruth J. Jones, R.N., M.S.

101 College Avenue

Moberly, MO 65270

Sincerely,

Ruth J. Jones, R.N., M.S.

Director of Nursing and Allied Health



101 College Avenue

Moberly, MO 65270-1304

Phone (660) 263-4110

Fax (660) 263-6252

Website www.macc.edu

Jeffery C. Lashley, Ph.D., President

http://www.macc.edu/

http://www.macc.edu/

MOBERLY AREA COMMUNITY COLLEGEVIRTUAL/HYBRID ACCELERATED ADMISSIONS FOR

LICENSED PRACTICAL NURSES INTO THE ASSOCIATE DEGREE NURSING PROGRAM

Articulation between nursing programs facilitates the education of nurses with advanced preparation necessary to meet current andfuture nursing needs. The advanced placement of licensed practical nurses is an accelerated admission option to the Associate Degreein Nursing (ADN) program that builds on the basic practical nursing education. This virtual/hybrid program combines traditionalclassroom/lab/clinical experiences with state-of-the-art patient simulation and web synchronous instruction. The MACC acceleratedADN Program will accept up to thirty students and begin classes January 2015. Ten students will be accepted for the Moberly site, tenstudents will be accepted for the Kirksville site, and ten students will be accepted for the Mexico site. Applicants must submit com-pleted forms by October 1 to the Allied Health Office (Moberly campus location).

All forms must be submitted by October 1 toMoberly Area Community College

Ruth J. Jones, R.N., M.S.101 College Avenue

Moberly, MO. 65270

ENTRANCE REQUIREMENTS

Admission to the nursing program Accelerated Admissions Option is based upon the following:

1. Complete all admission requirements for Moberly Area Community College.

2. Complete all developmental courses including Intermediate Algebra prior to admission into the Accelerated AdmissionsOption Program.

3. Obtain a composite ACT of 20 or above. The ACT must be repeated if completed five years or more before the dateof entry into the AADN program. Test dates are available from Student Services.

4. Complete the NLN Challenge Exam with a score of 62% or greater on the NACE I Nursing Care of the Child andNACE I Nursing Care of the Childbearing Family. Please register online for the exam at www.nln.org

5. Submit official transcripts of high school, GED transcript, previous college, and/or schools of nursing to the Registrarin the Office of Student Services.

6. Complete and return a notarized Revocation of Licensure form to the Allied Health office prior to or on October1.

7. Complete and return a notarized Essential Qualifications form to the Allied Health office prior to or on October 1.

8. Submit to and pass a criminal background check as well as the review of the Employee Disqualification List throughthe Department of Health and Senior Services.

9. Consideration is given for prior experience in the health care field.

10. Submit three reference forms. The composite score of each must be no higher than 2.0. These may not be completedby personal friend or relative. Obtain from the Allied Health Office.

11. Provide proof of graduation with a minimum GPA of 2.5 or above from a state-accredited program of Practical Nursing.

12. Provide a copy of current undisciplined Missouri Practical Nursing license.

13. Have earned a "C" or above grades in all required courses which are part of the ADN curriculum.

14. Have a cumulative 2.5 grade point average from high school or college. All university or college coursework attemptedwill be considered when determining a student's cumulative grade point average. College transcript supersedes highschool transcript.

15. Once accepted into the program, students must maintain a 2.5 cumulative grade point average.

16. Have a TOEFL score of 560 on the written exam or a score of 86 on the TOEFL IBT exam, or an ACT English scoreof 20 or greater, or a "C" or better in Composition I for students for whom English is a second language.

The above information will be received and evaluated by an admissions committee. Applicants whose records indicate thegreatest potential for successful achievement in nursing will be selected. Please be reminded that these are minimumapplication criteria for the program and does not guarantee admission. Decisions of the Admissions Committee arefinal.

4-9-14 AH 107

(Rev. 4-13-11)

*RECOMMENDED COURSE SEQUENCE

Spring TermMental Health 4 credit hoursMaternal Child Studies 4 credit hoursMicrobiology 4 credit hoursComposition II 3 credit hoursTOTAL 15 credit hours

Summer TermAdult Health I 6 credit hoursManaging Intravenous Therapies 1 credit hoursProfessional Perspectives 3 credit hoursPublic Speaking 3 credit hoursTOTAL 13 credit hours

Fall TermAdult Health Nursing II 10 credit hoursFunctions and Policies of American Government orAmerican History to 1865 3 credit hoursTOTAL 13 credit hours

Fundamentals of Nursing advanced standing - 6 credit hours will be awarded after successful completion of Adult Health Nursing I.Medication Administation advanced standing of 1 credit hour will be awarded after completion of Adult Health Nursing I. Maternal-ChildNursing Advanced standing - 4 credit hours will be awarded upon successful completion of the NLN Challenge Exam and subsequentcompletion of Maternal Child Nurse Studies Course.

Physiology and Microbiology must be repeated if completed five years or more before the first nursing course date of the VirtualAccelerated ADN Program.

Upon successful completion of the program, the student is eligible to apply to take the National Council of Licensing Examination forRegistered Nurses. MO Nursing Practice Act, Section 335.066, provides additional criteria for eligibility to apply for licensure to practicenursing. Successful completion of the program does not guarantee eligibility to take the licensing exam. Satisfactory performanceon this examination will qualify the student for licensure as a registered nurse.

**NOTIFICATION**Please be advised that clinical facilities will request a drug screen and additional background checks for nursing students doingclinical practicums in their facilities. This will be at the student's expense.

4-9-14 AH 107

Required Pre-Entry Courses Additional Recommended Courses

Class Credit HoursHuman Anatomy 4Physiology 4General Psychology 3Human Lifespan 3

Class Credit HoursComposition I 3College Algebra 3Sociology 3

REQUIRED PRE-ENTRY COURSESPrior to beginning the professional nursing sequence, 23 credit hours of general education coursework must be completedincluding 14 credit hours of the following required courses, and an additional 9 credit hours of college-level courses thatpertain to the AADN curriculum.

Moberly Area Community College is committed to a policy of nondiscrimination on the basis of race, color, national origin, gender, disability, age,

marital or parental status, religion, genetics, ancestry, or veteran status in admissions, educational programs, activities, and employment. Inquiries

concerning Section 504 of the Rehabilitation Act of 1973, which guarantees access to education regardless of disability, should be directed to: Meghan

Holleran, Director - Office of Access and ADA Services, 601 Business Loop 70 West, Suite 216, Columbia, Missouri 65203, 573-234-1067, ext.

12120. All other inquiries concerning nondiscrimination, including equal opportunity and Title IX, should be directed to one of the following people:

Dr. Jackie Fischer, Dean of Academic Affairs, 101 College Avenue, Moberly, Missouri 65270, 660-263-4100, ext. 11236 or Patricia Twaddle, Career

and Placement Services, 101 College Avenue, Moberly, Missouri 65270, 660-263-4100, ext. 11232.

Application For AdmissionMoberly Area Community College

101 College AvenueMoberly, MO 65270

(660) 263-4100 or 1-800-622-2070Have you previously attended MACC? Yes No Fax: (660) 263-2406 E-Mail address: [email protected] complete (print or type) both sides of this application in ink and return to MACC. No Admission Fee

General Information Social Security Number:

Legal Name:Last First Middle Previous or Maiden

Permanent Legal Address: (Verification may be requested) Home Phone: ( )Cell Phone: ( )Work Phone : ( )

Street Box Apt. No.E-mail Address:

City State Zip County Resident Status: Moberly(Check One) Missouri

How long at this address? Out-of-State

Local Address (if different from above):Address City State Zip County

Date to begin classes: 20 Fall Spring Summer

Personal Information *This information is requested for the purpose of reporting to Federal Compliance Agencies and will not be used in determining admission status. Your response to this information is strictly voluntary.

