Application Checklist
Student Name:
Acknowledgement of Completion:
Program application form
Criminal background check disclosure/consent form
Review and self-assessment of performance standards
American Heart Association BLS/AED for Healthcare Providers certification achievement card to be completed after admission
Health certification requirements:
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Immunizations:
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MMR immunizations 1 and 2 or rubella titer
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Rubeola immunization or titer
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Chicken pox – proof of having chicken pox or chicken pox immunization per authorized medical signature or varicella titer
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Influenza immunization
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Meningitis immunization
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TB skin test – to be completed after admission to the program
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Hepatitis B vaccination (series of 3) Signed verification of Hepatitis B status or declination
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DTAP – Diphtheria, tetanus and pertussis immunization within the last 10 years
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Influenza immunization - to be completed in season no later than November 1.
All requirements are subject to change based on clinical affiliate requirements.