UofA Hope LPN Day Program Application 2018-2019
University of Arkansas Hope Practical Nursing Program Application for UofA Hope Campus Day Program 2018-19. SUBMISSION DEADLINE: May 1. This application is good from March 1 through May 1. Program start date is July 2, 2018. READ everything carefully!!! Answer all questions with complete information. Schedule pre-entry test (CAT test) at the end of this application. Exam fee of $10 (Cash or Money Order) collected on day of exam. CAT Test may only be taken one time in 12 month period. Your application will be ineligible if exam repeated before 12 month period.
Email address *
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
City *
Your answer
State *
Your answer
Primary Phone Number or Cell Phone Number *
Your answer
Prerequisite Courses
Tell me about your prerequisite classes. YOU must provide copy of transcripts to NURSING.

If PN prerequisites were taken at another learning institution, you MUST submit an unofficial transcript -COPY to the nursing department. Failure to do so may result in an ineligible application.

IN ADDITION, an OFFICIAL transcript should be mailed (from previous school/college) to Enrollment Services on this campus. We do NOT pull transcripts from Registrar or Enrollment.

Do you understand that if any courses taken at another learning institution, YOU MUST submit an unofficial transcript to the nursing department. We DO NOT have access to transcripts sent to college that may have been submitted.
Are you currently attending UAHT? or did you in the past?
If not, apply now:
click this link to apply: https://forms.uacch.edu/?page_id=280
Your answer
Where did you complete your prerequisite courses? List any/all colleges attended.
Remember to request transcript(s) if taken at another college.
Your answer
Which Prerequisite Courses courses have you completed? ALL MUST BE COMPLETED BY May.
Check all that apply. *You may check the box if taking the course(s) now.
Select the option that best describes you.
Applicant must have a grade of “C” or better in ENGL 0053 Reading and ENGL 0063 Advanced Writing; or ACT 19 (Reading and English) or COMPASS 83 (Reading) and 80 (Writing).
Have you previously attended another nursing or allied health program of study?
A Letter of "Good Standing" must be submitted. See Program Director immediately for FORM.
How many times have you been in a nursing program? How many admissions or readmission?
If yes, please list the program(s) and the institution(s):
Your answer
If yes, what was your reason for leaving?
Your answer
Program Related Questions:
Honesty is very important when answering these questions. The State Board of Nursing may review this record and your answers upon your request for licensure. An answer of "Yes" to the following questions does not necessarily bar you from selection.
Have you ever been arrested? *
Do you have any unresolved arrests, warrants or pending criminal charges against you? Have you ever been convicted of a misdemeanor? Or felony? *
Have you ever pled guilty, nolo contendere, no contest, or been convicted of any crime? *
Includes ALL convictions except minor traffic violation. This includes any warrants for arrest.
Have you ever been sentenced to serve jail/prison time? Have you ever been placed on community supervision or court-ordered probation? *
Do you have any civil related lawsuits- alleging child abuse, spouse abuse, elder abuse, patient abuse, harassment and/or dishonest, violent, or discriminatory conduct (such as fraud, embezzlement, theft, assault, battery, etc.), have you ever been found liable (i.e., judgment was rendered against you) in any such matter, or is any such matter currently pending against you? *
Do you have expunged or sealed offenses? *
While expunged or seal offences, arrests, tickets, or citations may seem undisclosed, these events could be identified by the state licensing agency. Honesty is very important in answering these questions.
Have you ever had a license or certification disciplined or revoked? Not driving related. *
Includes any CNA, Dental, or any type of Medical license. Include CDL.
Have you ever engaged in drug-related behavior or been admitted to a chemical or alcohol dependency program? *
This includes DWIs, DUIs, arrests for drug-related problems, or rehabilitation programs (AA/NA or Rehabs)?
Have you ever been diagnosed with or treated or hospitalized for schizophrenia and/or psychotic disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder which impaired or does impair your behavior, judgement, or ability to function in school or work? *
All Applicants must complete the CAT Test to be considered for the nursing program.
VERY IMPORTANT - - REMEMBER your testing date!!! BRING ID and $10. REMEMBER your selected LOCATION

CAT Test may only be taken one time in 12 month period. You will be ineligible if exam repeated before 12 month period.