*Sex: Male Female *1. Are you Hispanic/Latino Yes No Citizenship:2. Race (select 1 or more) U.S. Citizen

Date of Birth: American Indian or Alaska Native Permanent Resident*Veteran: Yes No Asian F-1/Other Visa,*First Generation College Student:Yes No Black or African American International Student*Marital Status: Married Single Native Hawaii/Other Pacific Islander Non U.S. Citizen

White Country:

Education Background (Note: An official copy of your high school transcript or of your G.E.D. scores must be submitted.)

Last High School Attended:School Name City State

Graduated: Month YearPassed G.E.D. Test: Month YearAttending and expect to graduate: Month Year Highest grade level completed:Not a graduate nor attending. Separation date: Month Year

Are you a graduate of a designated A+ School? Yes NoIf you answered yes, have you met the criteria for the A+ schools program? Yes No Don't Know

Did you complete a one- or two-year vocational program during high school? Yes NoIf you answered yes, are you applying for vocational credit by articulation? Yes No

Name of Vocational School: Program:Enrollment Status: (please check one)

Non-degree seeking (enrolled in college credit course work for an unspecified amount of time but not intending to earn a degreeat this institution and not seeking financial aid).Degree-Seeking (options on back, please check one).High School Student (enrolled for dual-credit). Your current grade level is: Junior SeniorHigh School Student (enrolled as dual enrolled).Special (have already graduated from a college or university with an associate or higher level degree and seeking a degree atMACC).Visitor (any student regularly enrolled at another college or university and taking college credit courses at MACC with thepermission of their home institution). Continue on back

3-11-11 Form SS 201A

Entered Rec'd LS Pend HP#

Career/Technical: Career ProgramsThese programs prepare you for immediate employment or assist youin upgrading job skills and are not designed as transfer programs.My MACC enrollment plans are: (Check Only One)

Graduate from MACC with an Associate of Applied Science degree (AAS)Graduate from MACC with a one-year CertificateGraduate from MACC with an Associate degree in NursingGraduate from MACC with an Accelerated Associate Degree in NursingGraduate from MACC with a Certificate in NursingUpgrade or improve existing job skills (no degree planned)Complete course(s) for personal/professional interest onlyComplete Child Development Associate (CDA - No Degree)

Associate of Applied Science degree: (Check Only One)Business Accounting Technology (5301)Business & Office Technology Executive (5304)

Legal (5305) Medical (5306)Computer Technology Programming (5319)Computer Technology Networking (5320)Early Childhood (6001)Drafting Design Technology (5904)Graphic Arts Technology (5903)Industrial Technology Machine Tool (5604)

Industrial Maintenance (5605) Power Plant (5607)Marketing/Management Technology (5303)Medical Laboratory Technology (5705)Pre-Occupational Therapy Assistant (5708)Welding & Metals Technology (5801)

Certificate Programs: (Check Only One)Business & Office Technology (5308)Computer Technology Programming (5317)Computer Technology Networking (5318)Early Childhood (6002)Drafting Design Technology (5907)Graphic Arts Technology (5906)Industrial Technology (5602)Law Enforcement Training Center/LETC (1318)Marketing/Management Technology (5309)Practical Nursing (5703)Welding & Metals Technology (5802)

Educational Background Continued (Note: All transfer credit must be submitted from EACH college/universitypreviously attended.)

Colleges or Universities Attended:

Name of College/University City/State Dates Attended Hours Earned/Degree Earned



Please Answer Questions In Only One Column.

3-11-11 Form SS 201A

Moberly Area Community College has two divisions throughwhich you may take courses. Please choose either theAssociate of Arts, Associate of Science Degree or the Career/Technical division and answer the appropriate questions inthat column only.

Associate of Arts Degree: Transfer ProgramsThese areas of study enable you to: complete the generaleducation requirements of 4-year colleges/universities, completemost lower division major requirements, to explore areas ifundecided, or take courses for personal interest.

My MACC enrollment plans are: (Check Only One)Graduate from MACC with an Associate of Arts degree(Transfer degree)Take selected courses to transfer to another college/university (no degree at MACC)Complete course(s) for personal/professional interestonly

Area of Concentration: (Please list major below)

Associate of Arts in Teaching: Transfer ProgramThis degree allows education majors to transfer into an educationprogram at a four-year college/university as juniors.

Associate of Science Degree: Transfer ProgramThis degree allows engineering majors to transfer to theUniversity of Missouri-Rolla or the University of Missouri-Columbia as juniors.

My MACC enrollment plans are:Graduate from MACC with an Associate Arts in Teaching(Transfer degree for education majors)Graduate from MACC with an Associate of Sciencedegree (Transfer degree for engineering majors)

Contact In Case of Emergency: Relationship: Phone:

Address: City/State: Zip:I understand that my high school transcript or a copy of my G.E.D. scores and all transcripts from colleges attended must be on file with MACC by the completion of the first ten days

of class in a 16-week semester or the equivalent in a shorter session. I understand giving misinformation or deleting information concerning previous enrollment in other colleges oruniversities will void my admission. All transcripts become the property of MACC and will not be returned.

I hereby certify that to the best of my knowledge the information on this application is true and complete without evasion or misrepresentation. I understand that if found to beotherwise, it is sufficient cause for rejection or dismissal with forfeiture of all my fees and/or deposits. Further, I agree to accept and abide by all rules, regulations and policies establishedby the Board of Trustees of MACC.

Date: Signature:(legal name) APPLICATION MUST BE SIGNED

Moberly Area Community Col lege is committed to a policy of non discrimination on the basis of race, color, nation al origin, gend er, disab ility, age, marital or p arental status, reli gion, genetics, an cestry, or veteran s tatus in admi ssions, education al programs,activities, and employment. Inquiries concerning Section 504 of the Rehabilitation Act of 1973, which guarantees access to edu cation regardless of disability, should be directed to: Cate Cooper, Coordinator - Office of Access and ADA Services, 101 Coll egeAvenue, M oberly, M issouri 6 5270, 6 60-263-4100, e xt. 1 1240. A ll o ther i nquiries c oncerning n ondiscrimination, i ncluding e qual o pportunity a nd T itle I X, s hould b e d irected t o o ne o f t he f ollowing p eople: D r. J eff L ashley, V ice P resident f or I nstruction,101 College Avenue, Moberly, Missouri 65270, 660-263-4100, ext. 11264 or Patricia Twaddle, Career and Placement Services, 101 C ollege Avenue, Moberly, Missouri 65270, 660-263-4100, ext. 11232.

(____)

MOBERLY AREA COMMUNITY COLLEGE

VIRTUAL/HYBRID OPTION ACCELERATED ADMISSIONSFOR LICENSED PRACTICAL NURSES INTO THE

ASSOCIATE DEGREE NURSING PROGRAM

APPLICATION FOR ADMISSIONDEADLINE FOR COMPLETED APPLICATION IS OCTOBER 1, 2014

MOBERLY KIRKSVILLE MEXICO

PLEASE PRINT OR TYPE

Date of Application __________________

Legal Name ____________________________________________ __________________________

Other names under which your records may be located ________________________

Home address _______________________________________________________________________

Telephone ___________________ Cell Phone __________________ E-mail Address _______________

Last

Last First Middle Social Security #

First Telephone

3-12-14 Form AH 106

*High School

*College orUniversities

Schools ofNursing

Other

*Must have official high school transcript, GED score (if applicable), and ALL college transcripts in the Student Services Office priorto October 1, 2014.

