Graham Hospital School of Nursing

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Graham College of Nursing Admission Application

Graham College of Nursing Application

INSTRUCTIONS & CHECKLIST

The Essential Functions for Students of Nursing form ensures you can perform the physical and mental functions, with or without reasonable accommodations, required to deliver safe and effective nursing care. The Graham Hospital Uniform Conviction Information Act (UCIA) form gives the hospital permission to file a background check on you. Graham Hospital Association makes a Uniform Conviction Information Act (UCIA) check on all students accepted to the college. The applicant must have a favorable criminal background check from the Illinois State Police and a negative drug screening done by Graham Hospital.
References should not be a friend or relative. You waive your rights to read your references unless you request permission in writing. Your references can access the Personal Reference Form at here.

Applications are reviewed monthly from August until May. Applications will be considered and reviewed at the discretion of the Admission, Retention, Promotion, and Graduation Committee. Applicants will be notified of their admission in writing after a review is completed.

APPLICATION FOR ADMISSION

Nondiscriminatory Policy

Equal opportunities are provided for all who apply regardless of race, color, national origin, creed, sex, age, or marital status. Section 504 of the Rehabilitation Act of 1973 protects all handicapped persons against discriminatory treatment. The Graham College of Nursing does not discriminate in matters of sex, handicap, age, marital status, race, religion, or national origin in admission or access to, or treatment in its programs, or activities.
Projected enrollment date
I am applying for admission as a:
IDENTIFICATION DATA
Address
MM slash DD slash YYYY
Marital Status (optional)
Address

PERSONAL DATA

Citizenship Status
Sex(Required)
Ethnic origin(Required)
Are you prepared to meet the expenses of this program in this college?
*Required by federal and state statistical reporting

ACADEMIC DATA

High Schools attended
Name of Institution
City
State
Dates Attended
Diploma
 
Colleges, universities, or other post-secondary schools attended
Name of Institution
City
State
Dates Attended
Certificate/Degree
 

EMPLOYMENT DATA

List all full- and part-time work experience since high school, beginning with the most recent.
From
To
Position
Company
City and State
 
How did you first hear about Graham College of Nursing? (Check one.)
How did you become interested in applying to Graham College of Nursing? (Check all that apply.)
I certify that the information provided on this application is accurate and complete to the best of my knowledge and realize that failure to provide correct information is considered sufficient cause for reconsideration of my admission status.

Essential Functions for Students of Nursing

YOUR APPLICATION IS NOT COMPLETE. YOU MUST COMPLETE THE ESSENTIAL FUNCTIONS FOR STUDENTS OF NURSING and GRAHAM HOSPITAL UNIFORM CONVICTION INFORMATION ACT (UCIA) FORMS .
A nursing career requires special functional abilities to ensure that safe and effective nursing care is delivered to consumers of health care. It is essential that students of nursing possess and maintain the following functional requirements, with or without reasonable accommodations. Examples identified below are not all-inclusive. Applicants who identify potential difficulty are to meet with the Director of the School of Nursing to discuss the individual situation.
ESSENTIAL FUNCTIONS EXAMPLES
Visual ability sufficient to monitor and assess health needs.
  • Identify subtle skin color changes
  • Read small print
Auditory ability sufficient to monitor and assess health needs.
  • Respond to emergency alarms
  • Respond to cries for help
  • Respond to verbal commands in an emergency situation
  • Use stethoscope to hear breath, bowel and heart sounds
Tactile ability sufficient for physical assessment.
  • Perform palpation to confirm inspection
  • Identify texture, temperature, moisture, and swelling
Physical abilities sufficient to move from room to room, maneuver in small spaces and provide safe and effective client care.
  • Perform CPR
  • Assist client in and out of bed
  • Move from room to room and maneuver in limited spaces
  • Lift clients and/or objects of 35 pounds
Fine motor abilities sufficient to safely manipulate/operate equipment.
  • Insert IV
  • Manipulate syringes
  • Insert catheters
  • Perform sterile procedures
Communication abilities sufficient for interaction in written, verbal and non-verbal form.
  • Communicate non-verbally in appropriate circumstances; e.g., facial expressions, eye contact, and body language
  • Communicate through use of spoken words in an intelligible, conversational pace
  • Explain treatment procedures
  • Document and interpret nursing actions and patient response
  • Communicate through use of computer technology
Interpersonal abilities sufficient to interact with individuals, families, and groups.
  • Use empathy to establish rapport with persons from diverse backgrounds
  • Adapt to a changing environment – deal with the unexpected, focus attention, control emotions
Critical thinking ability sufficient to adapt to an ever-changing environment.
  • Identify clinically significant cause/effect relationships
  • Develop nursing care plans, calculate medications
  • Use problem solving skills
  • Set priorities
I have read and understand the physical and mental requirements for students at Graham Hospital School of Nursing.

Graham Hospital Acknowledgement

It is understood by the applicant that the policy of Graham Hospital is to file, on behalf of the applicant, a criminal background check. Student activities involving patient care at Graham Hospital are contingent on a favorable determination from the Illinois State Police. Should an unfavorable determination be obtained, each applicant is afforded the right to submit to the Illinois State Police a request for Waiver, at the applicant’s expense.
The applicant’s signature acknowledges the understanding of this request and authorizes Graham Hospital to file appropriate request information, knowing that all information will be held in strictest confidence and that a copy of the results will be forwarded to the applicant.
Applicant’s Full Name
MM slash DD slash YYYY
MM slash DD slash YYYY
Applicant’s Printed Name