registration information for nursing assistants · 2020-03-06 · registration information for...

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REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the following: Complete the enclosed forms (PLEASE PRINT NEATLY): 1. Student Data Information 2. Student Rights, Responsibilities & Authorizations for the Collection and Release of Data 3. Nursing Assistant Refund Policy 4. Deferred Payment Agreement (employer must sign the top, student must sign the bottom) **Please send payment with registration forms if the student is paying** 5. Background Study Form - Minnesota West will submit this electronically to MN Department of Human Services. Minnesota law requires all students providing direct patient care to undergo a background study. Please mail to: Mel Lamote Nursing Assistant Registration Minnesota West Community & Technical College P.O. Box 250 Pipestone, MN 56164-0250 OR FAX the registration forms to 507-825-4656 or scan and email: [email protected] Nursing Assistant Reading Test Policy Students attending a Nursing Assistant class will be required to take an Accuplacer test to measure their ability/proficiency to read and course readiness. Students must score a 31+ (reading) on the test to be enrolled in this course. The following test scores may be used in lieu of the Accuplacer: ACT: 11+ on the Reading portion or High School MCA: 1042+ or Accuplacer Next Gen Reading 221+. Please provide a copy of these test scores with the registration paperwork. If the ACT score is below 11 or MCA score below 1042, an Accuplacer reading test score of 31+ or Accuplacer Next Gen score of 221+ will be required. ALL STUDENTS MUST ATTEND A TESTING SESSION PRIOR TO STARTING THE COURSE. A confirmation letter will be sent to the student with testing information. NOTICE: Due to the limited Accuplacer testing the College is accepting HS transcript, relevant GPA or relevant college level course work. Tuition Refund Policy In order to be eligible for a refund, you must officially drop the class. This means that you must notify Mel Lamote at 507-825-6822 or via email (preferred) at: [email protected]. The date you notify the Pipestone campus will be the official date of the drop. Tuition will only be refunded if the official drop dates takes place as follows: 100% Tuition and fees refund if you drop BEFORE the second class meets. Rates Charged as of August 2020 To be eligible for the Minnesota resident tuition rate, you must be a resident of Minnesota for a minimum of 12 months prior to registration for this class. Due to negotiated agreements with the states of South Dakota and North Dakota, residents of those states must fill out a reciprocity form to qualify for the lower resident tuition rate. Residents of other states will be allowed to pay the lower resident rate without completing any additional paperwork. Classes running August 2020 – December 2020 (MN/ND/SD/Non Resident) Tuition/Fees $624.96 Text book $55.50 Skill Sheet $9.75 Total $ 690.21 Classes running January 2021 – May 2021 (MN/ND/SD/Non Resident) Tuition/Fees $640.86 Text book $55.50 Skill Sheet $9.75 Total $706.11 TUITION/FEES/BOOKS SUBJECT TO CHANGE There will be a State Nurse Aide Test fee of $200.00 (retakes $125) at the end of training. A separate payment {check, money order or cash} will be required at that time to cover the student’s test fee. This document is available in alternative formats to individuals with disabilities by contacting the Student Services Advisor by calling 800-658-2330 or via your preferred Telecommunications Relay Service. Deaf and Hard of Hearing Minnesota Relay Service 800-627-3529. Minnesota West Community & Technical College is accredited by the Higher Learning Commission North Central Association. A member of Minnesota State Colleges and Universities (Minnesota State). An Affirmative Action Equal Opportunity Educator/Employer

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Page 1: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

REGISTRATION INFORMATION FOR

NURSING ASSISTANTS

To be registered for the Nursing Assistant Course, you must do the following:

Complete the enclosed forms (PLEASE PRINT NEATLY):

1. Student Data Information

2. Student Rights, Responsibilities & Authorizations for the Collection and Release of Data

3. Nursing Assistant Refund Policy

4. Deferred Payment Agreement (employer must sign the top, student must sign the bottom)

**Please send payment with registration forms if the student is paying**

5. Background Study Form - Minnesota West will submit this electronically to MN Department of

Human Services. Minnesota law requires all students providing direct patient care to undergo a

background study.

