STUDENT FORMS

For continuing students in our program

All students are strongly encouraged to receive the influenza vaccination while enrolled in the Nursing Program.  If the vaccine is declined, you will be required to wear a mask in certain clinical rotations during your time in the program.  The Grossmont College Health Services Office has the vaccine available during this fall and early spring semester.

1. Background Check Form
2. Community Service Form
3. Dental Record Form
4. Immunization Record and Statement of Health
5. Influenza Vaccination Consent
6. Influenza Vaccination Declination (Students are not eligible to decline without a Physician's statement documenting an adverse reaction)
7. Physical Examination Form
8. Remediation Plan
9. Sweatshirt order form - CNSA
10. Tuberculosis Form
11. Basic HIPAA Training (37 pages %7e.pdf file) Select #1. HIPAA Training Module. Students must print and sign the last 2 pages and submit to the Nursing Office.

Course and Clinical Evaluation forms:

1. Course Evaluation
2. Clinical Site Evaluation
3. Program Evaluation (For NURS 235 students only)
4. Evaluation of Facilities
5. Faculty Evaluations of Facilities (Faculty only)

NLNAC ACCREDITED