APPLICATION CHECK LIST Level I: Neosho Campus

APPLICATION CHECK LIST

Level I: Neosho Campus

Before submitting your application to the Nursing Department please make sure

you have all of the items listed below. Only return the pages that you have had to

sign or fill out plus any documents requested. The remaining pages of the

application packet is information for you to keep.

YOUR APPLICATION WILL NOT BE PROCESSED IF ANYTHING IS MISSING.

________Crowder College Application completed online (if not already a Crowder student)

________Signed Nursing Application for Admission

________$40.00 (non-refundable) Application fee Cash, Check or Money Order made

payable to Crowder College. This fee must accompany the application

. This is a separate

fee from the application fee to Crowder College for college admission.

________

$10.00 If you choose to apply to the Cassville campus as second choice

you must fill out a Cassville application and send it to that campus with

the $10.00 fee.

________Copy of all College transcripts MUST BE INCLUDED WITH APPLICATION.

(It can be an unofficial copy if you attend Crowder College or already have submitted an

official copy to Crowder College)

________Completed (3) reference forms from non-relatives in sealed envelopes

with signature of reference across the back seal of envelope

________ Copy of ACT or (converted SAT), composite score of 19 or above (or a

minimum score of 18 will be accepted if GPA on completed general

education courses for the degree is equal to or greater than 3.0)

________Copy of any certifications or licenses (healthcare related)

________Copy of an active certification for Certified Nursing Assistant, CMA, RMA

or EMT or Paramedic License (Missouri or equivalent) required prior to

admission.

________Signed Criminal History Record Disclosure Consent

________Completed personal information form for Criminal Background Check

________ Completed MOVECHS WAIVER AGREEMENT AND STATEMENT

________ Completed Community Service (please include dates)

________Completed Family Care Safety Registry (Include printed report) Rev 5/28/19

NURSING DIVISION

Davidson Hall room 205

417.455.5554

Fax 417.455.5705

NursingNeosho@Crowder.edu

601 Laclede | Neosho, MO 64850

To: Applicants of the Crowder College Level I Program

Neosho Campus

From: Heather VanLue, MSN, RN

Nursing Program Coordinator, Neosho Campus

Date: May 1, 2019

RE: Program Application Materials

Enclosed are the program application materials you requested. Please read the information,

requirements, and guidelines carefully. Any question answered in a false manner will result in

the application being void and therefore not considered. The required application materials

must be submitted by September 1, 2019.

The selection process takes several weeks. All applicants will be contacted by letter once

selection is made.

To be considered for acceptance you must have:

An official ACT composite score of 19 or above or equivalent SAT score, and a GPA of 2.75

or above. July 13, 2019 is the last national ACT test date that the ACT can be taken and still

receive the results before the nursing application deadline. You may go to www.actstudent.org or

contact Student Services for an ACT registration packet. (or a minimum ACT score of 18 will be

accepted if GPA on completed general education courses for the degree is equal to or greater

than 3.0)

• An active Certified Nursing Assistant, CMA, RMA or EMT Certification or Paramedic

License (Missouri or equivalent) is required prior to admission.

• Completed Family Care Safety Registry. You must go to www.dhss.mo.gov website to register

if you have not previously registered. There is a cost of $15.25 to register for this.

Anatomy & Physiology I must be completed before starting the nursing program in January.

Anatomy & Physiology II is required before entering the second semester of nursing (Fall 2020).

Microbiology is required before entering the third semester of nursing (Spring 2021).

Thank you for your interest in the Crowder College Nursing Program. If you have any questions,

don’t hesitate to call our nursing department (Neosho campus) at 417.455.5554 or email

[email protected] I look forward to receiving your application.

Best Wishes

Heather VanLue

Enclosure: Application

Building a civil, serving, literate, learning community of responsible citizens.

PROCEDURE FOR APPLICATION

Submit the following to the Nursing department:

(a) a completed nursing application

(b) official college transcripts

(c) application fee of $40 (if paying by check, please make payable to Crowder College)

(d) official copy of ACT (or converted SAT) composite score of 19 or above

(or a minimum ACT score of 18 will be accepted if GPA on completed general

education courses for the degree is equal to or greater than 3.0)

(e) signed Criminal Records Check form

(f) copy of any certifications or license relating to the medical field

(g) An active Certified Nursing Assistant, CMA, RMA or EMT Certification or

Paramedic license (Missouri or equivalent) required prior to admission.

(h) Completed Family Care Safety Registry

(i) Submit completed reference forms in sealed envelopes (3) from non-relatives

Applicants to the nursing program must also apply & receive acceptance to Crowder

College. Apply online at www.crowder.edu for a general college application.

All nursing application materials are to be submitted to the Nursing Department, Crowder

College, 601 Laclede Ave., Neosho, MO 64850 if applying to Neosho Campus. If you have

questions, feel free to contact the Neosho nursing department office at 417.455.5554 for

assistance.

GUIDELINES TO DETERMINE ACCEPTANCE INTO THE PROGRAM

1. The applicant must be approved for admission to the college and will have completed the

application requirements for nursing.

2. The applicant will have a high school diploma or G.E.D. certificate.

3. The applicant must be at least 19 years of age by completion of the program.

4. Requirements include:

A. Minimum cumulative grade point average of 2.75 or higher on the required core

general education courses.

