Phlebotomy Application Packet

Transcription

1 1 Phlebotomy Application Packet Applications will be accepted on a first-come-first-serve basis. Once the program is full, there will be a waitlist for that quarter. Students on the waitlist that are not admitted into the program will need to reapply for the following quarter. The program cost follows regular Green River tuition and fees for a 12 credit load. For funding assistance, visit The I-BEST option is available for Phlebotomy. If you would like more information about the supported instruction available through I-BEST, please contact Cynthia Gaede, I-BEST & Transitions Director, at ext or cgaede@greenriver.edu. 18 Years of Age or Older Requirements to Apply: Take care of these before you turn in your application Please include a photocopy of valid photo ID. Valid photo ID includes driver s license or any stateissued photo ID. Background Checks: As part of the application packet, each applicant should completely fill out the Washington State Patrol background check form located on page 6 of this packet and include it in his/her application. Once admitted to the Phlebotomy Program, a Certified Background check of each applicant (see details below) will also be required to be in compliance with the Child/Adult Abuse Information Act (RCW and ). Nelson Denny Reading Assessment: It can be taken at the Assessment and Testing Center. Applicants are required to achieve a grade equivalent of 8 as scored by the Nelson Denny Reading Test; scores must be included with the application. Individuals who do not achieve the appropriate score will be required to take an additional reading course prior to being allowed to retake the Nelson Denny. The reading portion of the COMPASS TEST is not used to satisfy this requirement. Students scoring a 7 will be admitted, but will also be enrolled in Read 83.1 concurrently with the program. Apply to Green River Community College: Go to for more information. High School Diploma or GED: Applicants must either have a high school diploma or GED. Applicants must submit a high school transcript or a GED certificate or transcript in the application packet. If a high school transcript is not accessible, a photocopy of the actual diploma will suffice. Documentation from other countries should be in English.

2 2 Phlebotomy Application Form STEP 1 Fill out the following information Name Student Number Phone Number By signing below, I verify that this application packet for the Phlebotomy Program is accurate and has been completed to the best of my knowledge. I hereby authorize Green River to perform criminal background checks, maintain the record(s) until I graduate or withdraw from the program, and share the information as requested by clinical sites. I understand that I may request reasonable accommodation in order to meet the standards. Signature (required) Date Quarter applying for: Summer Fall Winter Spring STEP 2 In a 9X12 ENVELOPE, include the following Phlebotomy Application Form (this page) Photocopy of valid photo ID Proof of high school or GED completion Washington State Patrol Background Check (Page 5) Nelson Denny results Documentation of immunizations (Optional at this step but highly recommended) STEP 3 Turn in your application package (9x12 envelope) to: Green River Enrollment Services C/O Phlebotomy Application SE 320th St Auburn, WA Hand-delivered applications still must be in a 9X12 envelope. Submitted applications become the property of Green River Community College and materials will not be returned to the applicant. STEP 4 Regularly check your for your application status You will receive an within two weeks. Make sure to also check your junk mail folder in case the is blocked. If you do not get an from Green River after two weeks, call Career and Advising at ext 2641 STEP 5 Orientation (if admitted) Approximately 2 weeks before class, you will go to an orientation where you will meet the faculty and staff and submit any remaining immunization paperwork. Dates and times TBD.

3 3 Next Steps after Admission What you need by the Mandatory Orientation Approximately 2 weeks before class, you will go to an orientation where you will meet the faculty and staff and submit any remaining paperwork. You will be automatically enrolled in your classes shortly after the orientation if you have submitted all of your paperwork. Immunizations (See next page for detailed information) At the orientation bring proof from your healthcare provider that you have received the following immunizations and/or tests: Current Tuberculosis Test (TB): 2 step method, 2 different injections, 2-3 weeks apart MMR or titer showing immunity Tdap Hepatitis B series or titer showing immunity Varicella series or titer showing immunity Flu shot for the current year, if available Students who fail to come with the required paperwork will not be enrolled or receive funding Liability Insurance What you need for class Liability Insurance can be purchased at the Green River Cashier s Office at a cost of approximately $21. Criminal History Background Check GRCC has designated (order package code RE90) as the vendor for the criminal background screening. Results from any other company will not be accepted. The student is responsible for the cost of the criminal background screen(s) at the time of the screening (approximately $50.00 but can be higher). The student will provide the Health Sciences Division with a copy of the criminal history background check results. The student is aware that, when applying for the criminal history background check, he/she automatically releases the results to the Health Sciences Division and that the results will be shared with affiliating agencies that provide clinical experiences in the program. Appropriate agency personnel evaluate all positive background checks, and at their sole discretion, make the determination if the individual student can participate in clinical experiences in their agency. Should a clinical agency refuse to place a student based on the outcome of the background check, the student may be unable complete the program. The school has no responsibility for arranging alternate clinical placements. Continued on next page

