Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
1
Lake Region State College
Paramedic – Nurse Bridge
Application
Spring 2022
Submit all documents required for admission to the Lake Region State College Paramedic Bridge
Program by placing application materials listed below in one large envelope. Print your full name
clearly on the outside of the envelope. The envelope may be mailed or hand-delivered to the address
below on or before October 15, 2021.
Karen Clementich
Director/Associate Professor
Lake Region State College
1801 College Drive North
Devils Lake, ND 58301
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
2
Paramedic to Nurse Bridge Admission Application
Description
The LRSC Paramedic to Nurse Bridge is a co-requisite group of three courses that makes the paramedic eligible to apply
to the Associate Degree nursing program.
REQUIREMENTS FOR ENTRY INTO THE LRSC Paramedic to Nurse Bridge Program
1.
High School Diploma or GED Certificate
a.
High School GPA of 2.5 or greater. If a student has completed 12 credits of college level classes
included in the program requirements, the college GPA will be considered instead of the HS
GPA.
2.
Students must be 18 years of age by December 31
st
of the year they start the program.
3.
Application and admission to the respective college is required before applying to the nursing program.
There are two application processes – first to the college and then to the nursing program.
4.
Student must be a graduate from a state board approved paramedic program have at least two years’
experience, with an active, unencumbered, license to practice as a paramedic in the United States of
America as a paramedic.
5.
Current CPR Certification for Basic Life Support, either instructor led or Heart Code BLS is acceptable,
(American Heart Association) or CPR/Healthcare Provider (Red Cross) and must be updated to remain
current throughout program.
6.
Proof of Math Skill Readiness.
a.
Student must have completed at minimum:
b.
The developmental math course (ASC 093 or other developmental math course that would
qualify a student to take Math 103 with a grade of Satisfactory or “C” or a higher-level math
course (such as MATH 103 College Algebra)
or
c.
Equivalent scores for ACT/PLAN/SAT/COMPASS and/or Accuplacer as listed below and taken
within the past 2 years:
Math Score Equivalencies According to Site
(COMPASS score is listed in the Algebraic domain)
ACT-Math
PLAN-Math
SAT Critical
Reading + Math
COMPASS
(Algebraic Domain)
Accuplacer
21 or higher
19 or higher
990 or higher
49 or higher
116 or higher
7.
Proof of Academic Readiness:
a.
All applicants are required to complete the most current Assessment Technologies Institute
(ATI), standardized Test of Essential Academic Skills (TEAS) prior to application deadlines.
i.
Applicants are allowed two (2) attempts per application period at the TEAS exam per
application period.
ii.
A minimum TEAS composite score must be in the Basic level or greater. Any applicant
scoring below the Basic level will not be accepted. The best score achieved, of two attempts,
may be submitted. Last year the average TEAS score for all admitted applicants was within
the Proficient level.
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
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iii.
TEAS scores are valid for up to two (2) years prior to July 15th of the year of application.
iv.
It is to your advantage to double check the other parts of your application to make sure you
are qualified in the other areas before you attempt the TEAS exam.
v.
It is recommended that you use the study materials on the TEAS website to score well on the
exam. As noted above you may repeat the TEAS to better your chance of admission.
8.
ACT composite score of 19, or
i.
ACT/ASSET/Accuplacer/Compass/SAT test(s) with an equivalent score, or
ii.
Successful completion of 12 credits of college courses with a minimum GPA of 2.50.
9.
For any required college courses completed prior to admission, the grade in that course must be a 2.0 (C)
or higher, and nursing GPA for all completed required nursing courses must be 2.75 or higher.
• Pre-requisites:
a.
Anatomy and Physiology I and II with Lab (A & P II must be taken within the last 7 years).
b.
Introduction to Pharmacology (must be taken within the last 7 years).
c.
Developmental Psychology (must be taken within the last 7 years).
d.
Introduction to Psychology
e.
English Composition I
• AD program requirements (may be completed before or while in the AD program)
f.
Microbiology
g.
Communications elective or English composition II
10.
Guidelines for approval include:
a.
High School GPA of 2.5 or greater or
b.
If a student has completed 12 credits of college level classes, the college GPA will be considered
instead of the HS GPA. Nursing GPA for any completed required nursing program courses must
be 2.75 or higher.
c.
Overall cumulative GPA for all college courses completed must be 2.5 or higher.
d.
No required course may have a grade lower than 2.0 (C).
e.
If a student repeats a required science course, or previous nursing course, a grade of 2.0 (C) or
higher must be obtained in the first repeat (A & P I and II, Microbiology). An appeal process
may be sought if the student has failed science course more than two times.
f.
Critical courses completed more than 7 years prior to program application must be repeated:
Anatomy and Physiology II, Developmental Psychology, and Introduction to Pharmacology.
11.
