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How do I fill this out?
To fill out this form, gather all necessary healthcare experience details. Ensure both pages are completed with accurate information. Verify that all supporting documents are translated to English and uploaded by the deadline.

How to fill out the Clackamas Community College Nursing Program Form?
1
Gather your healthcare experience documentation.
2
Complete both pages of the form with accurate details.
3
Have your supervisor or HR representative fill out Part 2.
4
Upload all documentation to your NCAS application.
5
Submit before the application deadline.
Who needs the Clackamas Community College Nursing Program Form?
1
Applicants to the CCC Nursing Program need this form to document their healthcare experience.
2
Supervisors may need to complete Part 2 to verify applicants' experience.
3
Human resource representatives may use this to authenticate employment details.
4
Admissions officers require it for evaluating applicants' qualifications.
5
Career counselors advise students on completing this form.
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1
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What are the instructions for submitting this form?
To submit the Healthcare Experience Documentation Form, you need to upload both completed pages to your NCAS online application before 8:59 PM PST on February 15, 2023. Ensure your supervisor signs Part 2 and all documents are in English. If you have questions, contact the CCC admissions office for guidance.
What are the important dates for this form in 2024 and 2025?
For the CCC Nursing Program, the important dates for submission are: February 15, 2023, by 8:59 PM PST for all required documentation. Make sure to stay updated for future application deadlines in 2024 and 2025, ensuring you meet all requirements in a timely manner.

What is the purpose of this form?
The purpose of this form is to capture the healthcare experience of applicants to the CCC Nursing Program. It ensures that applicants can substantiate their experience in direct patient care, which is crucial for assessment during the admissions process. This documentation facilitates the evaluation of applicants and helps maintain the program's standards.

Tell me about this form and its components and fields line-by-line.

- 1. Applicant Name: The full name of the applicant.
- 2. Applicant Student ID Number: The ID number for current students.
- 3. Healthcare Experience Hours: Total hours of healthcare experience completed.
- 4. Supervisor Name: The name of the supervisor verifying the work experience.
- 5. Dates of Employment/Service: Start and end dates for the applicant's employment.
- 6. Signature: Signature of the applicant and supervisor.
What happens if I fail to submit this form?
Failure to submit this form can result in disqualification from the CCC Nursing Program application process. Incomplete or incorrect submissions will not be accepted by the admissions committee.
- Application Nullification: Submitting false information can lead to your application being canceled.
- Missed Opportunities: Delaying submission may result in missing the admission deadline.
- Lack of Verification: Without a signed verification, your experience may not be considered valid.
How do I know when to use this form?

- 1. Nursing Applicants: Individuals applying to the Nursing Program must complete this form.
- 2. Healthcare Workers: Those with healthcare experience seeking credit for their application need this form.
- 3. Employers: Supervisors need to complete Part 2 for verification of employment.
Frequently Asked Questions
How do I fill in the Healthcare Experience Documentation Form?
Simply gather all required documentation and complete both parts of the form. Ensure that your supervisor verifies your experience.
Can I edit this PDF online?
Yes, you can edit this PDF using our online tools before downloading the final version.
What happens if I submit an incomplete form?
An incomplete form may result in your application being nullified.
Are there any deadlines I need to know?
Yes, all documents must be uploaded by February 15, 2023, by 8:59 PM PST.
Can I share this completed PDF easily?
Absolutely! Use the share feature to send your PDF through email or social media.
Is there a specific format for the supporting documents?
Yes, all documents must be translated into English.
Do I need a supervisor's signature?
Yes, a valid supervisor's signature is required on Part 2 of the form.
What should I do if I have more questions?
Feel free to contact the admissions office for further assistance.
Is this form necessary for all applicants?
Yes, all applicants must submit this form to document their healthcare experience.
What if I make an error on the form?
You can edit the document on PrintFriendly before finalizing your submission.
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