Acknowledgement Statements

Please read and acknowledge each of the following statements by checking the box:

I will be at least 18 years of age by the first day of class.

I will have a high school diploma or equivalent by the first day of class.

I have a cumulative GPA of 3.0 or higher from all regionally accredited colleges from which I have taken prerequisite classes.

I understand that all prerequisite courses must be completed with a "C" grade or better by the first day of class.

I understand that I must submit official transcripts by the application deadline. Failure to do so will render my application incomplete.

I understand that admission to, and progression in, the Practical Nursing Program is contingent upon submission of satisfactory local, national, and sex offender registry background check results. A Social Security Number or Individual Tax Identification Number (ITIN) is required to run a background check. Any felony or misdemeanor conviction on a student's record may negatively impact the chances of completing the program and being placed at a clinical site. There will be no tuition or fee refund for students who are unable to complete the program due to their criminal record. Prospective students with a criminal record are strongly encouraged to contact the Program Manager, Madison Reed at madison.reed@otech.edu, to discuss their record prior to applying. Please note, many states, including Utah, do not seal juvenile records.

I understand that students must inform the Practical Nursing Program Manager of any criminal charges pending against them. Students who have falsified or withheld information regarding pending criminal charges may be dismissed from the Practical Nursing Program.

In compliance with the requirements of our clinical partners, students accepted into the PNP will be required to complete drug testing and meet current vaccination requirements to qualify for participation in clinical experiences at healthcare facilities. Clinical experience is required for completion of the program. Inability to comply with all health requirements of clinical partners may prevent the student from completing their clinical experience and subsequently their training program.

I understand that placement in my preferred session time is not guaranteed and is determined based on a point system. If I have indicated a preferred session but noted that I am willing to attend the other available session, I may be contacted to be offered a position in the alternate session. However, if I have marked that I can only attend my preferred session, I understand that I will not be contacted for placement in the other group.

I understand that three references must be submitted on my behalf. Failure to submit three references by the application deadline will render my application incomplete.

I have attached all of the required documentation including a copy of my CNA certification (if applicable) and completed Health-Related Employment Verification Forms.

I have saved copies of my documentation.

I understand that communication regarding my application/admission status will be sent via email to the email address I provided on this application.

I Accept

I do hereby certify that statements in this application are true and complete to the best of my knowledge. Furthermore, I understand that by selecting the "I Accept" button, I am signing this application electronically. I agree my electronic signature is the legal equivalent of my manual signature on this application.

Signed

Date

Authnet_Hidden_Fields

Last Name	First Name	Middle Initial
Maiden/Other Names Used	Birthdate	Email Address
Mailing Address	City	State
Zip Code	Cell Phone	Home Phone

American Indian or Alaska Native	Asian	Black or African American
Native Hawaiian or Pacific Islander	White	Prefer not to answer

Reference Name	Relationship	Email Address	Phone