B. Achieve a grade of “C” or better in all degree required courses.

Achieve a composite score of 19 or higher on the ACT or equivalent SAT score. This

“exam” must have been taken on a National Test Date or taken as a Residual at

Crowder College. Residual tests at other institutions cannot be used. (or a minimum

ACT score of 18 will be accepted if GPA on completed general education courses for

the degree is equal to or greater than 3.0)

C. An active Certified Nursing Assistant, CMA, RMA or EMT Certification or

Paramedic License (Missouri or equivalent) or enrollment in a class that will be

successfully completed prior to beginning the nursing program.

E. Completed Anatomy and Physiology I before beginning the program in January with a

“C” or higher.

F. Complete Kaplan Entrance Exam.

Note: All tattoos must be covered with clothing and not visible, tattoos on the hands

and tattoos that cannot be covered must be removed. Failure to comply may result

in dismissal from the program.

CROWDER COLLEGE

Department of Nursing-Neosho Campus

Application for Admission

Associate Degree of Nursing with BSN Articulation Track

Please type or print legibly:

Name:_______________________________________________________________________________________

(last) (first) (middle) (maiden)

Address:_______________________________________City:__________________State:_______Zip:________

Social Security #:________________________________Telephone Number:_____________________________

Telephone Number to leave message if unable to reach at above number: ______________________________

E-Mail address: _______________________________________________________________________________

Crowder Student lD #__________________________________________________________________________

Have you previously applied to the Crowder College registered nursing program? ______Yes ______No

If yes, which campus?___________________________________

If applying to multiple campuses, which campus is your first choice to attend?

_________Neosho _________Cassville

Have you previously attended any nursing program? __________Yes __________No

If yes, where_________________________________________________________________________________

Please mark all licensures or certifications that you have in the medical field:

LPN_______ CNA________ CMA_______ RMA_______ EMT_______ Paramedic________ CPR________

Other (please name) ___________________________________________________________________________

You must also attach a copy of certificate or license when submitting application

I. Have you ever committed an act described in section 2 of the State of Missouri Nursing Practice Act

Missouri Statues? (see attached). ______Yes ______No

If yes, please explain on an attached sheet.

Which school do you plan to attend to complete your Bachelor of Science in Nursing Degree?

__________Central Methodist University ________Missouri Southern State University _______Hannibal LaGrange University

_________Missouri State University* __________University of Missouri-Columbia _________Chamberlain College of Nursing

___________University of Arkansas ________Saint Luke’s College of Health Science _________John Brown University

_________Pittsburg State University* ________Other

*Dual enrollment available for MSU & PSU

II. Education: List high school or GED and all college (including classes currently in):

Name of School Address From To Degree or Hours Earned

_____________________________________________________________________________________________

III. Occupational Experience-list all employment within the

past 10 years, start with last date of

employment (employers may be contacted for references).

Employer Address Type of Work From To Phone #

_____________________________________________________________________________________________

IV. I do hereby certify that the information provided on this application is complete and correct to the best

of my knowledge under penalty of perjury.

V. I understand that any question answered in a false manner will result in the application being void and

therefore not considered. I understand that I will not be considered for admission into the nursing

program until I have completed the application process as outlined in the application information sheet.

______________________________________ ____________________________________

Signature (written) Signature (printed)

CROWDER COLLEGE NURSING PROGRAM

CRIMINAL HISTORY RECORDS DISCLOSURE CONSENT

As a requirement of the Crowder College Nursing Program application process, in

response to the House Bill 1362, I consent to the release of my criminal history records to

the Crowder College Nursing Program. The Crowder College Nursing Program will

consider material contained in my criminal history solely for the purposes of determining

my suitability for the position of student nurse for which I applied. I do not authorize

release of information for any purposes beyond the program admission decision. I

understand that a prior conviction may not necessarily disqualify me for admission into the

program, but will be a factor which may be considered before acceptance into the program.

Signed: ______________________________________________________________________

Date: ________________________________________________________________________

Witness: _____________________________________________________________________

This does not have to be notarized, just signed by an individual that has witnessed your

signature.

Are you on the disqualification list for the Department of Social Services?____Yes____No

By execution of the application, I do hereby authorize Crowder College or its

representatives to verify all information contained within this application, and do waive

any privilege I may have as to confidentiality to Crowder College or its representatives,

and do authorize any agency - -educational, health, or law enforcement - - to furnish to

Crowder College or its representatives the information necessary to validate the

information contained upon my nursing application including a background check for

criminal record if any.

___________________________________________ ________________________________

Signature of Applicant Date Submitted

*Application cannot be processed without your signature in ink

ACCESS TO RECORDS INFORMATION 10/93

“The Family Educational Rights and Privacy Act of 1974”, Public Law 93-380 as amended

and signed into law by President Ford on December 31, 1974, states that enrollees have the

right to examine confidential files. It also states that they may waive this right if they do so

desire.

The law provides that references may be either confidential or non-confidential at the

option of the registrant. The registrant has the option to inspect the references in a non-

confidential file. Confidential references are those which the registrant has waived the right

to see.

Please consider the following in making a decision to have confidential or non-confidential

references.

1. School officials prefer to see confidential references, believing the references are

more frank in such credentials. The limited number of studies which have been

made of confidential vs non-confidential references indicate a preference of both

hiring officials and college faculty for confidential or enclosed references.

2. Registrants should be most selective in asking persons to be references for them.

The persons selected should know the registrant well and be able to state facts and

competencies of the registrant.

3. Writer of references will be informed at the time of writing that the reference is

confidential or that the registrant will be permitted to see the reference.