SchoolsAttended

PREVIOUS EDUCATIONDatesName and Location Certificate, Diploma, or

Degree AwardedYear

Have you been convicted, been imprisoned, been on probation, or been on parole? (Include felonies, firearms or explosives, misdemeanors,and all other offenses.) ________Yes or _______No You must answer "yes" if you received a Suspended Imposition of Sentence (SIS).*If "YES", attach additional sheets to provide the details.

Guardian

In case of emergencyParent

Other Relative

In the box below please rank in numerical order your preference for physical location. 1= 1st preference, 2= 2nd preference, 3= 3rdpreference. If you do not desire a location place an X in the related box. Select only campuses where you are willing to commute or

relocate for the Virtual Accelerated Admissions Option program.

City State Zip Code

I understand that all information contained in this application, high school, college or university transcripts,together with the information received from references, will be presented to an admissions committee forreview, and I hereby grant permission to have my records reviewed.

Signature

3-12-14 Form AH 106

**NOTIFICATION**Please be advised that clinical facilities will request a drug screen and additional background checks for nursing studentsdoing clinical practicums in their facilities. This will be at the student's expense.

WORK EXPERIENCE

Employer Address Dates Reason for Leaving

Meeting the Grade point requirementA minimum overall cumulative 2.5 GPA (Grade Point Average) or higher is required in all college coursework at the timeof AADN application submission. Points are earned in the AADN application review process for GPA; higher cumula-tive GPA's will receive more points than lower cumulative GPA's.Grade Point Average is calculated using all college coursework completed, whether or not the coursework is specificallyrequired for entrance into the AADN program. Applicants with coursework older than 5 years may request up to 12credit hours (with grades of "D" or lower) be waived from the GPA calculation. Waivers are not guaranteed but will bereviewed and approved on a case-by-case basis. To request a waiver for older coursework grades, please fill out theenclosed waiver form and return to the Allied Health office on the Moberly campus no later than September 1, 2014.

Moberly Area Community College is committed to a policy of nondiscrimination on the basis of race, color, national origin,

gender, disability, age, marital or parental status, religion, genetics, ancestry, or veteran status in admissions, educational programs,

activities, and employment. Inquiries concerning Section 504 of the Rehabilitation Act of 1973, which guarantees access to

education regardless of disability, should be directed to: Meghan Holleran, Director - Office of Access and ADA Services, 601

Business Loop 70 West, Suite 216, Columbia, Missouri 65203, 573-234-1067, ext. 12120. All other inquiries concerning

nondiscrimination, including equal opportunity and Title IX, should be directed to one of the following people: Dr. Jackie Fischer,

Dean of Academic Affairs, 101 College Avenue, Moberly, Missouri 65270, 660-263-4100, ext. 11236 or Patricia Twaddle, Career

and Placement Services, 101 College Avenue, Moberly, Missouri 65270, 660-263-4100, ext. 11232.

NLN Challenge Exam Requirements

An admission requirement of the Virtual/Hybrid Accelerated Associate Degree of Nursing

program requires successful completion of the National League for Nursing (NLN) Challenge

Exams with a score of 62% or greater on the NACE I Care of the Childbearing Family and a

score of 62% or greater on the NACE I Care of the Child exams.

The NLN Challenge Exams are comprehensive exams. The NACE I Care of the Childbearing

Family exam assesses the understanding of nursing care during the antepartal, intrapartal,

postpartal, and neonatal periods. The NACE I Care of the Child exam assesses nursing care of

children and adolescents.

The applicant will have a total of 2 attempts on each exam to achieve a score of 62% or greater

on each exam. Successful achievement on each exam is necessary to meet one of the admission

criteria. Should an applicant not be successful on the exams after two attempts, his/her

application will be withdrawn since he/she is not eligible for admission into the program. Please

note NLN Challenge Exam scores older than two years from the last test date will not be

accepted.

Testing Information

Applicants can obtain testing locations, dates, and times on the college website

www.macc.edu.

Please note, the NLN will close the exams for registration 3 days prior to the

scheduled exam date.

Testing locations include the Moberly site, Kirksville MACC site, and the Mexico

MACC site.

Applicants will need to take the following exams:

o NACE I Care of the Childbearing Family

o NACE I Care of the Child

Applicants will need to register and pay the testing fee online to the National League for

Nursing (NLN);

To register:

o Go to the NLN website www.nln.org

o Select NLN Testing Services, click on and create account.

o Select Online NACE Registration, and complete the registration process.

o You will then select the location, date, and time of your choice.

o Remember you must have your login ID and password. This will be used to

access the online exam.

o After registration is completed, applicants must print a copy of their

confirmation number and bring it with them on their testing date. Please

note that fees associated with the NLN on-line registration are non-

refundable.

o Please read the NLN’s policies related to the exam, refunds, and rescheduling.

If you are not successful in passing either exam on the first attempt, you will have an

opportunity to retake that exam within 30 days. The applicant will be responsible for the

cost and scheduling of a retake exam and this must be accomplished by the application

date of October1.

http://www.nln.org/


VIRTUAL/HYBRID ACCELERATED ASSOCIATE DEGREE IN NURSING

ADMISSION CRITERIA

All of these items need to be returned to the Allied Health Office or the College. After all

these forms have been completed please check the boxes and turn in all forms together.

These must be in your file prior to October 1, 2014.

o MACC Application

o Virtual Accelerated Associate Degree Nursing Application

o Official transcript from high school or GED must be sent to the Registrar at Moberly

Area Community College, Moberly location

o Official transcripts from all colleges and any nursing school(s) attended must be sent to

the Registrar at Moberly Area Community College, Moberly location

o ACT composite score of 20 or above on file. (The ACT must be repeated if completed

five years or more before the first nursing course date of entry into the Virtual

Accelerated ADN Program.)

o Completed the NLN Challenge Exam with a score of 62% or greater on the

NACE I Care of the Childbearing Family

o Completed the NLN Challenge Exam with a score of 62% or greater on the

NACE I Care of the Child

o A completed Release of Information form

o A completed Caregiver Background Screening form

o A completed and notarized Revocation of Licensure form

o A completed and notarized Essential Qualifications form

o A completed Criminal Background form that has been sent to the Missouri Highway

Patrol ***Please see note below related to on-line option.***

o A copy of your current LPN license

o Three completed reference forms

o Please note that health insurance is required for all nursing students.

Student Signature: ____________________________ Date: _________________________

*** If you chose not to submit your criminal record check via traditional mail, a faster service

on-line option is present. The Missouri State Highway Patrol has implemented a new public

website that allows users to submit and receive name-based criminal record checks on-line with

payment using a credit/debit card. This service is called the Missouri Automated Criminal

History Site (MACHS) and may be accessed at: www.machs.mshp.dps.mo.gov. If you select

the on-line option, you will need to print and include the results with your application

packet. The results must be present in your application packet by the designated

admission deadline date.

STATE OF MISSOURI

CAREGIVER BACKGROUND SCREENING

MO 300-1590 (7-10)

NOTARY PUBLIC EMBOSSER OR STATE COUNTY (OR CITY OF ST. LOUIS)BLACK INK RUBBER STAMP SEAL

SUBSCRIBED AND SWORN BEFORE ME, THIS

DAY OF YEAR USE RUBBER STAMP IN CLEAR AREA BELOW.NOTARY PUBLIC SIGNATURE MY COMMISSION

EXPIRES

NOTARY PUBLIC NAME (TYPED OR PRINTED)

AGENCY USE

BLOCK I - TO BE COMPLETED BY THE REQUESTOR

BLOCK II - TO BE COMPLETED BY THE CAREGIVER

SECTION A: TYPE OF SCREENING (Check as many as applicable)

SECTION B: REQUESTOR INFORMATION

SECTION C: IDENTIFYING DATA FOR BACKGROUND SCREENING

ADDRESSES FOR THE LAST 3 YEARS

SECTION D: AUTHORIZATION TO RELEASE BACKGROUND CHECK INFORMATION

SECTION E: NOTARY INFORMATION (Required for screening type 1. See Section A above)

BLOCK III - REQUESTOR MUST PROVIDE RETURN ADDRESS BELOW

1. Child Abuse or Neglect File (No charge, Notary req) 4. Department of Mental Health Disqualified Registry (No charge)2. Family Foster Care Licensing (No charge) 5. Child Day Care Licensing (No charge)3. Department of Health and Senior Services Employee 6. State Criminal Background Check/Sexual Offender Registry - Name Search ($10.00)3. Disqualified List (No charge)

Responses generated as a result of this form are confidential. Any person disclosing the information in violation of 43.540, 589.400 RSMo.and/or 210.150 RSMo. is guilty of a class A misdemeanor.

