Updated May 2022
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Certified Nurse Aide
Certified Nurse Aide
Certified Nurse Aide
Program Application Packet
Semester Requested (Check one):
Fall
Spring Summer Year:
Applications MUST be received
by the application deadline no later than 5 pm. to be considered for acceptance to the program.
Application Deadlines
Fall :
May 15 -June 15
Spring : October 15 - November 15
Summer: February 15 - March 15
Please Type or Clearly Print Date of Birth / _/
ACC Student ID: e-mail address:
Leave blank if you do not have one Email is the preferred method of communication
Name:
Last First Middle
Home Address:
Number & Street County City State Zip
Day Phone: Alternate Phone:
Social Security Number or International Tax Identification Number: ____________________
Students are REQUIRED by the state to have one of these forms of identification. NO EXCEPTIONS
The following items are required before any student will be considered for acceptance to the program
:
Application Checklist:
1. Read and review the entire packet carefully.
2. Create an ACC ID: https://continue.austincc.edu/register/
3. Complete the top portion of Page 1. Sign Page 2. Submit pages 1-3 to our CE Healthcare Advising
Specialist via email: Aida Lasanta at [email protected]
4. Create a student account with Castle Branch by visiting: https://www.castlebranch.com/sign-in
5. Complete the Health Science Training Module at:http://sites.austincc.edu/hipaa/training-module/
health-science-hipaa/
(Complete the 3 page “HIPAA Confidentiality and Security Agreement Form”. Fill out the
1st page Post-test completion form). Upload all four pages to CastleBranch. Press Place Order then
enter code UL47im
6. Have your Medical Provider transcribe your immunization records onto the provided immunization
form found in the application packet. No other forms will be accepted. Upload your completed
immunization form to CastleBranch. Press Place Order then enter code: UL64im There are
additional fees for Castlebranch.
7. Have your Medical Provider transcribe your influenza vaccine record onto the provided influenza
vaccine form which can be downloaded from Castlebranch. Press Place Order then enter code
UL47im2 . Flu season is from September to April and your vaccine must be administered during
this time period.
Updated May 2022
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Certified Nurse Aide
o
Prior to receiving access to register for NURA-1001 and NURA-1060, students must:
o
Complete the application process as described above. Only those selected students will be
PETITIONED and allowed to register for the classes.
Access to Austin Community College’s programs
or activities shall not be limited on the basis of race, color,
creed, national origin, religion, age, gender, sexual orientation, political affiliation, or physical disability.
Acceptance of an application does not guarantee a student a seat in the course. Classes may fill quickly,
preventing you from registering even though you have completed the application process. Students must
notify the Health Professions Institute, Continuing Education of any change in applicant data. Failure to do so may
result in the withdrawal of permission to register in the classes or the inactivation of the application. It is the
student’s responsibility to drop or withdraw from a class after it has started; you will remain enrolled even if you do not
attend class.
I hereby certify that the information contained in this application is true and complete to the best of my
knowledge. I understand that any misrepresentation or falsification of information is cause for denial of
admission or expulsion from the College. I understand that the faculty and staff of the Health Professions
Institute, Continuing Education will read the information contained in this application.
I have read and understand all information included as part of this application.
__________________________________________________________ __________________ Signature of
Applicant Date
It
is the student’s responsibility to:
Return pages 1-3 to the CE Healthcare Advising Specialist, Aida Lasanta at [email protected].
8. All applications received by the deadline will be reviewed. Only a select few will be chosen to
proceed with the next steps in the application process and will be notified via email by the CE
Healthcare Advising Specialist, Aida Lasanta.