Please mail to: Mel Lamote – Nursing Assistant Registration

Minnesota West Community & Technical College

P.O. Box 250

Pipestone, MN 56164-0250

OR FAX the registration forms to 507-825-4656 or scan and email: [email protected]

Nursing Assistant Reading Test Policy

Students attending a Nursing Assistant class will be required to take an Accuplacer test to measure their

ability/proficiency to read and course readiness. Students must score a 31+ (reading) on the test to be enrolled in this course.

The following test scores may be used in lieu of the Accuplacer: ACT: 11+ on the Reading portion or High School MCA:

1042+ or Accuplacer Next Gen Reading 221+. Please provide a copy of these test scores with the registration paperwork. If

the ACT score is below 11 or MCA score below 1042, an Accuplacer reading test score of 31+ or Accuplacer Next Gen score

of 221+ will be required. ALL STUDENTS MUST ATTEND A TESTING SESSION PRIOR TO STARTING THE

COURSE. A confirmation letter will be sent to the student with testing information. NOTICE: Due to the limited

Accuplacer testing the College is accepting HS transcript, relevant GPA or relevant college level course work.

Tuition Refund Policy

In order to be eligible for a refund, you must officially drop the class. This means that you must notify Mel Lamote at

507-825-6822 or via email (preferred) at: [email protected]. The date you notify the Pipestone campus will be

the official date of the drop. Tuition will only be refunded if the official drop dates takes place as follows:

100% Tuition and fees refund if you drop BEFORE the second class meets.

Rates Charged as of August 2020 To be eligible for the Minnesota resident tuition rate, you must be a resident of Minnesota for a minimum of 12 months prior

to registration for this class. Due to negotiated agreements with the states of South Dakota and North Dakota, residents of

those states must fill out a reciprocity form to qualify for the lower resident tuition rate. Residents of other states will be

allowed to pay the lower resident rate without completing any additional paperwork. Classes running August 2020 – December 2020 (MN/ND/SD/Non Resident) Tuition/Fees $624.96 Text book $55.50 Skill Sheet $9.75 Total $ 690.21

Classes running January 2021 – May 2021 (MN/ND/SD/Non Resident) Tuition/Fees $640.86 Text book $55.50 Skill Sheet $9.75 Total $706.11

TUITION/FEES/BOOKS SUBJECT TO CHANGE

There will be a State Nurse Aide Test fee of $200.00 (retakes $125) at the end of training.

A separate payment {check, money order or cash} will be required at that time to cover the student’s test fee. This document is available in alternative formats to individuals with disabilities by contacting the Student Services Advisor by calling 800-658-2330 or via your

preferred Telecommunications Relay Service. Deaf and Hard of Hearing Minnesota Relay Service 800-627-3529. Minnesota West Community & Technical College is accredited by the Higher Learning Commission North Central Association.

A member of Minnesota State Colleges and Universities (Minnesota State). An Affirmative Action Equal Opportunity Educator/Employer

Page 2: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

Nursing Assistant Class

2020-2021 {3 credits}

This three credit Nursing Assistant Class is designed to prepare students for entry level jobs in nursing homes and other health care

facilities. The nursing assistant will be able to perform tasks which are related to patient/resident care and supportive to nursing care. The

clinical experience in a nursing home is included. This course is designed to prepare one to successfully complete the Minnesota Nursing

Assistant Certification Competency Examination and be able to apply for the Minnesota Board of Health Registry.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

The charges for the course are listed on the Registration Information Sheet enclosed with this packet. Tuition prices are subject to

change after June 1 every year. The cost for the class needs to be paid by the student before or on the first day of the class or the

deferred payment form signed by the employer. For more information, call Mel Lamote, Minnesota West Community & Technical

College, Pipestone Campus at {507}825-6822. ************************************************************************************************************************

Due to limited Accuplacer testing, the College is accepting High School transcript, relevant GPA or college level

course work.