The information provided is complete and accurate to the best of my knowledge. I understand it is unlawful to withhold or falsify information required on this form.I grant my permission to obtain any and all information needed to process this request, to make the information available to the requestor and to use theinformation as permitted by law.

REQUESTORʼS NAME REQUESTORʼS TELEPHONE

REQUESTORʼS ADDRESS CITY STATE ZIP CODE

SIGNATURE OF REQUESTOR (REQUIRED IN INK) DATE

CAREGIVER NAME( LAST, FIRST, MI JR, SR, III) SOCIAL SECURITY NUMBER

MAIDEN NAME DATE OF BIRTH (MMDDYY) STATE OF BIRTH SEX RACE

MALE FEMALEALIAS NAME(S)

STREET CITY STATE STREET CITY STATE

SIGNATURE OF CAREGIVER, MUST BE SIGNED IN PRESENCE OF A NOTARY PUBLIC (REQUIRED IN INK) DATE

� ATTN (REQUESTORʼS NAME)

� ADDRESS 1

� ADDRESS 2 (IF APPLICABLE)

� CITY, STATE, ZIP CODE

MISSOURIʼS CAREGIVER BACKGROUND SCREENING SERVICE

INSTRUCTIONS

This service allows the public to receive background information on people who provide daycare or healthcare services to children, the elderlyand persons with disabilities.

The State, through various departments, offers several resources to screen caregivers:

1. Child abuse/neglect records, maintained by the Division of Family Services (573) 751-23302. Family Foster Care Licensing records, maintained by the Health and Senior Services (573) 522-24493. The Employee Disqualification List, maintained by the Health and Senior Services (573) 522-24494. The Disqualified Registry, maintained by the Department of Mental Health (573) 751-85675. Child Daycare Licensing, maintained by the Department of Health (573) 751-24506. State criminal background checks, sexual offender registry, conducted by the Missouri State Highway Patrol (573) 526-6153

The Caregiver Background Screening Request form allows the public to obtain information from these databases through a single request.The form must be completed and signed by both the requestor and the caregiver. The requestor will receive separate responses from eachagency database that is selected.

1. Once completed, send the form to the appropriate address below.2. If you have a question about a particular response, please call the agency that sent you the response at the phone number

above.

For purposes of this form, the requestor is the person who wishes to obtain background information on a potential caregiver. The caregiveris the person being screened for the purposes of potential employment as a daycare or healthcare service provider.

BLOCK I (To be completed by the requestor, or person obtaining information)

Section A: Type of Screening

Section A contains the resources available to screen potential caregivers. The requestor must indicate the resources to be included in thebackground screening. All screenings, except for the state criminal background check, are free of charge. Requests for state criminalbackground checks must be accompanied by a check for $10 payable to the Missouri State Highway Patrol. In addition, screenings for option1, the child abuse or neglect file, require a notary public to witness the caregiverʼs signed authorization to release information (See SectionD and E). All other screenings are considered open information under state statute and do not require a notaryʼs verification.

Section B: Requestorʼs Information

The requestor must complete Section B.

BLOCK II (To be completed by the caregiver, or person being screened)

Section C: Identifying Data for Background Screening

The caregiver, or person being screened for potential employment, must complete Section C. This section consists of identifying informationthat is needed to conduct background screenings.

Section D: Authorization to Release Background Check Information

The caregiver must sign Section D to authorize the State to conduct the screening and to provide the information to the requestor. Thecaregiver must sign Section D in the presence of a notary public if screening 1 is selected.

Section E: Notary Information

A notary public must complete Section E after witnessing the caregiverʼs signed authorization for release of information in Section D.

BLOCK III (To be completed by the requestor, or person obtaining information)

The requestor must complete Block III by providing return address information.

Fill out the form as completely and accurately as possible. Accurate information on the form is essential for a quality backgroundcheck.

SCREENINGS 1, 2, 3, 5 AND 6 SHOULD BE SENT TO: SCREENING 4 SHOULD BE SENT TO:

Missouri State Highway Patrol Department of Mental HealthCriminal Justice Information Services Division Central OfficeP.O. Box 9500 1706 East ElmJefferson City, MO 65102 Jefferson City, MO 65101

or Fax - (573) 526-4561MO 300-1590 (7-10)

Essential Qualifications of Candidates

for Admission and Continuance

Moberly Area Community College (MACC) Program of Associate Degree in Nursing (ADN) signifies that the holder of

that degree has been educated to competently enter nursing practice in all healthcare settings and to apply for ADN

licensure in the State of Missouri. The education of a nurse requires assimilation of knowledge, acquisition of skills and

development of judgment through patient care experience in preparation for a.) Independent and b.) Semi-autonomous

and or c.) making appropriate decisions required in practice. The practice of nursing emphasizes collaboration among

physicians, nurses, allied health care professionals, and the patient.

The curriculum leading to the degree in Associate Degree in Nursing (ADN) from MACC requires students to engage in

diverse complex and specific experiences essential to the acquisition and practice of essential nursing skills and

functions. Unique combinations of cognitive, affective, psychomotor, physical, and social abilities are required to

satisfactorily perform these functions. In addition to being essential to the successful completion of the requirements of

the RN, these functions are necessary to ensure the health and safety of patients, fellow candidates, faculty and other

healthcare providers.

The essential abilities necessary to acquire or demonstrate competence in a discipline as complex as nursing and needed

for successful admission and continuance by candidates for the Associate Degree in Nursing degree at Moberly Area

Community College include by are not limited to the following abilities:

Motor Skills

Candidates should have sufficient motor function so that they are able to execute movements required to provide general

care and treatment to patients in all health care settings. (For example: For the safety and protection of the patients, the

candidate must be able to perform basic life support, including CPR, and function in an emergency situation. The

candidate must have the ability, within reasonable limits, to safely assist a patient in moving, for example, from a chair to

a bed, or from a wheelchair to a commode.

Sensory/Observation

A candidate must be able to acquire the information presented through demonstrations and experiences in the basic and

nursing sciences. He or she must be able to observe a patient accurately, and at a distance and close at hand and observe

and appreciate non-verbal communications when performing nursing assessment and intervention or administering

medications. The candidate must be capable of perceiving the signs of disease and infection as manifested through

physical examination. Such information is derived from images of the body surfaces, palpable changes in various

organs, and tissues, and auditory information (patient voice, hear tones, bowel and lung sounds.)

Communication

The candidate must communicate effectively and sensitively with other students, faculty, staff, patients, family, and other

professionals. He or she must express his or her ideas and feelings clearly and demonstrate a willingness and ability to

give and receive feedback. A candidate must be able to: convey or exchange information at a level allowing

development of a health history; identify problems presented; explain alternative solutions; and give directions during

treatment and post-treatment. The candidate must be able to process and communicate effectively in oral and written

forms. The candidate must be able to process and communicate information on the patient's status with accuracy in a

timely manner to members of the health care team. The appropriate communication may also rely on the candidate's

ability to make correct judgment in seeking supervision and consultation in a timely manner.