9. The selected students chosen to proceed with the next steps in the application process will be
required to submit to further screenings which will include a background check through
Castlebranch and a Two step TB screening through your health care provider. Further information
on costs and process will be provided via email by the CE Healthcare Advising Specialist, Aida
Lasanta. Estimated costs for background checks is up to $60
Updated May 2022
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Certified Nurse Aide
For Continuing Education Office Use Only
Application Received – Date:
Accepted Rejected Added/Verified to Datatel – Date:
Petitioned – Date:
Reviewed By:
Track:
_________________ __________ Date: __ __________
Print Name and Phone Extension
Cohort:
Student Advised of Status – Date: by email by mail by phone by message in person
Order Instructions for
Austin Community College - CE Certified Nurse Aide
1. Go to https://mycb.castlebranch.com/
2. In the upper right hand corner, enter the Package Code that is below.
Package Code UL47im: )*1""Phase 
About
Order Summary
About CastleBranch
Austin Community College - CE Certified Nurse Aide has partnered with CastleBranch, one of the
top ten background check and compliance management companies in the nation to provide you a
secure account to manage your time sensitive school and clinical requirements. After you complete
the order process and create your account, you can log in to your account to monitor your order
status, view your results, respond to alerts, and complete your requirements.
You will return to your account by logging into castlebranch.com and entering your username (email
used during order placement) and your secure password.
Payment Information
Your payment options include Visa, Mastercard, Discover, Debit, electronic check and money
orders. Note: Use of electronic check or money order will delay order processing until payment is
received.
Accessing Your Account
To access your account, log in using the email address you provided and the password you created
during order placement. Your administrator will have their own secure portal to view your compliance
status and results.
Contact Us
For additional assistance, please contact the Service Desk at 888-723-4263 or visit
https://mycb.castlebranch.com/help for further information.
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Order Instructions for
Austin Community College - AA Immunizations
1. Go to https://mycb.castlebranch.com/
2. In the upper right hand corner, enter the Package Code that is below.
Package Code UL64im: Core Requirements for Applicants
About
Order Summary
About CastleBranch
Austin Community College - AA Immunizations has partnered with CastleBranch,
one of the top ten background check and compliance management companies in
the nation to provide you a secure account to manage your time sensitive school
and clinical requirements. After you complete the order process and create your
account, you can log in to your account to monitor your order status, view your
results, respond to alerts, and complete your requirements.
You will return to your account by logging into castlebranch.com and entering your
username (email used during order placement) and your secure password.
Payment Information
Your payment options include Visa, Mastercard, Discover, Debit, electronic check
and money orders. Note: Use of electronic check or money order will delay order
processing until payment is received.
Accessing Your Account
To access your account, log in using the email address you provided and the
password you created during order placement. Your administrator will have their
own secure portal to view your compliance status and results.
Contact Us
For additional assistance, please contact the Service Desk at 888-723-4263 or
visit https://mycb.castlebranch.com/help for further information.
Order Instructions for
Austin Community College - CE Certified Nurse Aide
1. Go to https://mycb.castlebranch.com/
2. In the upper right hand corner, enter the Package Code that is below.
Package Code UL47im2: 5#BOE'MVPhase 2
About
Order Summary
About CastleBranch
Austin Community College - CE Certified Nurse Aide has partnered with CastleBranch, one of the
top ten background check and compliance management companies in the nation to provide you a
secure account to manage your time sensitive school and clinical requirements. After you complete
the order process and create your account, you can log in to your account to monitor your order
status, view your results, respond to alerts, and complete your requirements.
You will return to your account by logging into castlebranch.com and entering your username (email
used during order placement) and your secure password.
Payment Information
Your payment options include Visa, Mastercard, Discover, Debit, electronic check and money
orders. Note: Use of electronic check or money order will delay order processing until payment is
received.
Accessing Your Account
To access your account, log in using the email address you provided and the password you created
during order placement. Your administrator will have their own secure portal to view your compliance
status and results.
Contact Us
For additional assistance, please contact the Service Desk at 888-723-4263 or visit
https://mycb.castlebranch.com/help for further information.
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Health Sciences
Health Professions (CE)
Immunizations and Tests
Required by State Law/Clinical Facilities
Name: ACC ID#:
Program: Date of Birth:
*Measles, Mumps, Rubella (MMR)/Varicella vaccines if not given on same day MUST be 28 days apart.
ALL DATES MUST INCLUDE MONTH, DAY AND YEAR.
