Name Information

Legal First Name:

Legal Middle Name:

Legal Last Name:

Suffix:

Sex at Birth:

Gender Identity:

Birth Date:

Citizenship Information

If you will be on a visa, please indicate which type:

What is your country of citizenship?

Birth City:

Race Information

Race (Choose one or more):

Ethnicity:

Candidacy Information

Which college are you interested in attending?

What type of student will you be?

Check any of the following sports you might want to participate in:

Check any of the following sports you might want to participate in:

While attending school, where do you plan to live?

Anticipated enrollment year:

Anticipated enrollment term:

Do you plan to take all of your coursework online?

Enrollment Status:

Choose a program of study:

Will/Did you graduate from a high school in the United States?

TOEFL test scores are required before acceptance into the Practical or Associate Degree Nursing program. See a list of exempted countries HERE.

Country of Birth:

Native Language:

If you are currently enrolled in or have graduated from a Practical Nursing (PN) program, indicate the college attended for the PN program and the date of graduation.

College attended for PN program:

Date of graduation/anticipated graduation:

LPN License #:

Please select your anticipated enrollment status:

Anticipated date of enrollment in the MA program:

IOWA CORE PERFORMANCE STANDARDS

*Reviewed 2018, 2023*

Iowa Community colleges have developed the following Core Performance Standards for all applicants to Health Care Career Programs. These standards are based upon required abilities that are compatible with effective performance in health care careers. Applicants unable to meet the Core Performance Standards are responsible for discussing the possibility of reasonable accommodations with the designated institutional office. Before final admission into a health career program, applicants are responsible for providing medical and other documentation related to any disability and the appropriate accommodations needed to meet the Core Performance Standards. These materials must be submitted in accordance with the institution’s ADA Policy.

CAPABILITY: Cognitive-Perception

STANDARD:
The ability to gather and interpret data and events, to think clearly and rationally, and to respond appropriately in routine and stressful situations.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Identify changes in patient/client health status
- Handle multiple priorities in stressful situations

CAPABILITY: Critical Thinking

STANDARD:
Utilize critical thinking to analyze the problem and devise effective plans to address the problem.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Identify cause-effect relationships in clinical situations
- Develop plans of care as required

CAPABILITY: Interpersonal

STANDARD:
Have interpersonal and collaborative abilities to interact appropriately with members of the healthcare team as well as individuals, families, and groups. Demonstrate the ability to avoid barriers to positive interaction in relation to cultural and/or diversity differences.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Establish rapport with patients/clients and members of the healthcare team
- Demonstrate a high level of patience and respect
- Respond to a variety of behaviors (anger, fear, hostility) in a calm manner
- Nonjudgmental behavior

CAPABILITY: Communication

STANDARD:
Utilize communication strategies in English to communicate health information accurately and with legal and regulatory guidelines, upholding the strictest standards of confidentiality.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Read, understand, write and speak English competently
- Communicate thoughts, ideas, and action plans with clarity, using written, verbal, and/or visual methods
- Explain treatment procedures
- Initiate health teaching
- Document patient/client responses
- Validate responses/messages with others

CAPABILITY: Technology Literacy

STANDARD:
Demonstrate the ability to perform a variety of technological skills that are essential for providing safe patient care.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Retrieve and document patient information using a variety of methods
- Employ communication technologies to coordinate confidential patient care

CAPABILITY: Mobility

STANDARD:
Ambulatory capability to sufficiently maintain a center of gravity when met with an opposing force as in lifting, supporting, and/or transferring a patient/client.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- The ability to propel wheelchairs, stretchers, etc. alone or with assistance as available

CAPABILITY: Motor Skills

STANDARD:
Gross and fine motor abilities to provide safe and effective care and documentation.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Position patients/clients
- Reach, manipulate, and operate equipment, instruments, and supplies
- Electronic documentation/keyboard

CAPABILITY: Hearing

STANDARD:
Auditory ability to monitor and assess, or document health needs.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Hears monitor alarms, emergency signals, auscultatory sounds, cries for help

CAPABILITY: Visual

STANDARD:
Visual ability sufficient for observations and assessment necessary in patient/client care, accurate color discrimination.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Observes patient/client responses
- Discriminates color changes
- Accurately reads measurement on patient client related equipment

CAPABILITY: Tactile

STANDARD:
Tactile ability sufficient for physical assessment, inclusive of size, shape, temperature, and texture.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Performs palpation
- Performs functions of physical examination and/or those related to therapeutic intervention

CAPABILITY: Activity Tolerance

STANDARD:
The ability to tolerate lengthy periods of physical activity.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Move quickly and/or continuously
- Tolerate long periods of standing and/or sitting as required

CAPABILITY: Environmental

STANDARD:
Ability to tolerate environmental stressors.