It should be noted that successful completion of the requirements for a degree does not guarantee eligibility to take the

NCLEX licensing examination or the ability to become licensed to practice nursing. Candidates with concerns or

questions about specific health conditions, personal histories, or disabilities should contact the Missouri State Nursing

Commission. Practice Advisory Questions and Advisory Opinions (573) 751-0073.

Cognitive

A candidate must be able to measure, calculate reason, analyze, integrate, and synthesize in the context of undergraduate

nursing study. The candidate must be able to quickly read and comprehend written material. He or she must be able to

evaluate information and engage in critical thinking in the classroom and clinical setting.

Behavioral/Emotional

A candidate must possess the emotional health required for the full utilization of his or her intellectual abilities, the

exercise of good judgment, the prompt completion of all responsibilities attendant to the diagnosis and care of patients

and families. In addition, he/she must be able to maintain mature, sensitive, and effective relationships with patients,

students, faculty, staff, and other professionals under all circumstances including highly stressful situations. The

candidate must have the emotional stability to function effectively under stress and to adapt an environment that may

change rapidly without warning and/or in unpredictable ways. The candidate must be able to experience empathy for the

situations and circumstances of others and effectively communicate that empathy. The candidate must know that his or

her values, attitudes, beliefs, emotions, and experiences affect his or her perceptions and relationships with others. The

candidate must be able and willing to examine and change in his or her behavior when it interferes with productive

individual or team relationships. The candidates must possess skills and experience necessary for effective and

harmonious relationships in diverse academic and working environments.

Professional Conduct

Candidates must possess the ability to reason morally and practice nursing in an ethical manner. Candidates must be

willing to learn and abide by professional standards of practice. He/she must possess the attributes that include

compassion, empathy, altruism, integrity, honesty, responsibility, and tolerance. Candidates must be able to engage in a

patient care delivery in all settings and be able to deliver care to all patient populations including but not limited to

children, adolescents, adults, developmentally disabled persons, medically compromised patients, and vulnerable adults.

RECEIPT AND ACKNOWLEDGMENT

The undersigned applicant to Moberly Area Community College nursing program hereby acknowledges

receiving, reading, and understanding a copy of this notice.

The applicant understands that completion of a MACC nursing program does not mean that the Missouri State

Board of Nursing or any other similar board will issue to the applicant a certificate of registration, authority, permit or

license.

Signature of Applicant

Date

STATE OF( )

COUNTY OF )

On this day of , 20 , before me, , a Notary Public in and for said state,

personally appeared, , known to me to be the person who executed the within instrument and

acknowledged to me that executed the same for the purposes therein stated.

IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal the day and year last

above written.

Notary Public

My commission expires:_______________


STATE OF MISSOURI NURSING PRACTICE ACT

NOTICE TO APPLICANTS FOR ADMISSION TO NURSING PROGRAMS

Read carefully and this must be signed, notarized, and returned with your nursing program application.

1. The Board may refuse to issue or reinstate any certificate of registration or authority, permit, or license

required pursuant to chapter 335 for one or any combination of causes stated in subsection 2 of this section or the

board may, as a condition to issuing or reinstating any such permit or license, require a person to submit himself or

herself for identification, intervention, treatment, or rehabilitation by the impaired nurse program as provided in

section 335.067. The board shall notify the applicant in writing of the reasons for the refusal and shall advise the

applicant or his or her right to file a complaint with the administration hearing commission as provided by chapter

621, RsMO.

2. The board may cause a complaint to be filed with the administration hearing commission as provided by

chapter 621, RSMo against any holder of any certificate of registration or authority, permit or license required by

sections 335.011 to 335.096 or any person who has failed to renew or has surrendered his or her certificate of

registration or authority, permit or license for any one or any combination of the following causes:

“(1) Use or unlawful possession of any controlled substance, as defined in chapter 195, RSMo, or

alcoholic beverage to an extent that such use impairs a person’s ability to perform the work of any profession

licensed or regulated by sections 335.011 to 335.096:

(2) The person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo

contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably

related to the qualifications, functions, or duties of any profession licensed or regulated pursuant to sections 335.011

to 335.096 under this chapter, for any offense an essential element of which is fraud, dishonesty or an act of

violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

(3) Use of fraud, deception, misrepresentation or bribery in securing any certificate of registration or

authority, permit or license issued pursuant to this chapter or in obtaining permission to take any examination given

or required pursuant to this chapter;

(4) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud,

deception or misrepresentation;

(5) Incompetency, misconduct, gross negligence, fraud, misrepresentation or dishonesty in the

performance of the functions or duties of any profession licensed or regulated by this chapter;

(6) Violation of, or assisting or enabling any person to violate, any provision of this chapter, or any

unlawful rule or regulation adopted pursuant to this chapter;

(7) Impersonation of any person holding a certificate of registration or authority, permit or license

allowing any person to use his or her certificate of registration or authority, permit, license, or diploma from any

school;

(8) Disciplinary action against the holder of a license or other right to practice any profession

regulated by sections 335.011 to 335.096 granted by another state, territory, federal agency or country upon grounds

for revocation or suspension is authorized by this state;

(9) A person is finally adjudged insane or incompetent by a court of competent jurisdiction;

(10) Assisting or enabling any person to practice any profession licensed or regulated by sections

335.011 to 335.096 who is not registered and currently eligible to practice pursuant to sections 335.011 to 335.096;

(11) Issuance if a certificate of registration or authority, permit or license based upon a material

mistake of fact;

(12) Violation of any professional trust or confidence;

(13) Use or any advertisement or solicitation which is false, misleading or deceptive to the general

public or persons to whom the advertisement or solicitation is primarily directed;

(14) Violation of the drug laws or rules and regulations of this state, any other state or the federal

government;

(15) Placement on an employee disqualification list or other related restriction or finding pertaining to

employment within a health-related profession issued by any state or federal government or agency following final

disposition by such state or federal government or agency.

(16) Failure to successfully complete the impaired nursing program.

NOTICE

Any applicant who has been convicted of felonies and/or misdemeanors, imprisoned, on probation,

on parole, or received a Suspended Imposition of Sentence (SIS) must discuss this matter with the

Coordinator of Practical Nursing/Director of Nursing and Allied Health Programs.

RECEIPT AND ACKNOWLEDGMENT

The undersigned applicant to Moberly Area Community College nursing program hereby acknowledges

receiving, reading, and understanding a copy of this notice that the Missouri State Board of Nursing may refuse to

issue any certificate of registration, authority, permit or license required to practice nursing in the State of Missouri

for the causes set out in Section 335.066, RsMo, which are subject to amendment from time to time by the State of

Missouri.

The applicant understands that completion of a MACC nursing program does not mean that the Missouri

State Board of Nursing or any other similar board will issue to the applicant a certificate of registration, authority,

permit or license.

Signature of Applicant: _________________________________

Dated: ______________________________________________

STATE OF _______)

COUNTY OF ________)

On this _____ day of ________________, 20___, before me, _____________________ a Notary Public in

and for said state, personally appeared ________________________, known to

me to be the person who executed the within instrument and acknowledged to me that executed the same for the

purposes therein stated.

IN TESTIMONY WHEREOF, I have hereunto set may hand and affixed my official seal the day and year

last above written.

______________________________

Notary Public

My commission expires:________________________

SOME OF THE THINGS YOU NEED TO KNOW REGARDING THE MACC-AADN PROGRAM

1. FINANCIAL AID IS AVAILABLE FOR STUDENTS WHO QUALIFY. IT IS YOUR

RESPONSIBILITY TO APPLY AT THE MACC FINANCIAL AID OFFICE. DO NOT

WAIT UNTIL THE LAST MINUTE TO APPLY FOR FINANCIAL AID. APPLY

IMMEDIATELY TO DETERMINE YOUR ELIGIBILITY.