Minnesota West Community & Technical College, Canby Campus, Room 109

July 2020

July 21,22,23,24,27,28,29,30,31 August 3,4,5,6,7,10,11,12 times will vary

Clinicals to be Announced

September, 2020 September 14, 17, 21, 24, 28, October 1, 5, 8, 12, 19 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

February, 2021

February 8, 11, 18, 22, 25, March 1, 4, 15, 18, 22 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

June, 2021

June 7, 8, 9, 10, 11, 14, 15, 16, 17, 18 from 9:00am-3:30pm

Clinicals: To Be Announced

Minnesota West Community & Technical College, Jackson Campus, Room R-103

June, 2020

June 8, 11, 15, 18, 22, 25, 29, July 2, 6, 9 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

September, 2020

August 31, September 3, 10, 14, 17, 21, 24, 28, October 1, 5 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

January, 2021

January 11, 14, 21, 25, 28, February 1, 4, 8, 11, 18 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

March, 2021

March 22,25,29, April 1,5,8,12,15,19,22 from 3:55 pm – 10 pm

Clinicals: To Be Announced

June, 2021

June 7,10,14,17,21,24,28, July 1,8, 12 from 3:55 pm – 10 pm

Clinicals: To Be Announced

Page 3: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

Minnesota West Community & Technical College, Granite Falls Campus, Classroom 118/Lab 121

September, 2020

August 24, 27, 31, September 3, 10, 14, 17, 21, 24, 28 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

October, 2020

October 19, 22, 26, 29, November 2, 5, 9, 12, 16, 19 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

January, 2021 January 11, 14, 21, 25, 28, February 1, 4, 8, 11, 18 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

March 2021

March 22, 25, 29, April 1, 5, 8, 12, 15, 19, 22

Clinicals: To Be Announced

June 2021

June 7,8,9,10,11,14,15,16,17,18 from 9:00 am – 3:30 pm

Clinicals: To Be Announced

Minnesota West Community & Technical College, Worthington Campus, Room 206

June, 2020

June 8, 9, 10, 11, 15, 16, 17, 18, 22, 23 from 9:00am-3:30pm

Clinicals: To Be Announced

August, 2020 August 24, 27, 31, September 3, 10, 14, 17, 21, 24, 28 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

October, 2020 October 19, 22, 26, 29, November 2, 5, 9, 12, 16, 19 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

January 2021 January 11, 14, 21, 25, 28, February 1, 4, 8, 11, 18 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

March, 2021 March 22, 25, 29, April 1, 5, 8, 12, 15, 19, 22 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

June 2021

June 7,8,9,10,11,14,15,16,17,18 from 9:00 am – 3:30 pm

Clinicals: To Be Announced

Page 4: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

Minnesota West Community & Technical College, Pipestone Campus, Room 106-108

June, 2020

June 8, 9, 10, 11, 12, 15, 16, 17, 18, 19 from 9:00am-3:30pm

Clinicals: To Be Announced

October, 2020 October 19, 22, 26, 29, November 2, 5, 9, 12, 16, 19 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

January, 2021 January 11, 14, 21, 25, 28, February 1, 4, 8, 11, 18 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

March, 2021 March 22, 25, 29, April 1, 5, 8, 12, 15, 19, 22 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

June 2021

June 7,8,9,10,11,14,15,16,17,18 from 9:00 am – 3:30 pm

Clinicals: To Be Announced

July 2021

July 19,20,21,22,23,26,27,28,29,30, from 9:00 am – 3:30 pm

Clinicals: To Be Announced

Lakeview Methodist Nursing Home, 610 Summit Drive, Fairmont, MN

October, 2020

October 26, 29, November 2, 5, 9, 12, 16, 19, 23, 30 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

March, 2021

March 15, 18, 22, 25, 29, April 1, 5, 8, 12, 15 from 3:55pm-10:00pm

Clinicals: To Be Announced

St. John Lutheran Nursing Home, The Maples Building, 301 South County Road 5, Springfield, MN

October, 2020

October 26, 29, November 2, 5, 9, 12, 16, 19, 23, 30 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

January, 2021

January 11, 14, 21, 25, 28, February 1, 4, 8, 11, 18 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

March 2021

March 22, 25, 29, April 1, 5, 8, 12, 15, 19, 22 from 3:55 pm – 10:00 pm

Clinicals: To Be Announced

Page 5: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

Name: ________________________________________________ Sex: Male Female Last Name First Name Full Middle Name Social Security #: ______ - _____ - ______ Birthdate: Month_____ Day _____ Year ______ Many colleges/universities use social security numbers for student identification purposes on student records. Providing your social security number is voluntary. If you do not provide this number, your inquiry will still be processed. This data is requested for purposes of administration, program evaluation and consumer data. Your number also may be used to create summary information about MnSCU programs through data matches with other state agencies.