CROWDER COLLEGE

Department of Nursing

≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈ ≈

I have elected: ______________ A confidential file

______________ A non-confidential file

_________________________________________ __________________________

Signature of Applicant Date

REQUEST FOR CRIMINAL RECORD CHECK

Crowder College Nursing Program

∼

PLEASE PRINT OR TYPE

∼

Name:_______________________________________________________________________________

Last First Middle

Maiden/Alias (if applicable): ______________________________________________________

Race: (please circle) American Indian/Alaskan Native Asian/Pacific Islander

Black/African Hispanic/Latino

Middle Eastern/East Indian White/Caucasian

White/Caucasian /Black/African

Social Security No.: _____________________________________________________________

Birthdate: _____________________________________________________________________

month day year

Address: _____________________________________________________________________

If at current address less than 1 year list former address: ________________________________

______________________________________________________________________________

Are you a citizen of the United States? ____________________

I authorize the release of any criminal history record information to Crowder College Nursing

Department.

Signature _____________________________________________________________________

Date

V07300002

Please list and describe below any community service that you have done in

the last 5 years (please include dates).

Crowder College Mission Statement

Building a civil, serving, literate, learning community of responsible citizens.

Crowder College Nursing Mission

The nursing program of Crowder College aims to provide a quality nursing education which will

enrich and inspire personal growth of citizens in the four state area and beyond.

Crowder College Nursing Philosophy

Definition of a Nurse

A nurse is a professional who subscribes to high ethical standards to provide quality, safe, and

patient-centered care. The nurse uses clinical judgment which is built on evidence-based

practice. A nurse serves as an advocate for individuals, families, and communities. A nurse is a

lifelong learner, seeking excellence in autonomous and collaborative practice.

Role of the Associate Degree Nurse

At the completion of the associate degree program, the nurse is able to provide safe and

competent care based on a firm foundation in current evidence based practice. A generalist nurse

provides compassionate and collaborative care to individuals, families, and communities in a

variety of settings. The roles of the nurse include client advocacy, health promotion, disease

prevention and care of the sick. Nurses also participate as leaders in shaping health care policy

and quality of care.

Nursing Education Philosophy

A conceptual framework will be utilized to teach patient centered care that is evidence based

with a focus on safety and quality. The Crowder nursing faculty ascribe to adult learning theory

in a conceptual learning environment. The adult learner:

• is self-directed and autonomous

• utilizes knowledge and life experiences

• is goal directed

• is relevancy-oriented

• is practical

• encourages collaboration

Conceptual learning centers on understanding broader principles or ideas that can be applied to a

variety of health and illness exemplars. Conceptual learning is a means to develop deeper

learning and clinical reasoning and judgment.

In addition, our nursing graduates will have the option of pursuing a baccalaureate degree in

nursing through a seamless transition into other educational programs.

SELECTION PROCESS

For Nursing Students

Crowder College, All campus locations

1. Applicant files are reviewed for submission of required application materials

(See PROCEDURE FOR APPLICATION).

2. Applicants will be selected for admission based on the following criteria as submitted

with the application packet:

a) ACT scores or equivalent SAT score

b) Grade Point Average

c) An active Certified Nursing Assistant, CMA, RMA or EMT Certification or

Paramedic license (Missouri or equivalent) required prior to admission

d) GED Scores (if applicable)

e) Reference Scores

f) Required Sciences Completed

g) College Degrees

h) Work Experience

i) Community Service

j) Kaplan Entrance Exam Score

TRANSFER POLICY

Transfer students may be accepted at the end of the first semester of the nursing program pending

space available. Transfer students must have:

1. A composite ACT score of 19 or higher,

(or a minimum ACT score of 18 will be

accepted if GPA on completed general education courses for the degree is equal to

or greater than 3.0)

2. A GPA of 2.75 or higher on the required general education courses.

3. Transcripts showing achievement of a “C” or better in courses equivalent to Health

Concepts I-A & I-B, Professional Concepts I and Pharmacology I (syllabi may be requested

from equivalent courses).

4. Letter from Director of nursing program regarding status of withdrawal or reason for

transfer.

5. Sign a Release of Information form for previous school records.

6. Successful completion with a grade “C” or better in courses equivalent to:

Anatomy and Physiology I and II.

7. Active CNA, CMA, RMA or EMT certification, or Paramedic license

(Missouri or

equivalent) is required

The student will be asked to:

1. Complete application

2. Submit a $40.00 application fee.

3. Submit official copies of college transcript.

4. Submit an official copy of ACT scores or equivalent SAT score.

5. Submit an official copy of high school diploma or GED.

6. Submit three references that can be contacted.

7. Take any required exams and score a passing grade.

ASSOCIATE OF SCIENCE IN NURSING

General Information

1. The Crowder College Nursing Program is fully approved by the Missouri State Board of

Nursing and has been granted initial accreditation by the Accreditation Commission for

Education in Nursing (ACEN).

2. Crowder College is committed to creating a learning environment that meets the needs of its

diverse student body. The Director of Human Resources, Newton Hall, coordinates

compliance efforts with federal and state EO rules and regulations. The Coordinator, Student

Accessibility Office, McDonald Hall, is designated for the Americans with Disabilities Act as

it pertains to students. Crowder College is an equal opportunity employer and provider of

employment and training services. Auxiliary aids and services are available upon request to

individuals with disabilities. Missouri Relay Services at 711.