2. The Virtual Accelerated Associate Degree Nursing Program is a one year program.

3. The Moberly, Kirksville, and Mexico locations are fully approved by the Missouri State Board of

Nursing.

4. Upon successful completion of the program, the student is eligible to apply to take the National

Council of Licensing Examination for Registered Nurses. The State of Missouri Nurse Practice Act,

Section 335.066, provides additional criteria for eligibility to apply for licensure to practice nursing.

Successful completion of the program does not guarantee eligibility to take the licensing exam.

Satisfactory performance on this examination will qualify the student for licensure as a registered

nurse. The State Board of Nursing may deny you the privilege of sitting for the exam if you

have ever been convicted of a crime or have an addiction to drugs.

5. Please be advised that clinical facilities request criminal background checks, drug screens, and

health insurance for nursing students attending clinical practicums in their facilities. This will

be at the student’s expense.

6. A great deal of material is covered in a short period of time, this requires a dedicated student. We

recommend 2 hours of study for every 1 hour of class time. It is recommended that student nurses

be employed no more than 16 hours per week.

7. Clinical experience is an extremely important part of your education. Clinical experience is

mandatory. All absences must be made up. If more than 20% of clinical is missed, it will be

necessary for you to drop that course. The course can be repeated if you are doing satisfactory work

and are in compliance with policies outlined in the ADN Student Handbook.

8. A critical skill in the AADN program is intravenous therapy. This course must be successfully

completed to progress within the AADN program.

9. We use several health care facilities in our area. Transportation to and from clinical is your

responsibility (students can car pool).

Clinical sites are subject to change.

Additional sites are used for 1-day observations. Students may be required to attend

educational workshops (usually one per nursing class). The fee for these workshops may vary

from free to $80.00. Transportation to all workshops is the responsibility of the student.

10. Most of the health care facilities that we use for clinical experience are or soon will be smoke free

environments.

11. Clinical days and hours vary with each course. There is a nursing course lab fee and it is assessed

per credit hour.

12. Be aware that a standardized test fee is required each semester.

13. Grants and scholarships are available to those who qualify. Contact Student Services and Financial

Aid as early as possible to ensure the best chance of securing aid.

14. Proper uniform and other equipment needed will be discussed the first week in class.

15. Professional Malpractice Insurance is required of all nursing students. The insurance is obtained as a

group policy by MACC. The college can certify 100% coverage to the clinical facilities. This

policy only covers you as you function in the student nurse role and NOT while working in any other

capacity.

16. Clinical facilities require current proof of BLS (basic life support) certification. Each student is

responsible for obtaining certification prior to entering the clinical area. The BLS certification

must be the course for health care providers.

17. If accepted, a physical exam, 14 panel urine drug screen, additional criminal background checks, and

immunization information are required.

18. The Student Nurses Association (SNA) is an active professional organization here at MACC. All

students are encouraged to join.

19. Upon acceptance to the nursing program each student will be assigned an ADN faculty advisor.

Please feel free to contact your advisor about any problems or concerns.

Revised 2/20/14

REQUEST FOR CRIMINAL RECORD CHECK

PLEASE PRINT OR TYPE.

Telephone (include area code)

SEND REPLY TO (Print or type your mailing label below.)

Missouri State Highway PatrolCriminal Justice Information Services Division

Post Office Box 9500Jefferson City, MO 65102

Please forward the request and fee to:

MISSOURI STATE HIGHWAY PATROL SHP-158M 01/10

fold fold

fold fold

NAME LAST FIRST

SEX

MIDDLE JR / SR

MAIDEN / ALIAS LAST FIRST MIDDLE JR / SR

DATE OF BIRTH (MM/DD/YYYY) SOCIAL SECURITY NUMBER RACE

STREET - P.O. BOX CITY STATE ZIP CODE

GENERAL INFORMATION

ENTITY TYPE PURPOSE FOR REQUEST

TYPE OF RECORD CHECK - PROCESSING FEE - METHOD OF PAYMENT

$11.00 NAME SEARCHBased on NAME, DATE OF BIRTH, AND SOCIALSECURITY NUMBER. Response will be returned withall open records and records of conviction.

$20.00 FINGERPRINT SEARCHBased on APPLICANT FINGERPRINT CARD.Response will be returned with complete records tothe individual or qualifying entity.

FORWARD TO - SEND REPLY TO

MALE

FEMALEBLACKWHITE

INDIANASIAN

OTHER

STATE

FEDERALEMPLOYMENTVOLUNTEER

LICENSING

Fee is payable either by check or money order (NO CASH) to "State of Missouri, Criminal Record System Fund."

OTHER (specify)

MSHP / CENTRAL REPOSITORY RESPONSE

ADDRESS

(per Sections 43.527 and 43.530, RSMo.)

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Typewritten Text

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Typewritten Text

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Typewritten Text

Criminal Justice Information Services DivisionGeneral Information

The Missouri Criminal Records Repository (MCRR), collects, maintains, and disseminates Criminal History Record

Information (CHRI) as defined by 43.500 and 589.400 RSMo.

Criminal History Record Information is information collected by criminal justice agencies on individuals consisting of

arrests, prosecution, a final disposition, correctional supervision, and release. All felony and serious misdemeanor

arrests (referred to as reportable arrests) including offender registration information as defined under 589.400, RSMo.

and all alcohol and drug related traffic offenses are reportable to the MCRR.

Criminal history records are designated as open or closed.

•Open records

1. arrest record for 30 days following arrest.

2. arrest record for which charges have been filed.

3. court disposition of guilty.

4. suspended imposition of sentence during probation period.

•Closed records

1. arrest record after 30 days following arrest.

2. nolle prossed.

3. dismissed.

4. found not guilty.

5. suspended imposition of sentence after probation completed.

•Closed records are accessible to certain groups designated in section 610.120, RSMo.

•MCRR will only release closed records to those noncriminal justice entities entitled to closed records,

when the criminal record check is based on a fingerprint search which will assure the identity of the subject

in question.

•Any person can receive their own record, open and closed, by submission of fingerprints and required fee.

Any requester may receive open record information.

Closed records are accessible by the following, in accordance with 610.120 RSMo, with the submission of fingerprints

and required fee.

FBI Record requests

•The FBI files are open to criminal justice agencies for the administration of criminal justice.

•The FBI has only open files in that if someone has the authority to receive the records, they receive all that is on

file.

•The FBI allows access to their files to noncriminal justice agencies for certain purposes for a fee.

•The purpose for the record check must be set forth in the federal regulations.

•The state, from which the noncriminal justice request originates, must have a state statute specifying the

entity has state authority to check the FBI files for the purpose specified.

•Fingerprints must be submitted before the FBI will release their files to a noncriminal justice entity.

•The result of the federal record search must terminate at a governmental agency and is not to be released

to a private entity.

•All requests into the federal file from the state entities must come through and be stamped by MCRR.

•Effective 10-01-2007, Federal record checks for noncriminal justice entities are $19.25 for licensing or

employment checks and $15.25 for volunteers to those covered care facilities.

PENALTY - A person who knowingly violates any provision of section 43.532, 43.540, 610.100, 610.105, 610.106, or

610.120 is guilty of a class A misdemeanor.