Maiden/Former Last Name: _____________________________________________________

Address:______________________________________________________________________ Street/Box/Rural Route City County State Zip

Home Phone Number: (____) ______________ Cell Phone Number: (____) ______________

Email Address: ________________________________________________________________ Are you Hispanic or Latino (a person of Cuban, Mexican, Chicano, Puerto Rican, South or

Central American, or other Spanish culture, regardless of race)? □ Yes □ No

Race and ethnic background (select any that apply) □ American Indian or Alaska Native – A person having origins in any of the original peoples of North, Central or South America and who maintains tribal affiliation or community attachment □ Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent □ Black or African American – A person having origins in any of the black racial groups of Africa □ Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands □ White – A person having origins in any of the original peoples of Europe, the Middle East or North Africa High School Graduated/or Will Graduate From: _____________ Year of HS Graduation______

If you have not graduated, do you have a GED? □ Yes □ No Date of GED _______________

Tuition Status (check one)

Are you a resident of Minnesota? □ Yes □ No

If Yes, how long? Years ________ Months ________ If No, of which state are you a resident? _______________________________________

All of the information included is true and complete to the best of my knowledge.

Signed ________________________________________________________________________

Dated _________________________________________________________________________

Register me for this Nursing Assistant course:

Location: _______________________________

Starting Date: ___________________________

_______________________________________________

Starting Date

___________________________________________

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STUDENTS RIGHTS, RESPONSIBILITIES, AND AUTHORIZATIONS

FOR THE COLLECTION AND RELEASE OF DATA I. Information Collection

When you apply for admissions, while you are enrolled, and after graduation from Minnesota West you will be asked to

supply information about yourself, including your social security number. You will be asked to report information in the

following ways:

Admission Application

Enrollment Form

Financial Aid Application

Assessment Testing

Minnesota State Colleges & Universities Forms

Placement and Employment Follow-up Information Forms

Oral Interviews with College Staff

Health Records

II. Use of the Information

The data is being collected to:

A. Assist college staff in developing a plan to help you succeed in your program/major area.

B. Report to the Minnesota State colleges & universities Office.

C. Report to Central Office of Minnesota West Community & Technical College.

D. Create statistical and research reports.

E. Assist the college in auditing employment follow-up data, and other college policies and practices.

F. Respond to requests for information from Federal & State Agencies and Departments and the public.

G. Comply with the state immunization law.

H. Your social security number is requested to create unique student identification number which will be used to identify

testing, academic and employment follow-up information about you. Submitting your social security number is voluntary.

The number is requested under the authority granted to the colleges through enabling state legislation.

Your social security number may be used to identify you for statistical reports conducted between state agencies.

III: Student Rights

A. You have the right to refuse to provide any or all of the data requested through a form available in Student Services

Office.

B. You have the right to know and to view all public and private data maintained on you.

C. You have the right to have the data explained to you and receive a copy of it.

D. You have the right to challenge the accuracy and completeness of the data and to include you own explanation of the data.

IV: Consequences

There are consequences for not supplying data which may result in denial of the following services:

A. You may not be admitted for enrollment if you do not complete the admissions application except social security number.

B. You may not receive developmental service assistance if you do not identify a need for services.

C. You may not receive financial aid assistance if you do not provide information on the financial aid forms.

D. You may not receive assistance in occupational placement if you do not provide that data.

E. You may not continue in school if you do not comply with immunization information as required by law.

F. You will be assigned a student identification number if you do not provide you social security number.

V. Access

With the exception of “directory information” which is public information, the data you provide will be released only with

your written consent or to the following persons/entities which are authorized by law to receive and use the data:

Minnesota State Legislature

Congress

Minnesota State Colleges & Universities Office

State & Federal Auditors & Agencies

College Staff

See the statement of your rights in the college student handbook for further information about “directory information”.