Hepatitis B
A. Recombivax HB or Engerix-B Vaccine (initial dose)
A. Recombivax HB or Engerix-B Vaccine Dose 2 (minimum 4 weeks after
date #1)
A. Recombivax HB or Engerix-B Vaccine Dose 3 (minimum 8 weeks after
date #2 and minimum 16 weeks after date #1)
OR
Date #1:
Date #2:
Date #3:
B. Heplisav-B Vaccine (initial dose)
B. Heplisav-B Vaccine Dose 2 (minimum 4 weeks after date #1)
OR
Date #1:
Date #2:
C. Serologic test positive for Hepatitis B antibody
Date of Collection:
____Positive Result ____Negative Result
Tdap
A. Tdap—received after 6/10/05
B. Td—if Tdap is 10+ years old (must
list both dates)
Date (Tdap):
Date (Td):
Physician or Approved Licensed Health Professional Information: Date of signature must be after last
immunization or additional immunizations must be signed and dated separately. Validates all information above.
Printed Name
Address
Signature
Date
Revised 5/6/22
Measles (Rubeola)
, Mumps & Rubella
(MMR)
A. Two doses of Measles, Mumps, Rubella (MMR) vaccine on or after their first
birthday and at least 28 days apart
OR
Date #1:
Date #2:
B. Serologic test positive for Measles antibody
Date of Collection:
____Positive Result ____Negative Result
B. Serologic test positive for Mumps antibody
Date of Collection:
____Positive Result ____Negative Result
B. Serologic test positive for Rubella antibody
Date of Collection:
____Positive Result ____Negative Result
Varicella
A. Two doses of Varicella vaccine on or after their first birthday and at least 28
days apart.
OR
Date #1:
Date #2:
B. Serologic test positive for Varicella antibody
Date of Collection:
____Positive Result ____Negative Result
Health Sciences
Health Professions (CE)
Initial Program Tuberculosis (TB) Test
Indicate program of application:
Applicant information:
Last Name First Name MI Maiden
Address
Apt.#
City State Zip
ACC E-mail ACC Student ID
Tuberculosis: must show proof of:
**See excerpt from CDC website below from Latent
Tuberculosis Infection
A. Documentation of a negative (<10mm) two-
step tuberculin skin test (TST) within the
past 90 days prior to beginning the Program
OR
Date Given: #1
Positive Negative (If negative, repeat in 1- 3 weeks)
Read by: _________________ Date: ___________
Date Given: #2 ________________________________
Positive Negative
Read by: __________________ Date: _______
B. Negative blood assay (QFT, TSPOT) within
the past 90 days prior to beginning the
Program
Date: ______________________________________
Result: _____________________________________
C. IF a prior positive reactor to TST, must
show documentation of a negative blood
assay within 90 days.
Date: ______________________________________
Result: _____________________________________
ONLY COMPLETE STEP D IF YOU HAVE A
PRIOR POSITIVE BLOOD ASSAY.
D. IF prior positive blood assay, present a
negative chest x-ray report within past 2
years (this must not expire prior to, or during
your first semester), be free of productive
cough, night sweats or unexplained loss of
weight. (submit Disease Screening TB
Questionnaire)
Date of positive blood assay: __________________
X-ray results: __ _
Date: ________________________________
Physician, Physician’s Assistant or Nurse Practitioner Information: FACILITY STAMP
Printed Name
Address
Signature Credentials Date
** This is required by our clinical agencies – no exceptions. “Some people infected with M. tuberculosis may have a
negative reaction to the TST if many years have passed since they became infected. They may have a positive reaction to a
subsequent TST because the initial test stimulates their ability to react to the test. This is commonly referred to as the “booster
effect” and may incorrectly be interpreted as a skin test conversion (going from negative to positive). For this reason, the “two-step
method” is recommended at the time of initial testing for individuals who may be tested periodically (e.g., health care workers).”
Revised 04-06-16
(https://www.castlebranch.com/)
Student FAQs
I'm a returning user, who is CastleBranch?