3. Graduation from the nursing program does NOT guarantee eligibility to take the licensure

exam. Eligibility is determined on an individual basis by the State Board of Nursing based on

the Missouri Nursing Practice Act section 335.066 or by the State Board in the state where

licensure is desired.

4. To apply to take the NCLEX-RN (licensure exam), the applicant must be at least 19 years of

age and have successfully completed the basic professional curriculum in an approved school

of nursing.

5. The following services are available to nursing students: guidance and counseling, full

service library, job placement, academic advisement, academic resource center, tutoring,

student organizations, computer labs, residence halls, and financial assistance including

grants, scholarships, and work-study opportunities.

6. Students who withdraw may be eligible for refunds if they have followed official procedures.

If the student has paid college costs and officially withdraws, tuition will be refunded

according to the Crowder College refund policy after all charges have been applied to the

account. If college costs have been partially or fully paid by financial aid, the refund will be

returned to that financial aid source first. Any remainder will be returned to the student.

7. Curriculum Plan: See attached suggested curriculum plan.

8. Approximate costs are attached.

Associate of Science in Nursing

Suggested Plan of Study

Based On Acceptance to the Program

Program Prerequisites: Anatomy & Physiology I (BIOL 152) – 5 credit hours

Active CNA, CMA, RMA or EMT certification or Paramedic license (Missouri or equivalent).

All general education courses must be completed by both Level I & Level II students.

Pre-Requisite Semester Hours

BIOL 152 Anatomy & Physiology I 5

COLL 101 College Orientation 1

MATH Approved Mathematics Course 3

PSYC 101 Gen Psych – OR – SOC 101 3

Total 12

First Semester Hours

NURS 111 Health Concepts IA (1

st

8 weeks) 3

NURS 171 Professional Concepts I (1

st

8 weeks) 1

NURS 112 Health Concepts IB (2

nd

8 weeks) 3

NURS 141 Pharmacology I (2

nd

8 weeks) 2

BIOL 252 Human Anatomy & Physiology II 5

Total 14

Second Semester Hours

NURS 121 Health Concepts IIA 1

st

8 weeks) 4

NURS 142 Pharmacology II (1

st

8 weeks) 1

NURS 122 Health Concepts IIB (2

nd

8 weeks) 4

NURS 172 Professional Concepts II (2

nd

8 weeks) 1

BIOL 220 Microbiology 5

Total 15

Third Semester Hours

NURS 211 Health Concepts IIIA (1

st

8 weeks) 4

NURS 241 Pharmacology III (1

st

8 weeks) 1

NURS 212 Health Concepts IIIB (2

nd

8 weeks) 4

NURS 271 Professional Concepts III (2

nd

8 weeks) 2

COMM 104 Fundamentals of Speech 3

Total 14

Fourth Semester Hours

NURS 221 Health Concepts IV (1

st

8 weeks) 3

NURS 242 Pharmacology IV (1

st

8 weeks) 1

NURS 290 Nursing Capstone (2

nd

8 weeks) 2

ENGL 101 English Composition 3

HIST 106, 107– OR – PLSC 103 3

Total 12

TOTAL HOURS REQUIRED 67

Approximate Cost List: Level I Students

Neosho-McDonald County (in-district) – Nevada-Cassville (out-of-district)

Nursing Degree (excluding 31 hours of General Education Courses) approximate costs are listed below and

are subject to change. The following cost list is for the Nursing program only.

First Semester

$ 972.00 Tuition in-district ($1539.00 out of district $2088.00 international) Nursing courses only.

207.00 Technology/Facility Use Fee ($23.00 per credit hour)

63.00 Safety & Security Fee ($7.00 per credit hour)

600.00 Course Fee

(includes drug screen, malpractice, student nurse association fee, Kaplan fee, lab supplies, simulation fee)

30.00 ExamSoft

70.00 Uniforms (must have 1 uniform, 1 white lab coat)

45.00 White Shoes

50.00 Watch with Second Hand

150.00 Supplies

10.00 Clinical ID and Patch

400.00 Books

300.00 Physical & Immunizations (Hepatitis B vaccine, Varicella Vaccine, MMR and/or titers, Flu, TB)

$2897.00 $3464.00 (out-of-district) $4013.00 (international)

Second Semester

$ 1080.00 Tuition in-district ($1710.00 out of district $2320.00 international) Nursing courses only.

230.00 Technology/Facility Use Fee ($18.00 per credit hour)

70.00 Safety & Security Fee ($7.00 per credit hour)

845.00 Course Fee

(includes drug screen, lab supplies, simulation fee)

30.00 ExamSoft

150.00 Supplies

175.00 Books

$2580.00 $3210.00 (out-of-district) $3820.00 (international)

Third Semester

$1188.00 Tuition in-district ($1881.00 out of district $2552.00 international) Nursing courses only.