4 4 What you need for class (continued) Urine Drug Screening The student will be provided with the name and location of an authorized agency who will conduct Urine Drug Screening for students enrolled in GRCC Phlebotomy. Results from any other agency will not be recognized. The student is responsible for all costs associated with the drug screening. This drug screen must be completed prior to clinical placement. If the screen comes back ineligible, a medical review may be done for an additional cost (some RX drugs will cause a positive drug screen). The student is aware that, when applying for the urine drug screen, he/she automatically releases the results to the Health Sciences Division and that the results will be shared with the appropriate agencies that provide clinical experiences for the program. Should a clinical agency refuse to place a student based on the outcome of the drug screen, the student may be unable complete the program. The school has no responsibility for arranging alternate clinical placements. Detailed Immunization Requirements Following is the list of required immunizations and/or titers required for the Phlebotomy Program at GRCC. Measles (rubeola), Mumps, & Rubella: Proof of vaccination (2 doses at appropriate intervals) or proof of immunity by titer, showing immunity to all three. Tuberculin Status [PPD(TB)]: If no records or more than 12 months since last Two-Step TST, a Two- Step TST or QuantiFERON (QFT) TB Gold test must be done prior to enrollment in the program. The 2-step process is explained as follows: First Visit: Get the TB shot (make sure you get documentation for this date and signature). Second Visit: Two days after visit #1 you go back to get the TB Test Reading (results) this should be given in millimeters (mm), which will determine whether the test is positive or negative. Third Visit: No sooner than one week after visit #1 (1st TB shot), no later than two weeks after visit #1. You will get the whole process done over again. This visit you get your 2nd TB shot. Fourth (Final) Visit: Two days after visit #3 you will get the 2nd TB shot reading. Again, you need documentation stating the results in millimeters (mm) and whether the result is positive or negative. Note of Caution: Do not make the mistake of thinking that because a normal TB Test has 2 components (TB shot and TB reading) that it will fulfill the 2-Step TB Test requirement. You must actually have 2 separate TB Tests. The tests must be done within the proper timeframe. There is a TB blood test called QuantiFERON (TB Gold Test). Results can be available within 24 hours. QuantiFERON should be drawn on the same day as live-virus vaccines or 4-6 weeks after administration of livevirus vaccines. Students with a history of positive TB results must provide proof of chest x-ray and submit an annual negative symptom check from their healthcare provider. Continued on Next Page

5 Hepatitis B: Series of 3 vaccines at appropriate intervals (0, 1, 6 months) with post vaccination titer confirming immunity 6-8 weeks after completion of the series (the first 2 vaccinations must be completed prior to entrance into the Phlebotomy program) or proof of immunity by titer. Tetanus, diphtheria, pertussis (Tdap): Tdap required once. Td required every 10 years after Tdap. Varicella (Chickenpox): Proof of vaccination (2 doses at appropriate intervals) or proof of immunity by tier. (People who have not been vaccinated by age 13 need two doses of vaccine, four to eight weeks apart). Flu: Proof of vaccination (based upon current flu season requirements). Other: Students must also meet all minimum requirements of all clinical agencies with which the program affiliates, including background check standards and drug screening. Should a clinical agency refuse to place a student based on lack of immunizations and/or titers, background checks, or drug test results, the student may be unable to complete the program. The school has no responsibility for arranging alternate clinical placements. 5 Immunization and titer documentation must be from a healthcare provider and include signature, credentials, and date (mm/dd/yyyy). If you have any questions regarding your immunization history, contact your healthcare provider. General questions regarding immunizations may be directed to Dana McCauley, Nursing Programs, Instructional and Classroom Support Tech at dmccauley@greenriver.edu

6 6 WASHINGTON STATE PATROL REQUEST FOR CRIMINAL HISTORY INFORMATION CHILD/ADULT ABUSE INFORMATION ACT RCW THROUGH All students who will be placed in practicum education sites for Green River Community College s health occupation programs are requested to complete the below Washington State Patrol Abuse Clearance section. The purpose of this abuse clearance is to assure the safety and well-being of patients, clients and children who come into contact with students. Practicum education sites are expecting that Green River students will not pose undue risks to the safety of patients/children. The Washington State Patrol abuse clearance request is for the following: Child/Adult Abuse Information: Response limited to convictions against children or other persons, dependency proceedings, abuse of vulnerable adults, and DOL disciplinary board final decisions and any subsequent criminal charges associated with the conduct that is the subject of the disciplinary board final decision. Please be aware that information on other felony and misdemeanor convictions may be reported from the state patrol office. This abuse clearance is used only for the purpose of practicum education placement determination and further dissemination or use of the record is prohibited. As stated earlier, all students are required to complete this form. Any student choosing not to complete this process must be aware that the ability of faculty to arrange practicum education experiences will be severely restricted and in some instances impossible. A large number of facilities (all of them for nursing) require proof of this clearance before students are allowed to participate in any practicum activities. I have read and understand this information about the Washington State Patrol Abuse Clearance. Please attach a copy of your driver s license for identification verification. Student s Signature and Date (required) PLEASE PRINT Student s Name: (Last, First, Middle) Alias/Maiden Name: Social Security Number: Date of Birth: / /19