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PART 1: To be completed by the College Advisor. Part 1 must be completed before proceeding to Part 2. Students with an incomplete portfolio will not be considered for admission into the practical nursing program. It is recommended that applicants retain a copy of their portfolio for their personal records. EGTC Admissions: __________ EGTC Admissions Application completed at www.emilygriffith.edu. Assessment Tests: Scores are valid up to one year after test date. First test is free. Fee for re-tests. Two tests allowed per subject within a six month time period. __________ Copy of Reading TABE assessment results: 12.0 or greater __________ Copy of Math EGTC Practical Nursing assessment results: 80% or greater Prerequisites: Official transcripts with a C grade or higher or EGTC Challenge Test results required. __________ HPR 178: Medical Terminology (1 Credit) __________ BIO 106: Anatomy & Physiology (4 credits) taken within the past 7 years (Anatomy and Physiology courses at or above BIO106 may be accepted from institutions approved for incoming transfer credit as defined in the EGTC catalog) Other Documents: __________ Copy of government issued photo ID __________ Official copy of U.S. High School transcript with graduation date, U.S. High School Equivalency certificate, or Associate’s degree or higher transcript with graduation date from a U.S. college approved for incoming EGTC transfer credit. Please see the PN Admission Policy for documentation required for education completed outside of the U.S. __________ Copy of Certified Nursing Assistant (CNA) license or official transcript of completion of a Medical Assistant (MA) program __________ Two (2) letters of recommendation, including the contact information of the person providing the recommendation I declare that the information provided is true and correct. I acknowledge and understand that the requirements for admission may change during the time between portfolio submission and official notification of program admission. Student Signature: ________________________________________________ Date: _______________________________________ Advisor Signature: ________________________________________________ Date: _______________________________________ PART 2: To be completed by EGTC Health Science department. Part 2 is completed after admission to the practical nursing program. Refer to your admissions acceptance letter for deadline information. Immunization Requirements: 2 Series MMR: (1) ____________, (2) _____________ Annual Influenza: _____________ TB Skin test or X-Ray expiration date: _______________ DPT within 10 years or Tdap within 5 years: ________________ Pre-admission/PN Portfolio Checklist [Revised 12/2/16] HEP B series of 3: (1) __________, (2) ___________, (3) ___________ Varicella (Chickenpox): _______________________________ Required Documents: Drug Screen: ______________________________ Background Check: ____________________________ Expiration date of Liability Insurance: _______________________________ BLS Cert. Expiration Date: _____________________ Signature of DNEP or designee: ___________________________________________________________ Pre-admission/PN Portfolio Checklist [Revised 12/2/16] Date:_____________________