253.00 Technology/Facility Use Fee ($23.00 per credit hour)

77.00 Safety & Security Fee ($7.00 per credit hour)

890.00 Course Fee

(includes drug screen, malpractice, student nurse association fee, Kaplan fee, lab supplies, simulation fee)

30.00 ExamSoft

150.00 Supplies

200.00 Books

$2788.00 $3481.00 (out-of-district) $4152.00 (international)

Fourth Semester

$ 648.00 Tuition in-district, ($1026.00 out-of-district $1392.00 international) Nursing courses only

138.00 Technology/Facility Use Fee ($23.00 per credit hour)

42.00 Safety & Security Fee ($7.00 per credit hour)

75.00 Books

1300.00 Course Fee

(includes drug screen, Kaplan fee, lab supplies, and simulation fee)

30.00 ExamSoft

35.00 Cap and Gown Fee

$2268.00 $2646.00 (out-of-district) $3012.00 (international)

Fees for Licensure: $ 200.00 NCLEX-RN Testing Fee

45.00 State Board Licensure Fee (subject to change)

45.00 Fingerprinting

10.00 Transcript Release Fee

$300.00

Total approximate cost of program: $10,533 In District, $12,801.00 Out-of-District, $14,997 International (nursing

only-does not include general education courses). In-district charges apply to property-tax paying residents of

Newton and McDonald Counties (they pay taxes that support Crowder College). All other Missouri residents pay

out-of district charges. Tuition increases are subject to change.

END OF PROGRAM STUDENT LEARNING OUTCOMES

Upon completion of the Associate Degree Nursing Program, the graduate will demonstrate

the ability to:

1. Practice safe care, minimizing risk of harm to clients and providers through individual

performance.

2. Advocate for clients with recognition that the client is the source of control and full

partner in providing compassionate and coordinated care, reflecting respect for the

dignity and uniqueness of others.

3. Work competently within nursing and inter-professional teams, fostering open

communication, mutual respect, and shared decision making to achieve quality client

care.

4. Utilize clinical judgment built on evidence-based practice in order to evaluate client

outcomes and improve quality of care.

5. Use information and technology to communicate, manage knowledge, prevent errors, and

support clinical judgment.

6. Demonstrate professionalism in the role of the nurse, which includes maintaining high

legal and ethical standards.

Required Functional Abilities

In order to complete the Crowder College Nursing Program, the student must be able to

demonstrate the following:

1. Fine and Gross Motor Skills:

Sufficient to move freely, maintain balance. Manipulate small objects, lift 25 lbs, move

50 lbs, and demonstrate appropriate body strength.

2. Visual Acuity:

Sufficient to accurately see close objects within 20 inches away and distant objects up to

20 feet.

3. Auditory Abilities:

Sufficient to hear faint sounds of various pitches and tones.

4. Physical Stamina:

Sufficient to perform nursing care for 12 hours or more.

5. Intact:

Sensory functions necessary for physical assessment.

6. Reading:

Ability at 10

th

grade level or above and demonstrate math abilities sufficient to perform

dosage calculations.

7. Demonstrate Empathy:

Emotional stability sufficient to handle stress. Demonstrate accountability and

responsibility and provide emotional support to clients.

8. Analytical Thinking:

Purposeful outcome directed thinking that aims to make decisions based on sound

evidence or critical thinking analytical skills in the use of nursing process.

9. Therapeutic Relations:

Establish therapeutic relationships with clients, peers and interdisciplinary team

members.

10. Communicate Effectively:

In oral and written modes.

Missouri Revised Statutes

Chapter 335

Section 335.066.1

August 28, 2018

335.066. Denial, revocation, or suspension of license, grounds for, civil immunity for

providing information — complaint procedures.

1. The board may refuse to issue or reinstate any certificate of registration or authority, permit or

license required pursuant to this chapter

*

for one or any combination of causes stated in

subsection 2 of this section or the board may, as a condition to issuing or reinstating any such

permit or license, require a person to submit himself or herself for identification, intervention,

treatment, or monitoring by the intervention program and alternative program as provided in

section 335.067. The board shall notify the applicant in writing of the reasons for the refusal and

shall advise the applicant of his or her right to file a complaint with the administrative hearing

commission as provided by chapter 621.

2. The board may cause a complaint to be filed with the administrative hearing commission as

provided by chapter 621 against any holder of any certificate of registration or authority, permit

or license required by sections 335.011 to 335.096 or any person who has failed to renew or has

surrendered his or her certificate of registration or authority, permit or license for any one or any

combination of the following causes:

(1) Use or unlawful possession of any controlled substance, as defined in chapter 195, by the

federal government, or by the department of health and senior services by regulation, regardless

of impairment, or alcoholic beverage to an extent that such use impairs a person's ability to

perform the work of any profession licensed or regulated by sections 335.011 to 335.096. A

blood alcohol content of .08 shall create a presumption of impairment;

(2) The person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo

contendere, in a criminal prosecution pursuant to the laws of any state or of the United States, for

any offense reasonably related to the qualifications, functions or duties of any profession

licensed or regulated pursuant to sections 335.011 to 335.096, for any offense an essential

element of which is fraud, dishonesty or an act of violence, or for any offense involving moral

turpitude, whether or not sentence is imposed;

(3) Use of fraud, deception, misrepresentation or bribery in securing any certificate of

registration or authority, permit or license issued pursuant to sections 335.011 to 335.096 or in

obtaining permission to take any examination given or required pursuant to sections 335.011 to

335.096;

(4) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud,

deception or misrepresentation;

(5) Incompetency, gross negligence, or repeated negligence in the performance of the functions

or duties of any profession licensed or regulated by this chapter

*

. For the purposes of this

subdivision, "repeated negligence" means the failure, on more than one occasion, to use that

degree of skill and learning ordinarily used under the same or similar circumstances by the

member of the applicant's or licensee's profession;

(6) Misconduct, fraud, misrepresentation, dishonesty, unethical conduct, or unprofessional

conduct in the performance of the functions or duties of any profession licensed or regulated by

this chapter, including, but not limited to, the following:

(a) Willfully and continually overcharging or overtreating patients; or charging for visits which

did not occur unless the services were contracted for in advance, or for services which were not

rendered or documented in the patient's records;

(b) Attempting, directly or indirectly, by way of intimidation, coercion or deception, to obtain or

retain a patient or discourage the use of a second opinion or consultation;

(c) Willfully and continually performing inappropriate or unnecessary treatment, diagnostic

tests, or nursing services;

(d) Delegating professional responsibilities to a person who is not qualified by training, skill,

competency, age, experience, or licensure to perform such responsibilities;

(e) Performing nursing services beyond the authorized scope of practice for which the individual

is licensed in this state;

(f) Exercising influence within a nurse-patient relationship for purposes of engaging a patient in

sexual activity;

(g) Being listed on any state or federal sexual offender registry;

(h) Failure of any applicant or licensee to cooperate with the board during any investigation;

(i) Failure to comply with any subpoena or subpoena duces tecum from the board or an order of

the board;

(j) Failure to timely pay license renewal fees specified in this chapter;

(k) Violating a probation agreement, order, or other settlement agreement with this board or any

other licensing agency;

(l) Failing to inform the board of the nurse's current residence within thirty days of changing

residence;

(m) Any other conduct that is unethical or unprofessional involving a minor;

(n) A departure from or failure to conform to nursing standards;

(o) Failure to establish, maintain, or communicate professional boundaries with the patient. A

nurse may provide health care services to a person with whom the nurse has a personal

relationship as long as the nurse otherwise meets the standards of the profession;

(p) Violating the confidentiality or privacy rights of the patient, resident, or client;

(q) Failing to assess, accurately document, or report the status of a patient, resident, or client, or

falsely assessing, documenting, or reporting the status of a patient, resident, or client;

(r) Intentionally or negligently causing physical or emotional harm to a patient, resident, or

client;

(s) Failing to furnish appropriate details of a patient's, client's, or resident's nursing needs to

succeeding nurses legally qualified to provide continuing nursing services to a patient, client, or

resident;

(7) Violation of, or assisting or enabling any person to violate, any provision of sections 335.011

to 335.096, or of any lawful rule or regulation adopted pursuant to sections 335.011 to 335.096;

(8) Impersonation of any person holding a certificate of registration or authority, permit or

license or allowing any person to use his or her certificate of registration or authority, permit,

license or diploma from any school;

(9) Disciplinary action against the holder of a license or other right to practice any profession

regulated by sections 335.011 to 335.096 granted by another state, territory, federal agency or

country upon grounds for which revocation or suspension is authorized in this state;

(10) A person is finally adjudged insane or incompetent by a court of competent jurisdiction;

(11) Assisting or enabling any person to practice or offer to practice any profession licensed or

regulated by sections 335.011 to 335.096 who is not registered and currently eligible to practice

pursuant to sections 335.011 to 335.096;

(12) Issuance of a certificate of registration or authority, permit or license based upon a material

mistake of fact;

(13) Violation of any professional trust or confidence;

(14) Use of any advertisement or solicitation which is false, misleading or deceptive to the

general public or persons to whom the advertisement or solicitation is primarily directed;

(15) Violation of the drug laws or rules and regulations of this state, any other state or the

federal government;

(16) Placement on an employee disqualification list or other related restriction or finding

pertaining to employment within a health-related profession issued by any state or federal

government or agency following final disposition by such state or federal government or agency;

(17) Failure to successfully complete the intervention or alternative program for substance use

disorder;

(18) Knowingly making or causing to be made a false statement or misrepresentation of a

material fact, with intent to defraud, for payment pursuant to the provisions of chapter 208 or

chapter 630, or for payment from Title XVIII or Title XIX of the federal Medicare program;

(19) Failure or refusal to properly guard against contagious, infectious, or communicable

diseases or the spread thereof; maintaining an unsanitary office or performing professional

services under unsanitary conditions; or failure to report the existence of an unsanitary condition

in the office of a physician or in any health care facility to the board, in writing, within thirty

days after the discovery thereof;

(20) A pattern of personal use or consumption of any controlled substance or any substance

which requires a prescription unless it is prescribed, dispensed, or administered by a provider

who is authorized by law to do so or a pattern of abuse of any prescription medication;

(21) Habitual intoxication or dependence on alcohol, evidence of which may include more than

one alcohol-related enforcement contact as defined by section 302.525;

(22) Failure to comply with a treatment program or an aftercare program entered into as part of a

board order, settlement agreement, or licensee's professional health program;

(23) Failure to submit to a drug or alcohol screening when requested by an employer or by the

board. Failure to submit to a drug or alcohol screening shall create the presumption that the test

would have been positive for a drug for which the individual did not have a prescription in a drug

screening or positive for alcohol in an alcohol screening;

(24) Adjudged by a court in need of a guardian or conservator, or both, obtaining a guardian or

conservator, or both, and who has not been restored to capacity;

(25) Diversion or attempting to divert any medication, controlled substance, or medical supplies;

(26) Failure to answer, failure to disclose, or failure to fully provide all information requested on

any application or renewal for a license. This includes disclosing all pleas of guilt or findings of

guilt in a case where the imposition of sentence was suspended, whether or not the case is now

confidential;

(27) Physical or mental illness, including but not limited to deterioration through the aging

process or loss of motor skill, or disability that impairs the licensee's ability to practice the

profession with reasonable judgment, skill, or safety. This does not include temporary illness

which is expected to resolve within a short period of time;

(28) Any conduct that constitutes a serious danger to the health, safety, or welfare of a patient or

the public.