A certain level of English proficiency is necessary for academic success in nursing as well as for patient
safety. In addition to general college English proficiency requirements, who was not born in USA or
Canada, or who have not attended 4 years of U. S. high school and achieved a HS GPA of 3.0 or higher,
must meet additional language proficiency requirements for admission to the Dakota Nursing Program.
These requirements must be met prior to consideration.
Minimum TOEFL Scores for Admission to the Dakota Nursing Program
To be considered for admission to the pre-licensure program, English as a second language (ESL)
applicants must achieve minimum scores on the TOEFL internet-based test (TOEFL iBT) of:
Minimum Cumulative Score of:
• 86 Combined
AND Minimum Individual Scores of:
• 26 in Speaking
• 20 in Writing
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
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• 20 in Reading
• 20 in Listening
Please contact the paramedic program manager before you submit your application to discuss
these requirements and to make arrangements to take the TOEFL exam if applicable.
Students accepted into the nursing program must have access to reliable, high speed internet.
PROGRAM APPLICATION AND ADMISSION PROCESS
Complete all requirements for admission to the College.
Complete all requirements for entry into the Paramedic Bridge Program and submit the application packet.
Interview with the admissions committee
Qualified students are accepted into the program on a competitive basis until all spaces are filled. After that,
qualified applicants are admitted as space becomes available for that academic year.
CHECKLIST FOR THE PARAMEDIC BRIDGE PROGRAM APPLICATION PROCESS
1. Application to your local college:
Complete an Application for Admission to LRSC as a degree-seeking student.
a. The application fee (this only applies if you are a new student to your local college)
b. Official high school transcript or GED test results
c. Official updated college transcripts, including current semester, from all colleges attended. Transcripts
must be mailed from the college attended or hand delivered in a sealed envelope. Faxed copies are not
accepted.
d. Immunization record (You will need to submit this again to the nursing program with additional
immunization information when you are admitted to the nursing program – keep a copy.)
e. Record of ACT, SAT, Compass, or Accuplacer scores (completed within the last 7 years)
2. Application to the Paramedic Bridge Program:
Submit all documents required for admission by placing application materials listed below in one large envelope.
Print your full name clearly on the outside of the envelope. The envelope may be mailed or hand-delivered on or
before October 15, 2019 to the address listed on the cover sheet/front cover.
a. Paramedic Bridge application form
b. Copy of current CPR certification for Basic Life Support Providers
c. Transcripts from each high school and college you have attended. Photocopies are allowed if it is a
copy of the official transcript found in Student Services.
d. Proof of math skill readiness (ACT, SAT, Compass, or Accuplacer, or transcript with math course)
e. Proof of academic readiness (ACT, SAT, Compass, or Accuplacer, or transcript with 12 required
credits)
f. TEAS test results
g. A narrative statement
• Summarize your educational/work experiences and how those experiences will help you
progress through the bridge and nursing program.
• Describe why you want to be a nurse and why this is a good time in your life to pursue a
nursing degree.
• Limit the narrative to 1.5 to 2 typed pages, double space, and use #12, Times New Roman Font.
• Content as well as your writing ability including grammar and spelling will be evaluated.
h. Provide statements from two (2) professional references. Use attached reference forms, to request
reference statements from employers, instructors, and/or professional colleagues who are not related
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
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to you.
• Complete section 1 on each form by printing your name and signing the waiver before
distributing the forms to your selected references.
• Instruct the reference providers to seal the statement in an envelope and reference providers
sign across the seal before returning the reference to you (the student).
• Collect the sealed letters of reference and include them in your application packet.
i. Complete criminal background disclosure form. See enclosure. NOTE: Background check with
CastleBranch. You will be given instructions on how to acquire fingerprint cards and complete
the form upon admission to the program.
j. Review essential functions (abilities) of the nurse and discuss any areas of concern with the
Paramedic Instructor. See enclosure.
k. Review the role of the student nurse and discuss any areas of concern with the Paramedic Instructor.
See enclosure.
l. Sign and date the role of the student nurse statement and return it in your application.
All applicants will be notified of status on or before October 31
st
, 2021.
*Incomplete applications are not able to be processed and will be refused*
Paramedic to Nurse Bridge Curriculum
Nurs 201: Nursing Concepts Transition I for the Paramedic (3 credit Theory Course)
Nurs 202: Nursing Concepts Transition II for the Paramedic (3 Credit Theory Course)
***Nurs201 & Nurs 202 will be online courses. Please schedule 18 hours of personal time per week to
complete required reading and assignments. Proctored testing will be on-campus.
Nurs 203: Nursing Practice Transition for the Paramedic (3 Credit Lab/SIM/Clinical Course)
***Nurs203 will be scheduled as 2 consecutive days, every other week on-campus. To begin in week 2.
Upon successful completion of the above curriculum, the student will be eligible to apply to the AD nursing program.