RELEASE OF INFORMATION FORM

FULL NAME:________________________________________________________________

MAIDEN/ALIAS NAME(S):____________________________________________________

ADDRESS:__________________________________________________________________

CITY:_____________________STATE:__________________ZIP:______________________

SOCIAL SECURITY #:__________________________DATE OF BIRTH:________________

PLACE OF BIRTH:______________SEX:_______MALE:____FEMALE:____RACE:_______

I authorize Moberly Area Community College to request and obtain a copy of my criminal

background as provided in section 610.120 RSMo and make an inquiry to the Department of

Social Services regarding the "Employee Disqualification List" as provided in section 660.315. I

also authorize Moberly Area Community College to request and obtain a copy of my drug screen

results, a Division of Family Services background check regarding child abuse or neglect, a

background check with the Office of Inspector General, and a Caregiver screening check

regarding abuse to mental health clients. I also realize additional background screenings may

be requested by the clinical sites affiliated with Moberly Area Community College. I also

realize I must provide a criminal background check for each state I have lived in within the past

10 years.

I further authorize Moberly Area Community College to provide the necessary documentation of

all the above stated data and self-reported information to individual clinical affiliates. This

information is to verify my eligibility to participate in the clinical experience.

SIGNATURE:_________________________

DATE:_______________________________

WITNESS:___________________________

Tuition and Fees

Fees listed below do not include lab/clinical fees,textbooks or personal expenses. All tuition and feeslisted in this catalog are subject to change withoutnotice by the MACC Board of Trustees.


Fact Sheet

District Residents $80.00 $13.00 $93.00Other Missouri Residents $117.00 $13.00 $130.00Non-Missouri Residents $173.00 $13.00 $186.00International Students $186.00 $13.00 $199.00

Online Courses


Hybrid Courses


Dual Credit Courses


Occupational Therapy Assistant

Continuing Education Courses

Fees vary per course.

Student Activity/Support Services Fee

A student activity/support services fee of $7 per credithour is charged to all students. Students enrolled indual credit courses are exempt from this fee for thosecourses. This fee is included in above total cost percredit hour.

Technology Fee

A technology fee of $6 per credit hour is charged tostudents to help support technology resources.Students enrolled in dual credit courses are exemptfrom this fee for those courses. This fee is included inabove total cost per credit hour.

RegularTuition/Fees

OtherFees Total

(Cost per credit hour)

Costs are subject to change by the Moberly AreaCommunity College Board of Trustees without notice.Moberly Area Community College retains the right tocancel course offerings when enrollment is too low tomake a course educationally sound and economicallyefficient. Course cancellation will result in a full refundof tuition/fees.

General Information

Founded in 1927, Moberly Area Community College isa co-educational, two year community collegelocated in Moberly, Missouri. The average enrollmentat Moberly Area Community College is approximately5,000 students, distributed between the day andevening programs and distance learning. MoberlyArea Community College offers the studentindividualed instruction and a strong sense of personalinvolvement. Moberly Area Community College isaccredited by the Higher Learning Commission and amember of the North Central Association, State Boardof Nursing, and the Department of Elementary andSecondary Education-Division of Vocational and AdultEducation.

ADMISSIONS

All graduates from accredited high schools orindividuals presenting a certificate of high schoolequivalency through the General EducationDevelopment (G.E.D.) test are eligible for admission.Additionally, college graduates (Associate Degree orhigher) may provide college transcripts (degree/graduation date) in place of a high school record. Alltranscripts must be on file by the completion of thefirst ten days of class in a 16-week semester or theequivalent in a shorter session. Students not meetingthe above requirement may be admitted to auditregular college courses or to non-credit collegecourses and programs.

ASSESSMENT

ACT/COMPASS, a placement assessment by MACC, isrequired for all students who plan to enroll in English ormath-related courses. Placement in English and mathclasses is made according to ACT/COMPASS testresults. Credit examinations are also provided on-campus through the CLEP test. The (TEAS) Test ofEssential Academic Skills is offered to those who wishto apply to the PN Program. C-BASE exams areprovided for MACC education majors.

Outcome assessment testing must be completed byall certificate, AAS, and ADN degree seeking studentsas a graduation requirement.

DUAL ENROLLMENT/DUAL CREDIT

College credit courses may be taken by high schoolstudents who have completed their sophomore year.Guidelines and applications are available from theOffice of Student Services.

3-31-14 Form SS 703

District Residents $217.00Other Missouri Residents $217.00Non-Missouri Residents $217.00International Students $217.00

DEGREES AVAILABLE

Associate of Arts Associate Degree in NursingAssociate of Applied Science Associate of ScienceAssociate of Arts in Teaching

CREDIT BY ARTICULATION

Students completing selected programs at area vocational-technical schools may be eligible for credit through an articu-

lation agreement. Contact the MACC Dean of Career and Technical Education for further information.

FINANCIAL AID

Federal Pell Grant Missouri Marguerite Ross Barnett Scholarship ProgramFederal Supplemental Education Opportunity Missouri A+ Schools ProgramFederal Academic Competitiveness Grant GAMM, Inc.Federal College Work Study Vocational RehabilitationFederal Direct Subsidized Loan Workforce Investment Act (WIA)Federal Direct Unsubsidized Loan Veteran's Administration BenefitsFederal Direct PLUS Loan Institutional ScholarshipsAccess Missouri Grant Endowment Scholarships

Students applying for financial aid should start by completing the Free Application for Federal Student Aid. Federal loanprograms and other programs require separate application forms to be completed. Applications are available atMoberly Area Community College's Financial Aid Office and online on our website macc.edu.

SCHOLARSHIPS

Moberly Area Community College makes scholarships available to new and returning students on the basis of academicperformance, financial need, or special aptitude. In addition, scholarships are awarded to Moberly Area Community Collegestudents by area benefactors, organizations, and businesses. Scholarship packets and applications are available from areahigh school counselors or the Moberly Area Community College Financial Aid Office.

CAREER and PLACEMENT/ADA SERVICES

Career and Placement Services provides free educational and career counseling, vocational assessment, and assistanceto students and alumni in conducting a successful job search. Call (660) 263-4100 ext. 11232 or 11319 to schedule anappointment off campus or visit C02 or C21 in the Career Center on-campus. Students with special educational, medical, orphysical needs are encouraged to contact Ms. Cate Cooper, Office of Access and ADA Services Coordinator, by calling 660-263-4100, ext. 11240.

STUDENT ORGANIZATIONS/HOUSING

Moberly Area Community College has active student organizations. Eligibility for membership is based on interest and insome cases, academic achievement. Student participation in activities and organizations is encouraged as a part of thetotal college experience. Moberly Area Community College provides limited on-campus housing for men and women.

SPECIAL FEATURES

Activity Center, Art Gallery, Outdoor Classroom, Multi-media Center, ACT Center, 600 hour POST Training Program, NJCAAWomen and Men's Basketball, Internet classes, Musical Performing Arts, Theatrical Productions, New Traditions, Learning/Resource Center (free tutoring), Student Newspaper, and state-of-the-art instructional facilities.

FOR FURTHER ASSISTANCE

Main Campus - Moberly Advanced Technology Center - MACC - Columbia Higher Education660-263-4100 Mexico 573-582-0817 Center 573-234-10671-800-622-2070

Jim Sears Northeast Technical MACC - Hannibal Area HigherActivity Center (on Main Campus) Center - Edina 660-397-2522 Education Center 573-231-0941660-263-1045

MACC - Kirksville Higher EducationEntrepreneurship and Business Development Center Center 660-665-0345(on Main Campus) 660-263-5865

3-31-14 Form SS 703

Moberly Area Community College is committed to a policy of nondiscrimination on the basis of race, color, national origin, gender, disability, age, marital or

parental status, religion, genetics, ancestry, or veteran status in admissions, educational programs, activities, and employment. Inquiries concerning Section 504

of the Rehabilitation Act of 1973, which guarantees access to education regardless of disability, should be directed to: Meghan Holleran, Director - Office of

Access and ADA Services, 601 Business Loop 70 West, Suite 216, Columbia, Missouri 65203, 573-234-1067, ext. 12120. All other inquiries concerning

nondiscrimination, including equal opportunity and Title IX, should be directed to one of the following people: Ms. Jackie Fischer, Dean of Academic Affairs,

101 College Avenue, Moberly, Missouri 65270, 660-263-4100, ext. 11236 or Patricia Twaddle, Career and Placement Services, 101 College Avenue, Moberly,

Missouri 65270, 660-263-4100, ext. 11232.