Select a Date & Time to complete the CAT (Cognitive Abilities Test) pre-entry examination. *
This exam will take approximately 30 minutes to complete. Pay exam fee of $10 (cash or money order only) the day of exam. Call or email program director if different time needed.
Nurses must possess knowledge, application of skills, and abilities in order to provide safe and effective nursing care. Functional Abilities are those specific abilities/attributes a nurse must possess in order to practice safely and effectively. The National Council of State Boards of Nursing (NCSBN) identified and defined categories of functional abilities (see below). The functional abilities for safe nursing practice include fine and gross motor skills, physical endurance and strength, mobility, hearing, visual, tactile, smell, reading, arithmetic competence, emotional stability, analytical thinking, critical thinking, interpersonal skills and communication skills.

Some limitations in ability can be accommodated with special devices or special circumstances; others cannot. The reasonableness of accommodations will be based upon client safety and the resources of the College and department. Temporary or newly diagnosed interruptions in abilities (i.e. casted hand) will require individual evaluation.

By checking yes on this application you are acknowledging that you have read the functional abilities, as outlined by NCSBN and realize the potential impact of deficiencies on my Practical Nursing program success.

Core Functional Ability Activities / Attributes Essential for Safe, Effective LPN Practice*
1. Fine Motor Skills: Pick up objects with hands, Grasp small objects with hands, Write with pen or pencil, Pinch/pick or otherwise work with fingers
2. Physical Endurance: Maintain physical tolerance,Stand/walk extended periods of time, Lift and transferring patients, Apply 10 pounds of pressure to bleeding site or for CPR, Performing up to 12 hours in clinical setting
3. Mobility: Bend, Move quickly, Walk, Push/pull/pivoting,
4. Hearing: Hear normal speaking level sounds & faint body sounds without auditory impairment
5. Visual: See objects close up to and distant and color perception, 6.Tactile: Feel vibrations, Discriminate dull/sharp and hot/cold
7. Reading: Read and understand printed documents
8. Arithmetic Competence: Read and understand columns of writing, Use measuring tools
9. Emotional Stability: Provide client with emotional support, Adapt to changing environment/stress, react appropriately, Focus attention on task, Monitor own emotions
10. Analytical Thinking: Process information, Prioritize tasks, Use good nursing judgment, Use long & short term memory, Perform mathematical calculations
11. Interpersonal Skills: Respect differences in client, Establish rapport with clients, Interact respectfully with peers and instructors
12. Communication Skills: Explain procedures, Interact with others, Communicate effectively oral and written

I have read and understand the “Functional Abilities for Safe LPN Practice” Listed Above. *
Contact program director by May 1 for any concerns you may have related to the identified abilities, or others not mentioned above.
Pre-Admission Background Check is required.
You must complete a criminal background check. The background check UF83 package is available for $60. To place your order, go to


Click on place order enter program number UF83

Must be done by May 1st. Background check good for 12 months.

Note: If you have a business hold, registrar hold, or career pathway hold we cannot access your records. You will not be eligible for the LPN program. Correct these obligations before May 5th.
Thank You for considering UACCH for your nursing education. We are honored! You may now SUBMIT your application. If you have any questions please contact Cyndi Graham at cyndi.graham@uacch.edu
Once you click submit you will not have access to the application. Please review before clicking submit. No automatic email will be sent. However the program director will send an email verifying receipt as time allows. Email may include your test date and more information about background checks. Please read information in email carefully.

Once submitted the PN Program will immediately have access to your application. No need to do more than 1 application.

You may revisit this application link as many times for information as needed without completing another.

A copy of your responses will be emailed to the address you provided.
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