Consent: I have read this document and/or have had this document read and explained to me. I understand the data collected

and it’s intended use. I agree to the specific releases of this data for the purposes listed in the section labeled “access” above.

Name (Printed) ________________________________________________________________________________________

Signed________________________________________________________Date_________________________________________

Page 7: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

Minnesota West Community & Technical College

Nursing Assistant Refund Policy

**********************************************************************

In order to be eligible for a tuition refund, the student must officially drop the course by contacting:

Mel Lamote – [email protected]

Nursing Assistant Registration Processor at 507-825-6822

The official drop date will be the date of notification by the student.

The student may receive a refund if official notification of drop is made as follows:

BEFORE 2ND CLASS MEETS - 100% REFUND

Short Courses: Students are entitled to attend one class session without obligation. Students who are registered for courses that are less

than three weeks in length will have one business day after the first class meets in which to drop classes without

obligation. Students who are registered for summer courses which do not start during the first five days of the term will

have one business day after the first class meets in which to drop classes without obligation.

In either case, no refund will be given for courses dropped after the next business day.

Students may withdraw from a course through the date on which eighty percent (80%) of the days in the academic

semester have elapsed. For courses not on a standard academic semester schedule, the final date for official course

withdrawal shall be the date on which eighty percent (80%) of the instructional days for the course have elapsed.

See “Short Course refund policy” on our website at: http://www.mnwest.edu/policies/5120

******************************************************************************

I am registering for the following Nursing Assistant Course:

Starting Date: ____________________________________________________________

Location: _______________________________________________________________

I have read this agreement and understand the refund and drop policy.

Signed _____________________________________________________________________________

Dated ______________________________________________________________________________

Page 8: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

Minnesota West Community & Technical College

Deferred Payment Agreement

Student Name:_____________________________________ Tech ID #:___________________________

Course Location:___________________________________ Course Date:_________________________

Total Tuition, Fees, Books, Supplies Due $________

Nurse Aid Test Out Fee $__200.00 (retakes $125.00)

Total Cost $_______

Contact Person________________________________________________________________

Business______________________________________________________________________

Address______________________________________________________________________

City_________________________________State_______________Zipcode______________

Business Telephone Number ( )_____________________________________________

Email Address ________________________________________________________________

X____________________________________________________________________________ Signature of Facility Representative Agreeing to Payment

*************************************************************************************************************** Terms of Agreement: 1. I understand that I am responsible for all tuition, fees, books, supplies, parking, and test out fees

incurred while in attendance at Minnesota West Community & Technical College.

2. I understand and have received a copy of the refund policy.

3. I agree to contact Minnesota West Community & Technical College to make arrangements for payment if the

payment due date cannot be met.

4. I understand that if I have a delinquent tuition, fee, book, supply or parking account, no

further enrollment at Minnesota West Community & Technical College will be permitted.

5. I understand that all uncollected charges will be turned over to a collection agency.

6. I understand that I am fully responsible for any reasonable attorney’s fees and other costs of collection

as a result of my default.

7. I understand that this is a legal binding contract.

I have read and agree to the terms specified.

Signed _____________________________________________Date__________________________________

THIS FORM MUST BE SIGNED BY THE STUDENT (BOTTOM) AND A REPRESENTATIVE FROM THE

FACILITY RESPONSIBLE FOR PAYMENT (TOP). A SPOT IN THE CLASS WILL NOT BE CONFIRMED

AND A TEXTBOOK WILL NOT BE ISSUED IF THIS FORM IS NOT COMPLETED.