We're exactly the same company you've already established an account with. We
just have a new name. Welcome to CastleBranch!
Has my username or password changed?
All usernames and passwords have remained the same. However, if you used your
browser to store your username and password - you will likely need to reset your
password. Simply visit this link: castlebranch.com/forgot-password
(https://www.castlebranch.com/forgot-password)
Remember, your usernamHis the same email address you used to establish your
account.
I forgot my password. How can I reset it?
Don't worry, you can simply reset your password by visiting
castlebranch.com/forgot-password(https://www.castlebranch.com/forgot-password)
Student
FAQ
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CastleBranch.com • phone: 888.723.4263
1
Submitting Documents
Submitting documents to myCB can be achieved three ways: via upload, fax, or mail. This guide will cover all three
options. If you need any further assistance, please call the number located at the bottom right of every page.
UPLOADING DOCUMENTS
The most ecient way to submit. Uploading your documents through myCB is not only secure, but ensures faster
processing time.
Options for Digitizing Your Document
Take a picture
Use the myCB app
Scan your document
Utilize a local FedEx, UPS, Library, or University’s resources
Submitting Through myCB
Click To-Do Lists within the myCB panel on the left
Expand the requirement you wish to upload to
Click Browse next to Your Computer or Flash Drive
Select file(s) needed, one at a time
Hit Submit
Note: Document removal may only happen before submission. Make sure you have attached the correct file
name(s) before submitting. To remove a document, simply click Remove Document and re-attach the correct
version.
All Documents uploaded are stored in
your Document Center for future use.
To attach a previously uploaded
document to a requirement, follow
the same steps and then click Browse
next to My Documents.
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Replacing Rejected Documents
Read the rejected reason
Re-upload using the same steps above
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The two most common rejection reasons are missing information and illegible documentation. Make sure your
documents are easily legible and contain their essential information, such as: signatures, physical exam dates,
vaccination dates, or titer collection dates.
CastleBranch.com • phone: 888.723.4263
2
Submitting Documents
FAXING DIRECTLY TO REQUIREMENTS
Following the steps below will result in your documents automatically attaching to their specific requirements,
designated by their included cover letters.
Print Cover Letters
Click To-Do Lists within the myCB panel on the left
Expand the requirement you wish to upload to
Click Download at the bottom
Read and close the warning prompt
Print the cover letter
Follow the directions on the cover sheet
Repeat for all requirements to be faxed
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FAXING TO DOCUMENT CENTER
Following the steps below will result in your documents going into your myCB document center, where you will
need to attach them to each requirement individually.
Print Cover Letter
Click Document Center within the myCB panel on the left
Click Print/Fax Mail Cover Sheet on far right
Read and close the warning prompt
Print the cover sheet
Follow the directions on the cover sheet
Faxed documents will display under My Documents within the Faxed folder
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Submit Through myCB
Click To-Do Lists within the myCB panel on the left
Expand the requirement you wish to upload to
Click Browse next to My Documents
Choose the Faxed folder
Pick document needed
Hit Submit
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CastleBranch.com • phone: 888.723.4263
3
Submitting Documents
MERGING FAXED PAGES
If submitting more than one document to a requirement, you have the option to merge them together.
To Merge Pages
Click Document Center
Find the Faxed/Mailed Documents folder
Select one file you wish to merge with another
Click Add PDF to Merge Queue
Repeat until all pages you wish to merge are queued
Select Merge These Documents at the top right
All merged files can be found in the Merged Files folder.
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MAILING DOCUMENTS TO CASTLEBRANCH
Follow the steps below to mail documents to CastleBranch for review.
Print Cover Letters
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Click To-Do Lists within the myCB panel on the left
Expand the requirement you wish to mail in
Click Download at the bottom
Read and close the warning prompt
Print the cover letter
Repeat for all requirements to be sent in
Mail to:
CastleBranch
1844 Sir Tyler Drive
Wilmington, NC 28405
Attn: TDL Document Center
Note: Pages mailed to CastleBranch should
be ordered accordingly:
Cover letter A, document A
Cover letter B, document B