3. After the filing of such complaint, the proceedings shall be conducted in accordance with the

provisions of chapter 621. Upon a finding by the administrative hearing commission that the

grounds, provided in subsection 2 of this section, for disciplinary action are met, the board may,

singly or in combination, censure or place the person named in the complaint on probation on

such terms and conditions as the board deems appropriate for a period not to exceed five years,

or may suspend, for a period not to exceed three years, or revoke the license, certificate, or

permit.

4. For any hearing before the full board, the board shall cause the notice of the hearing to be

served upon such licensee in person or by certified mail to the licensee at the licensee's last

known address. If service cannot be accomplished in person or by certified mail, notice by

publication as described in subsection 3 of section 506.160 shall be allowed; any representative

of the board is authorized to act as a court or judge would in that section; any employee of the

board is authorized to act as a clerk would in that section.

5. An individual whose license has been revoked shall wait one year from the date of revocation

to apply for relicensure. Relicensure shall be at the discretion of the board after compliance with

all the requirements of sections 335.011 to 335.096 relative to the licensing of an applicant for

the first time.

6. The board may notify the proper licensing authority of any other state concerning the final

disciplinary action determined by the board on a license in which the person whose license was

suspended or revoked was also licensed of the suspension or revocation.

7. Any person, organization, association or corporation who reports or provides information to

the board of nursing pursuant to the provisions of sections 335.011 to 335.259

**

and who does so

in good faith shall not be subject to an action for civil damages as a result thereof.

8. The board may apply to the administrative hearing commission for an emergency suspension

or restriction of a license for the following causes:

(1) Engaging in sexual conduct as defined in section 566.010, with a patient who is not the

licensee's spouse, regardless of whether the patient consented;

(2) Engaging in sexual misconduct with a minor or person the licensee believes to be a

minor. "Sexual misconduct" means any conduct of a sexual nature which would be illegal under

state or federal law;

(3) Possession of a controlled substance in violation of chapter 195 or any state or federal law,

rule, or regulation, excluding record-keeping violations;

(4) Use of a controlled substance without a valid prescription;

(5) The licensee is adjudicated incapacitated or disabled by a court of competent jurisdiction;

(6) Habitual intoxication or dependence upon alcohol or controlled substances or failure to

comply with a treatment or aftercare program entered into pursuant to a board order, settlement

agreement, or as part of the licensee's professional health program;

(7) A report from a board-approved facility or a professional health program stating the licensee

is not fit to practice. For purposes of this section, a licensee is deemed to have waived all

objections to the admissibility of testimony from the provider of the examination and

admissibility of the examination reports. The licensee shall sign all necessary releases for the

board to obtain and use the examination during a hearing; or

(8) Any conduct for which the board may discipline that constitutes a serious danger to the

health, safety, or welfare of a patient or the public.

9. The board shall submit existing affidavits and existing certified court records together with a

complaint alleging the facts in support of the board's request for an emergency suspension or

restriction to the administrative hearing commission and shall supply the administrative hearing

commission with the last home or business addresses on file with the board for the

licensee. Within one business day of the filing of the complaint, the administrative hearing

commission shall return a service packet to the board. The service packet shall include the

board's complaint and any affidavits or records the board intends to rely on that have been filed

with the administrative hearing commission. The service packet may contain other information

in the discretion of the administrative hearing commission. Within twenty-four hours of

receiving the packet, the board shall either personally serve the licensee or leave a copy of the

service packet at all of the licensee's current addresses on file with the board. Prior to the

hearing, the licensee may file affidavits and certified court records for consideration by the

administrative hearing commission.

10. Within five days of the board's filing of the complaint, the administrative hearing

commission shall review the information submitted by the board and the licensee and shall

determine based on that information if probable cause exists pursuant to subsection 8 of this

section and shall issue its findings of fact and conclusions of law. If the administrative hearing

commission finds that there is probable cause, the administrative hearing commission shall enter

the order requested by the board. The order shall be effective upon personal service or by

leaving a copy at all of the licensee's current addresses on file with the board.

11. (1) The administrative hearing commission shall hold a hearing within forty-five days of the

board's filing of the complaint to determine if cause for discipline exists. The administrative

hearing commission may grant a request for a continuance, but shall in any event hold the

hearing within one hundred twenty days of the board's initial filing. The board shall be granted

leave to amend its complaint if it is more than thirty days prior to the hearing. If less than thirty

days, the board may be granted leave to amend if public safety requires.

(2) If no cause for discipline exists, the administrative hearing commission shall issue findings

of fact, conclusions of law, and an order terminating the emergency suspension or restriction.

(3) If cause for discipline exists, the administrative hearing commission shall issue findings of

fact and conclusions of law and order the emergency suspension or restriction to remain in full

force and effect pending a disciplinary hearing before the board. The board shall hold a hearing

following the certification of the record by the administrative hearing commission and may

impose any discipline otherwise authorized by state law.

12. Any action under this section shall be in addition to and not in lieu of any discipline

otherwise in the board's power to impose and may be brought concurrently with other actions.

13. If the administrative hearing commission does not find probable cause and does not grant the

emergency suspension or restriction, the board shall remove all reference to such emergency

suspension or restriction from its public records. Records relating to the suspension or restriction

shall be maintained in the board's files. The board or licensee may use such records in the course

of any litigation to which they are both parties. Additionally, such records may be released upon

a specific, written request of the licensee.

