Forms & Packets
Various forms are required for enrollment into the Health Sciences programs. Required forms must be completed prior to being granted entry into the program. Forms with instructions have been compiled into packets so that students will be able complete enrollment requirements collecting and submitting official documents as requested.
Packets for all programs may be submitted to the Health Sciences Division located at:
- 1400 Market Street, Suite 8204, Redding, CA 96001
Office Hours:
- Spring & Fall Semesters: Monday – Friday | 8:00 am – 4:30 pm
- Summer Session (June & July): Monday – Thursday | 8:00 am – 4:30 pm
Application Packets
| Application Packets | Status |
|---|---|
| Associate Degree Nursing Program Application Packet (PDF) | Currently Available |
| Dental Hygiene Program Application Packet (PDF) | Currently Available |
| Health Information Management Application Packet (PDF) | Currently Available |
| Physical Therapist Assistant Application Packet (PDF) | Not Currently Available |
| Vocational Nursing Program Application Packet (PDF) | Not Currently Available |
Program Packets
| HSUP Program | Program Packets |
|---|---|
| Health Information Technology & Health Information Management | |
| Medical Assisting (MA) | |
| Nurse Aide/Home Health Aide (CNA) |
Individual Forms
- Clinical Requirements Checklist (Nursing) - Documentation for CPR certification, influenza vaccination information, and Tuberculosis screening Step 1 for Nursing, Dental Hygiene and PTA programs
- Clinical Requirements Checklist (Allied Health-HIT/HIM) - Documentation form for all immunizations and CPR certification for Medical Assistant, Medical Scribe, and HIT/HIM programs
- Technical Standards for Nursing, MA, and PTA Programs - Questionnaire for students to assess their ability to meet physical requirements of health sciences nursing programs
- Technical Standards for Non-Nursing Programs - Questionnaire for students to assess their ability to meet physical requirements of non-nursing health sciences programs
- Technical Standards for Dental Hygiene - Questionnaire for students to assess their ability to meet physical requirements of health sciences Dental Hygiene program
- Health Data & Physical Exam - (applicant questionnaire and form for healthcare provider to meet physical examination requirement)
- Confidential Application for Clinical Practice - form regarding drug screening and criminal background checks results and clinical placement restrictions
- Tuberculosis PPD Screening - NEW STUDENTS- Form required to document TB immunity for new students when entering & continuing students for annual renewal while in their program
- Tuberculosis PPD Screening – CONTINUING STUDENTS – Form required to document annual TB test results for continuing students while in their program
- NEW Student Tuberculosis Screening & Questionnaire - Chest X-Ray/QuantiFERON Gold/Positive PPD - Form to used by new students who have a history of a positive TB screening (PPD), chest x-ray, or QuantiFERON Gold
- CONTINUING Student Tuberculosis Screening & Questionnaire - Chest X-Ray/QuantiFERON Gold/Positive PPD - Form to used by continuing students who have a history of a positive TB screening (PPD), chest x-ray, or QuantiFERON Gold
- ADN Student Data Form - Form for students entering the ADN program to provide information that is required by the BRN
- LVN Student Data Form - Form for students entering the LVN program to provide information that is required by the BVNPT
- Photography & Publication Release - Acknowledgment that the student has read and understands the contents and policy of the Publication Release
- PTA Student Data Form - Form for students entering the PTA program to provide information required throughout the program
- Student Assumption of Risk and Release - Acknowledgment that the student has read and understands the assumption of risk associated with enrollment and participation in a Health Sciences program
- Student Honor Contract - Acknowledgment that student has read and understands the Academic and Scholastic Honesty Policy. This form is kept in students file
- Student Handbook Acknowledgment - Acknowledgment that student has read and understands the contents, policies, requirements in the student handbook for their program
- Time Commitment Schedule Planner - Health Sciences (form for students to plan study time)
- Use of Electronic Device - Acknowledgment that student has read and understands the standards for use of electronic devices in the classroom and clinical skills lab settings