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Nursing Department -> Student Forms

Student Forms

Any new or ongoing immunizations/tests and TB tests* that are completed while attending the Nursing Program can be submitted directly to the Nursing Office in the following manner;
                -Health Professions Immunization record (see forms below)
                -Printout of immunizations or lab results from your physician
                              (must include a signature of physician by each new immunization/test to be valid)

                -A copy of your yellow immunization card w/signature and stamp

*TB tests- For incoming and continuing students, a new positive TB test must be cleared by the RN in Health Services.  For continuing students, a yearly TB Questionnaire can be completed in the Nursing Program Office.  Positive TB tests must be submitted with documentation of the initial reported indurations measured in mm, a printout of a clear chest x-ray and a recent TB Questionnaire.

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

  1. ADB Background check information
  2. Community Service Form
  3. Essential Functions of the Nursing Student 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 or a statement from their pastor indicating refusal for religious reasons)
  7. Petition for Re-Entry
  8. Physical Examination Form
  9. Tuberculosis Form
  • Basic HIPAA Training Read “HIPAA Privacy Basics & Intermediate Module including Information Security Awareness” (17 pages) Print “HIPAA Privacy Posttest” and answer the questions. Fill in the date, your name, title (student) and submit to instructor on first day of class. 
  • Statstrip Training module

Weekly Student Evaluation forms:

1.   First Year Weekly Clinical Evaluation Form
     (used for NURS 120, 130, and 132).

Second Year Weekly Clinical Evaluation Form
     (used for NURS 220, 222, and 230).

Course and Clinical Evaluation forms:

  1. Course Evaluation
  2. Clinical Site Evaluation
  3. Program Evaluation (For NURS 235 students only)
  4. Student Evaluation of Grossmont College Facilities
    (For end of 2nd year only)
  5. Faculty Evaluations of Facilities (Faculty only)


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