Page 9: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

Name: ____________________________________________________________________ Last Name First Name Full Middle Name

Sex: Male Female

Social Security #: _______ - _____ - _______

Birthdate: Month ______ Day ______ Year _______

Maiden/Former Last Name: _________________________________________________

Other aliases/former names you were known by: ________________________________

Address:

__________________________________________________________________________ Street/Box/Rural Route City County State Zip

Have you lived in any state besides MN in the last 5 years? Yes No

If yes, list all city and states where you have lived within the past 5 years:

City: State: Year From: Year To:

Birthplace: Country _________________________ State _____________________

Home Phone Number: (_____) _______________

Cell Phone Number: (_____) ________________

E-mail address:

____________________________________________________________________

Race (select any that apply):

_____ Asian or Pacific Islander

_______ Hispanic

_____ Black

_____ White

_____ Native American

_____ Other/Unknown

Driver’s License #: _______________________________

State Issued by: _________________

Eye color: _________Hair color: ___________ Height: _______ Weight: ______

Acknowledgement I acknowledge that I have read the Background Study Notice of Privacy Practices Form and

that I have been notified of and understand that the Minnesota Department of Human

Services needs this information to complete the background study.

Signature__________________________________________________

Date______________________________________________________

Background Study Data Collection Form

PLEASE PRINT NEATLY AND COMPLETE ENTIRE FORM

Minnesota law requires all students providing direct patient care to undergo a background study.

Page 10: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

Because the Department of Human Services (DHS) is asking you to provide private information, you have privacy rights under the

Minnesota Government Data Practices Act. This law protects your privacy, but also allows DHS to give information about you to

others when the law requires it. This notice describes how your private information may be used and disclosed, and how you may

access your information.

Why is DHS asking me for my private

information?

A background study from the Department of Human Services

(DHS) is required for your job or position. The private

information is needed to conduct the background study.

What if I refuse to provide the information?

You will be disqualified if you refuse to provide information to

complete an accurate background study. You will not be able to

work in a position that requires a DHS background study.

How will I be notified that a background study

was submitted on me?

DHS will mail you a notice within three working days after a

request for a background study is submitted on you. The notice

will contain the background study result or let you know that

more time is needed to complete the background study. The

notice will also identify the entity that submitted the background

study request.

Who will DHS give my information to?

DHS will only share information about you as needed and as

allowed or required by law. The identifying information you

provide will be shared with the Minnesota Bureau of Criminal

Apprehension and in some cases the Federal Bureau of

Investigation (FBI). If there is reasonable cause to believe that

other agencies may have information related to a disqualification,

your identifying information may also be shared with:

county attorneys, sheriffs, and agencies;

courts and juvenile courts;

local police;

the Office of the Attorney General, and;

agencies with criminal record information systems in other

states.

What information must I provide to complete

the background study?

You are required to provide enough information to ensure an

accurate and complete background study. This includes your:

first, middle, and last name and all names you have ever been

known by or used;

current home address, city, zip code, and state of residence;

previous home addresses, city, county, and states of residence

for the last five years;

sex and date of birth;

driver’s license or other identification number, and;

fingerprints and a photograph.

What information will DHS share with the entity

that requested my background study?

The entity that requested the background study will be notified of

your background study determination.

If you are disqualified, the entity will not be told the reason

unless you were disqualified for refusing to cooperate with the

background study or for substantiated maltreatment of a minor or

vulnerable adult.

How will the information that I give be used?

The information will be used to perform a background study that

will include a check to determine whether you have any criminal

records and/or have been found responsible for substantiated

maltreatment of a vulnerable adult or child. Background study

data is classified as “private data” and cannot be shared without

your consent except as explained in this notice.

What other entities might DHS share

information with?

Information about your Background study may be shared with:

the Minnesota Department of Health;

the Minnesota Department of Corrections;

the Office of the Attorney General, and;

health-related licensing boards.

What may happen if I provide the information?

You could be disqualified from positions that require a DHS

background study if you are found to have committed certain

crimes, been determined responsible for maltreatment of a

vulnerable adult or child, or have other records that require a

disqualification. If you do not have a disqualifying record, you

will be cleared to work.

What if my disqualification is set aside?

If you request reconsideration of your disqualification and your

disqualification is set aside, the entity that requested the

background study will be informed of the reason(s) for your

disqualification unless the law states otherwise. DHS will provide

information about the decision to set aside your disqualification if

the entity requests it.

Unless prohibited by law, your name and the reason(s) for your

What are my rights about the information you

have about me?

You may ask if we have information about you and request in

writing to get copies. You may have to pay for copies.