14. If the administrative hearing commission grants temporary authority to the board to restrict

or suspend the nurse's license, such temporary authority of the board shall become final authority

if there is no request by the nurse for a full hearing within thirty days of the preliminary

hearing. The administrative hearing commission shall, if requested by the nurse named in the

complaint, set a date to hold a full hearing under the provisions of chapter 621 regarding the

activities alleged in the initial complaint filed by the board.

15. If the administrative hearing commission refuses to grant temporary authority to the board or

restrict or suspend the nurse's license under subsection 8 of this section, such dismissal shall not

bar the board from initiating a subsequent disciplinary action on the same grounds.

16 (1) The board may initiate a hearing before the board for discipline of any licensee's license

or certificate upon receipt of one of the following:

(a) Certified court records of a finding of guilt or plea of guilty or nolo contendere in a criminal

prosecution under the laws of any state or of the United States for any offense involving the

qualifications, functions, or duties of any profession licensed or regulated under this chapter, for

any offense involving fraud, dishonesty, or an act of violence, or for any offense involving moral

turpitude, whether or not sentence is imposed;

(b) Evidence of final disciplinary action against the licensee's license, certification, or

registration issued by any other state, by any other agency or entity of this state or any other

state, or the United States or its territories, or any other country;

(c) Evidence of certified court records finding the licensee has been judged incapacitated or

disabled under Missouri law or under the laws of any other state or of the United States or its

territories.

(2) The board shall provide the licensee not less than ten days' notice of any hearing held

pursuant to chapter 536.

(3) Upon a finding that cause exists to discipline a licensee's license, the board may impose any

discipline otherwise available.

(L. 1975 S.B. 108 § 12, A.L. 1981 S.B. 16, A.L. 1995 S.B. 452, A.L. 1999 H.B. 343, A.L. 2007

H.B. 780 merged with S.B. 308, A.L. 2013 H.B. 315, A.L. 2018 H.B. 1719)

CROWDER COLLEGE NURSING PROGRAM

Reference Questionnaire

Please place in sealed envelope with signature across the seal and return to the applicant to be

submitted with their application.

Please complete this reference form, which pertains to:______________________________

(Applicant Name)

The applicant has chosen this to be a confidential . non-confidential reference.

An honest and complete opinion will be most helpful. Please return this completed form as soon as possible.

1. How long have you known this individual and in what capacity?

2. From your experience with this individual please rate him/her in the following areas as they pertain to

the practice of nursing.

Communication

Coping

Commitment to

Task

Conflict

Management

Problem-Solving

Organization &

Planning

Grooming

Punctuality

Very Strong

evidence

skill is

present

4

Strong

evidence

skill is

present

3

Some

evidence

skill is

present

2

Strong

evidence

skill is not

present

0

3. Would you recommend this person for the nursing program? Yes______________ No _______________

4. Additional Comments: (use back if necessary)

Date: ____________________ Signature/Title: ______________________________________________________________

Printed Name: ______________________________________________________________

Address:______________________________________________________________________________________________

Phone #:____________________________________ Email address:______________________________________________

Insufficient

evidence for

or against

skill

1

CROWDER COLLEGE NURSING PROGRAM

Reference Questionnaire

Please place in sealed envelope with signature across the seal and return to the applicant to be

submitted with their application.

Please complete this reference form, which pertains to:__________________________

(Applicant Name)

The applicant has chosen this to be a confidential . non-confidential reference.

An honest and complete opinion will be most helpful. Please return this completed form as soon as possible.

1. How long have you known this individual and in what capacity?

2. From your experience with this individual please rate him/her in the following areas as they pertain to

the practice of nursing.

Communication

Coping

Commitment to

Task

Conflict

Management

Problem-Solving

Organization &

Planning

Grooming

Punctuality

Very Strong

evidence

skill is

present

4

Strong

evidence

skill is

present

3

Some

evidence

skill is

present

2

Strong

evidence

skill is not

present

0

3. Would you recommend this person for the nursing program? Yes______________ No _______________

4. Additional Comments: (use back if necessary)

Date: ____________________ Signature/Title: ______________________________________________________________

Printed Name: ______________________________________________________________

Address:______________________________________________________________________________________________

Phone #:____________________________________ Email address:______________________________________________

Insufficient

evidence for

or against

skill

1

CROWDER COLLEGE NURSING PROGRAM

Reference Questionnaire

Please place in sealed envelope with signature across the seal and return to the applicant to be

submitted with their application.

Please complete this reference form, which pertains to:___________________________

(Applicant Name)

The applicant has chosen this to be a confidential . non-confidential reference.

An honest and complete opinion will be most helpful. Please return this completed form as soon as possible.

1. How long have you known this individual and in what capacity?

2. From your experience with this individual please rate him/her in the following areas as they pertain to

the practice of nursing.

Communication

Coping

Commitment to

Task

Conflict

Management

Problem-Solving

Organization &

Planning

Grooming

Punctuality

Very Strong

evidence

skill is

present

4

Strong

evidence

skill is

present

3

Some

evidence

skill is

present

2

Strong

evidence

skill is not

present

0

3. Would you recommend this person for the nursing program? Yes______________ No _______________

4. Additional Comments: (use back if necessary)

Date: ____________________ Signature/Title: ______________________________________________________________

Printed Name: ______________________________________________________________

Address:______________________________________________________________________________________________

Phone #:____________________________________ Email address:______________________________________________

Insufficient

evidence for

or against

skill

1