ATTENTION ALL ALLIED HEALTH STUDENTS PLEASE BE AWARE OF THE

FOLLOWING POLICY:


Allied Health Division

Positive Criminal Background Checks and Urine Drug Screen Reporting Policies

If the Allied Health Division at Moberly Area Community College has any student with a positive

Criminal Background Check and or Urine Drug Screen, the following reporting system will be utilized

to report the results to clinical sites and to students.

1. All Allied health students must sign the “Release of Information” form so this information may

be released to the clinical facilities. A copy of this form will be in the student’s file in the

appropriate allied health office.

2. If a positive urine drug screen is found on any allied health student, the student must provide the

program with a copy of the prescription verifying the medication prescribed and a written letter

from the physician who prescribed the medication verifying why the student is taking the

medication. This documentation must be kept for the student’s file in the appropriate allied

health office.

3. If no prescription and/or letter from the physician is obtained by the student, or an illegal drug is

found in their urine drug screen, a student may be immediately dismissed from the program in

which they are enrolled.

4. For positive criminal background checks and urine drug screens, a letter will be submitted stating

the student’s name and what the current issue is at the beginning of each semester.

5. A letter will be written and a copy provided to the student notifying him/her of the positive

results and informing them if any of the clinical sites deny them clinical privileges in their

facilities. The student may be dismissed from the program in which they are enrolled at any

time if admission to a clinical site is denied.

6. The appropriate allied health admissions committee may accept or decline any student who has a

positive criminal background check prior to the beginning of the program. If a crime is

committed during the time in which the student is enrolled, the situation will be evaluated by the

Director of Nursing and Allied Health Programs and the Dean of Career and Technical

Education. The Dean of Career and Technical Education will confer with the President’s

Council to obtain a final decision.

7. Moberly Area Community College reserves the right, at the College’s expense, to drug or

alcohol test any student enrolled in MACC Allied Health programs. Students refusing to abide

by this policy may be immediately dismissed from the program in which they are enrolled.


101 College Avenue

Moberly, MO 65270

Please return this form to the Allied Health Office at Moberly Area Community College prior to October 1,

2014. Thank you for your assistance.

_________________________ (Please Print) is a candidate for admission into the Moberly Area Community

College Virtual/Hybrid Accelerated Admissions Option.

Please note: I hereby authorize parties who receive requests to give full and complete information as may be

requested by Moberly Area Community College. I further agree that the information will not be

disclosed to me and I thereby waive any right to review this reference form.

___________________________________ ________________________

Student Signature Date

Please Check: APPLICANT'S

CHARACTERISTICS

STRONGLY

AGREE

(1)

AGREE

(2)

DISAGREE

(3)

STRONGLY

DISAGREE

(4) Reliability/

Accountability

Communication Skills

(Oral and Written)

Good Moral Character

Integrity

Ability to Work

With Others

Ability to Cope With Stress/Crisis

Initiative

Please indicate whether or not Relationship to Candidate:

you endorse the applicant: Teacher________ No. of courses from you_______

Endorse with enthusiasm______ Employer_______ No. of years employed _____

Endorse_______ Other (Specify) ________

Do not endorse_______ (No friends or relatives)

How long have you known applicant?__________

(Please Print)

Name:_______________________________

Position:_____________________________

Address:_____________________________

______________________________

Telephone:___________________________

Signature____________________________ Date:___________________________


101 College Avenue

Moberly, MO 65270








___________________________________ ________________________



CHARACTERISTICS

STRONGLY

AGREE

(1)

AGREE

(2)

DISAGREE

(3)

STRONGLY

DISAGREE

(4) Reliability/

Accountability


(Oral and Written)


Integrity

Ability to Work

With Others


Initiative







(Please Print)

Name:_______________________________

Position:_____________________________

Address:_____________________________

______________________________

Telephone:___________________________

Signature____________________________ Date:___________________________


101 College Avenue

Moberly, MO 65270








___________________________________ ________________________



CHARACTERISTICS

STRONGLY

AGREE

(1)

AGREE

(2)

DISAGREE

(3)

STRONGLY

DISAGREE

(4) Reliability/

Accountability


(Oral and Written)


Integrity

Ability to Work

With Others


Initiative







(Please Print)

Name:_______________________________

Position:_____________________________

Address:_____________________________

______________________________

Telephone:___________________________

Signature____________________________ Date:___________________________

Cumulative Grade Point Average (GPA) is calculated using all college coursework completed, whether or not the coursework is specifically required for entrance into the AADN Program. Higher GPA’s will earn more points than lower GPA’s in the AADN application review process. Applicants with coursework older than 5 years may request up to 12 credit hours (with grades of “D” or lower) be waived from the GPA calculation. Credit hours for general education coursework required for the AADN Program cannot be waived from GPA calculation. Waivers will be granted as long as the applicant submits this completed form and transcripts before the September 1

st deadline. Requests that do not have transcripts on file will not be reviewed. Requests postmarked after

September 1st

will not be reviewed. A waiver of the older coursework from GPA calculation will be granted if…

The coursework was completed at least 5 years ago and the grade earned was a “D” or lower.

The coursework is not a required general education course (Composition I, General Psychology, US History, Anatomy, etc).

The applicant submits this completed form and transcripts from the college(s) where the coursework was taken is on file with the Registrar’s office. The transcript must be an original that is on file with the college.

Applicant Name: First Initial Last

Address: Street/PO Box City State Zip

Email Address: Campus(es) where applicant intends to apply for the AADN Program (circle at least one): MOBERLY MEXICO KIRKSVILLE Applicant Signature: Date:

For the coursework you wish to exclude from the cumulative GPA calculation (up to a maximum of 12 credit hours), complete the information below and include the transcripts from the college(s) where you took the course(s): Semester Course Course Number of Grade & Year College Number Name Credit Hours Earned for example: Fall 1999 St. Charles Community College MATH200 College Algebra 3 credits F

If you have questions about the Request for Waiver process, please call the Allied Health office @ 660-263-4110 x11250. After the request form and transcripts are reviewed, the AADN Program office will notify the applicant of their revised GPA by email. Before September 1

st, submit this completed form along to:

Moberly Area Community College Attn: Allied Health 101 College Ave. Moberly, MO 65270

Committee Action: Approved Denied Revised GPA after waiving older coursework: Comments: Date Signature

Request for Waiver of Older Coursework from GPA Calculation


TRANSCRIPT REQUEST FORM

SEND THIS FORM TO YOUR SCHOOL(S) YOU HAVE ATTENDED FOR OFFICIAL

TRANSCRIPT.

PLEASE SEND AN OFFICIAL TRANSCRIPT OF MY RECORDS. TO ASSURE PROPER

RECEIPT OF MY TRANSCRIPT IT MUST BE ADDRESSED TO:

LYNN WALKER, REGISTER


101 COLLEGE AVENUE

MOBERLY, MO 65270

THIS FORM MUST ACCOMPANY MY TRANSCRIPT.

PLEASE PRINT LEGIBLY:

______________________________________________________________________________

Last First Middle Maiden

______________________________________________________________________________

Address

Date of Birth Social Security Number

______________________________________________________________________________

Graduation or Attendance

______________________________________________________________________________

Signature

Applicant:

This form may be copied if you have more than one school to send this request to.

Documents

Successful completion of the program does not guarantee