You may give other people permission to see and have copies

of private information about you.

You may ask in writing a report that lists the entities that

submitted a background study request on you.

Page 11: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

disqualification will become public data if your set aside is for:

a child care center or a family child care provider licensed

under chapter 245A, or;

an offense identified in section 245C.15, subdivision 2.

For future background studies submitted by entities that provide

the same type of services as the services you were set aside for,

the set aside will apply unless:

you were disqualified for an offense in section 245C.15,

subdivision 1 or 2, or;

DHS receives additional information indicating that you pose

a risk of harm, or;

your set aside was limited to a specific person receiving

services.

In addition, those entities will be informed of the reason(s) for

your disqualification unless prohibited by law.

You may ask in writing that the information used to complete

your background study be destroyed. The information will be

destroyed if you have:

(1) not been affiliated with any entity for the previous

two years, and;

(2) no current disqualifying characteristic(s).

Please send all written requests to:

Minnesota Department of Human Services

Background Studies Division

NETStudy 2.0 Coordinator

PO Box 64242

St. Paul, MN 55164-0242

Will my fingerprints be kept?

DHS and the Bureau of Criminal Apprehension will not keep

your fingerprints. However, if an FBI check is required for your

background study, the Federal Bureau of Investigation (FBI) will

keep your fingerprints and may use them for other purposes.

How long will DHS keep my background study

information?

DHS will destroy:

your photo when you have not been affiliated with an entity

for two years.

any background data collected on you after two years

following your death or 90 years after your date of birth,

except when readily available data indicates that you are still

living.

What information can the fingerprint and photo

site view and keep?

The fingerprint and photo site can view identifying information to

verify your identify. The fingerprint and photo site will not keep

your fingerprints, photo, or most other information. The

fingerprint and photo site can keep your name and the date and

time your fingerprints were recorded and sent, for auditing and

billing purposes.

What is the legal authority for DHS to conduct

background studies?

Background studies are completed by DHS according to the

requirements in Minnesota Statutes, chapter 245C. Background

studies are authorized under Minnesota Statutes, sections

256B.0943, subdivision 5a; 256B.0659, subdivision 11(a)(3);

241.021, subdivision 6(a);144.057, subdivision 1; 518.165,

subdivision 4, and 524.5-118;

Who can see my photo?

Your photo will be kept by DHS. If you provide your social

security number to allow your background study to be

transferable to future entities, your photo will be available to

those entities to verify your identity.

What if I think my privacy rights have been

violated?

You may report a complaint if you believe your privacy rights

have been violated. If you think that the Minnesota Department

of Human Services violated your privacy rights, you may send a

written complaint to the Minnesota Department of Human

Services, Privacy Official at:

Minnesota Department of Human Services

Privacy Official

PO Box 64998

St. Paul, MN 55164-0998

Updated: 02/12/2015

Page 12: REGISTRATION INFORMATION FOR NURSING ASSISTANTS · 2020-03-06 · REGISTRATION INFORMATION FOR NURSING ASSISTANTS To be registered for the Nursing Assistant Course, you must do the

You will need to set up a StarID to access the D2L site for the online learning portion of the course. If you do

not have a one please follow the directions below. Please email me with your current email address that will be

used to contact you throughout the course for your Tech ID that you will need to create your StarID.

[email protected]

Go to our Website – www.mnwest.edu

Hover your mouse over Current Student and Click on “Student Account” from the drop down menu.

Go down to the middle of the page (yellow highlighter in a paragraph with red lettering) and click on “StarID Self Service

Menu”.

On the right side click on “Activate my StarID”

Click on “I know my Tech Id”. – keep that for if you need it in the future.

College/University – Click on Minnesota West Community & Technical College.

Hit Continue

Add your SS#

Hit Continue.

It will ask you to reset (or create new) your password.

The password has to be at least 8 digits long. Use three of these things: Upper case letters, lower case letters, numbers

and characters. You cannot use your first name or last name.

After you click on Set Password you will find your StarID on the next page along with a confirmation of accepting the

password.

Please make note of your StarID and password as you will need this to access class. This information is confidential and I

am not able to retrieve it for you.