SOME EXAMPLES OF NECESSARY ACTIVITIES (NOT ALL INCLUSIVE):
- Adapt to rotating shifts
- Work with chemicals and detergents
- Tolerate exposure to fumes and odors
- Work in areas that are close and crowded
- Work in areas of potential physical violence
- Work with patients with communicable diseases or conditions

By typing my full name below, I certify that I have read this information and am responsible for contacting the Associate Dean of Health Occupations if there is a need for reasonable accommodations in order to meet the Core Performance Standards.

Services/Activities

Students with disabilities should, as early as possible, contact the Learning Services Specialist at 641-648-8587 (Marshalltown) or Director of Student Success at 641-648-8513 (Ellsworth) to request assistance and accommodation coordination.

Permanent Address

Do you reside outside of the United States?

Permanent Address Line 1:

Permanent Address Line 2:

City:

State:

Zip/Postal Code:

Country:

Do you receive mail at this address?

Current Address

Address Line 1:

Address Line 2:

City:

State:

Zip/Postal Code:

Country:

Phone and Email

DO NOT USE a high school email address. This will be our main source of communication with you throughout the admissions process, and it will be the email you will use for password reset information once you are a student. Please use an email address you have consistent access to; parent email addresses are discouraged for this reason.

This information is used to send codes for multi-factor authorization so you can log into your college email and access your academic information.  This needs to be your PERSONAL number and email address. Do not use your parent's information. 

Cell Number:

(format: 555123456 - only numbers)

Select Cell Carrier:

Personal Email Address:

(non-school/non-parent address)

Confirm Email Address:

Do you want us to send you school-related notifications?

(We send out electronic notifications [email, fax, text, social media]. Please note, this is for school-related purposes only and not solicitations.)

High School Information

What is your high school enrollment status? 

Are/were you a home school student?

Do you have a GED?

GED Test Date:

Select your anticipated or actual high school/GED graduation month:

List your anticipated or actual high school/GED graduation year (yyyy):

Name of School:

City:

State:

Country:

Are you now, or have you previously attended a college OTHER THAN Iowa Valley Community College District (Ellsworth or Marshalltown) for credit?

College Information

List previous colleges/universities attended. Contact each college to have an official transcript sent to Admissions.

Name of Most Recent Institution:

Country

Degree:

Name of 2nd Institution:

Country

Degree:

Name of 3rd Institution:

Country

Degree:

Parent/Guardian Information

Parent/Guardian First Name:

Parent/Guardian Last Name:

Parent/Guardian Date of Birth:

Address Line 1:

Address Line 2:

City:

State:

Zip/Postal Code:

Country

Cell Number:

(format: 555123456 - only numbers)

Email:

Confirm Email:

Of your parents, which one has the most education?

Please indicate the highest level of your mother's education:

Please indicate the highest level of your father's education:

Emergency Contact Last Name:

Emergency Contact First Name:

Emergency Contact Cell Number:

(format: 555123456 - only numbers)

Scholarship Information

We will consider you for scholarships when you answer the questions below, file a FAFSA, and submit your high school transcript.

Check out the MCC Foundation website for additional scholarship opportunities.

Check all that apply to you:

By checking this box, I certify that the information on this application is correct and complete, and I consent to the release of personally identifiable information from my education records protected under FERPA. I understand that the records to be disclosed include my FAFSA Student Aid Index (SAI) score, Grade Point Average, information about my field of study and future college plans, as well as other personally identifiable information from my education records. I acknowledge that the purpose of the disclosure is to assist the Marshalltown Community College Foundation in evaluating my eligibility for scholarships.

Certification Statement