It is the applicant/student’s responsibility to verify that all required documentation, general education
courses, electives, and nursing courses are complete and met the requirements of the Dakota Nursing
Program one semester prior to graduation.
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
6
Criminal Background Checks
Upon admission to the Paramedic Bridge Program, the student will be required to complete and pay for a
background check through the agency designated by LRSC. Student is responsible for any costs associated
with the background check.
The student will not initiate the background check until directed to do so upon receipt of the letter notifying the
applicant of acceptance into the program. The acceptance letter will specify the background check process to be
followed.
If a background check is received with any offenses (felonies, misdemeanors, or infractions), the student
must address in writing their account of the offense and what specific rehabilitation measures occurred.
If the offense is less than 5 years old or of a grave nature, the student must make an appointment to appear
before the admissions committee to personally address each offense.
The information will be used by the admissions committee to determine the suitability of the candidate for
admission to the nursing program.
If the background check is returned with offenses that are greater than 5 years or of less than grave nature, the
committee will notify you of what your next action will be.
Upon applying for licensure examination, the North Dakota State Board of Nursing will require the applicant to
complete and pay for another background check. All offenses must be reported to the NDBON when applying
for licensure.
Mandatory Drug Testing and Screenings
The Dakota Nursing Program maintains a no tolerance policy regarding substance abuse. Students must
undergo drug screens if requested by the Dakota Nursing Program, a clinical agency or if suspected to be under
the influence of alcohol, narcotic prescription drugs or illegal drugs while on a clinical rotation. Failure of the
student to either take the drug test or show a clear drug screen will result in termination from the nursing
program and all nursing courses. Drug testing/Background check will be done by Castle Branch. The
student is responsible for any costs associated with drug test or screening. **You will be given
instructions on how to create an account with Castle Branch and where to pick up the Chain of Custody
form to complete the drug testing which will include designated testing location.
Please complete disclosure form enclosed in this application packet.
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
7
Application Form for Admission to the Paramedic Bridge Program
All lines must be completed for the application to be accepted
First Name: Middle Initial: Last Name:
Personal Email: College Email:
Permanent Mailing Address:
Local Mailing Address:
(If different from
address above)
Telephone: Home: Cell: Work:
Social Security Number: Student ID:
Birth Date: Age: _ Male Female
Place of Birth:
Country City/Municipality State/Province County
Is English your second language? Yes No
Ethnicity: White/Caucasian Black/African American Hispanic/Latino
American Indian/Alaskan Native Asian Native Hawaiian or other Pacific Islander
Other (Please Specify):
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
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Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
9
To be completed by the applicant’s reference (non-relatives such as employers, instructors, and/or
professional colleagues):
NOTE: The person whose name appears above has applied for admission to the Paramedic to Nurse Bridge Program.
The information you provide will be confidential.
How long have you known the candidate and in what capacity?
_ _ _
_
_ _ _
_
Please Check:
Other Comments: (Please use the back of this form if you need more space)
Please print:
Name of Reference (Please print): Company Title:
Signature of Reference:
Address:
SECTION 1
REFERENCE FORM FOR ADMISSION
To be completed by paramedic to nurse bridge program applicant:
Name of the Applicant (Please print):
_ _ _
Last First Middle Former, if
applicable
I waive the right to access this evaluation:
SECTION 2
Outstanding
Very Good
Average
Below Average
Do not know
Integrity/Honesty
Initiative/Motivation
Maturity
Ability to work with others
Communication Skills
Empathy/Caring
Judgment
Ability to make Decisions
Dependability
Overall Rating
The letters of reference must be:
• Sealed in an envelope with the signature of the reference written across the seal
• Returned to the applicant to be placed in the application packet for the Dakota Nursing Program
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
10
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
11
To be completed by the applicant’s reference (non-relatives such as employers, instructors, and/or
professional colleagues):
NOTE: The person whose name appears above has applied for admission to the Paramedic to Nurse Bridge Program.
The information you provide will be confidential.
How long have you known the candidate and in what capacity?
_ _ _
_
_ _ _
_
Please Check:
Other Comments: (Please use the back of this form if you need more space)
Please print:
Name of Reference (Please print): Company Title:
Signature of Reference:
Address:
SECTION 1
REFERENCE FORM FOR ADMISSION
To be completed by paramedic to nurse bridge program applicant:
Name of the Applicant (Please print):
_ _ _
Last First Middle Former, if
applicable
I waive the right to access this evaluation:
SECTION 2
Outstanding
Very Good
Average
Below Average
Do not know
Integrity/Honesty
Initiative/Motivation
Maturity
Ability to work with others
Communication Skills
Empathy/Caring
Judgment
Ability to make Decisions
Dependability
Overall Rating
The letters of reference must be:
• Sealed in an envelope with the signature of the reference written across the seal
• Returned to the applicant to be placed in the application packet for the Dakota Nursing Program
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
12
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
13
Disclosure Form
The Paramedic to Nurse Bridge Program requires that all applicants provide information concerning
any past felony or misdemeanor records.
Past convictions of a felony or misdemeanor would not necessarily prevent an applicant from being accepted
into the program. However, failure to provide information concerning such conviction would warrant dismissal
if the information were later revealed, thus indicating that the applicant had falsified this form.
Note: The Dakota Nursing Program requires FBI background checks with fingerprints before you are fully
admitted to the program. It has been our experience that occasionally, applicants with a criminal history have
been told by their attorney that their records have been expunged. We have been able to see that history on the
FBI background check and students have been denied acceptance depending on the offense and the fact that
they did not disclose it. Please be sure to disclose all information requested below.
Please complete, sign, and submit this form as part of your application to the Paramedic to Nurse Bridge
Program.
1.
Have you ever been arrested (outcome was either dismissal, deferral, or conviction) of a felony, a
misdemeanor, traffic violation or appeared in court for anything?
Yes No
2.
Have you ever been subject to limitation, suspension or termination of your right to practice in a health
care occupation or voluntarily surrendered a health care licensure to The National Registry in
Emergency Medicine or the Department of Health DEMST Licensing Agency in any state?
Yes No
3.
Have you ever been on the Office of Inspector General (OIG) list of excluded individuals (abuse list)?
Yes No
4.
Have you ever been on the Certified Nurse Aide abuse list?
Yes No
If you answered yes to any of the above questions, please explain the issue(s) and/or disciplinary
action(s). Please use a separate sheet of paper and attach it to this form.
My signature below certifies that to the best of my knowledge the information above is true and complete. I
understand that if the background check is found to be other than stated above, it is sufficient cause for rejection
of my application or dismissal from the program. I give permission to release this information and information
received on my background check to affiliated nursing practice agencies.
Print Name:
Signature: Date:
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
14
Mandatory Drug Testing and Screenings
My signature below signifies that I agree to undergo the mandatory and/or random drug testing and screenings
requested by the Paramedic to Nurse Bridge Program or clinical agencies affiliated with the program and adhere
to the listed policy.
Print Name:
Signature: Date:
LRSC Paramedic to Nurse Bridge STUDENT ESTIMATED COSTS – 2021-2022
Paramedic Bridge
Subtotals
Uniforms
1 pair program-designated scrubs WITH PATCH = $50.00 (you may want 2 pair)
Clinical Specific Shoes = $50.00, Black Dress Shoes = $50.00
Dress Slacks = $20.00, Polo Shirt = $30.00
$235.00
Equipment
Stethoscope = $60.00 or more based on quality
Sphygmomanometer = $30.00 or more based on quality
Watch with second hand = $25.00, Bandage scissors = $3.00, Penlight = $5.00
$123.00
Textbooks and
Skyscape electronic
reference books.
Spring semester = $578.00
The cost may vary depending on the general education classes you take each semester.
Check your bookstores online site for book cost and ISBN numbers.
$578.00
ATI
Access to Assessment Technologies Institute (ATI) online practice and proctored exams,
and online resources (books and videos). Payment due to college bookstore or business
office
$464.00
Program Fee
$400.00 each semester = $400.00
$400.00
Lab Fee
$50 for each lab/clinical course
$ 50.00
Background Check
and Drug Screen
Must be done after a student is accepted but before designated date in the summer before
they start class.
$150.00
Tuition and Fees
6 Credits: Online Classes
3 Credits: On-Campus Class
$1574.00
Individual Expenses
such as travel, child
care, etc.
Per individual student (may include travel to clinical sites),
Others: Name pin if you lose the first one - $10.00.
Nursing Program Pin per program - varies - check with coordinator
Varies
Laptop Computer
and Printer
Students must have access to a computer and high-speed internet which may entail
purchasing a laptop if they do not have one. Students at several sites must have their own
computers to bring to class to complete exams and assignments.
$2,000.00
Handheld Electronic
Device
Students will access the Skyscape electronic references for clinical on a handheld electronic
device which may entail purchasing the device if they do not have one. Students in the past
have found that the iPod Touch and iPhone are very compatible with this format. Other
smart devices such as Blackberry or Android devices are also effective.
$300.00
Total
Plan on costs from $3536.50 - $5836.50
Work with your financial aid officer and nursing advisor for an individualized estimation.
Please note that this is an estimate. To the best of our knowledge this form is complete. There may be unforeseen expenses that
come up during the year. You will be responsible for all program expenses even if they have been inadvertently left off this form.
These costs are non-refundable if you are dismissed or voluntarily leave the bridge program.
Paramedic Bridge Application Form 2021-2022
Originated 06/19/2015. Reviewed Annually.
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