Virginia Appalachian Tricollege Nursing Program

Student Forms/Clinical Documents

No Documents are to be sent to the VATNP office.  All paperwork is to be submitted through the Certified Background website.  You must convert your paperwork to electronic files, PDF is the required format and can be achieved by scanning.  When preparing your documents for upload, your HIPAA certificates must be combined into a single file for upload, as must the Student Information and Physical Assessment pages.

In the Certified Background instructions, you are asked to provide a classification code depending on the school where you have enrolled.  When you enter the Certified Background site, you will see Virginia Highlands as the school.  This is OK - please go ahead with registration.


VATNP Student Documents- New and Readmitted Students: 

Proof of all the health and professional requirements must be on file prior to participation in any nursing classes. These records are required by our clinical agencies with which the VATNP has binding contracts. Student files will be reviewed each semester for compliance. Failure to provide this documentation by the deadline dates will result in the student being unable to attend clinicals and therefore failing the course.

Deadlines: All paperwork for LPN-RN students must be submitted by May 15th, others must be submitted no later than August 1st into your Certified Profile Clinical Requirements -.  Required Documents should be kept by the student for a personal portfolio.

To access the descriptions of required paperwork and accompanying forms for new and readmitted students, please follow this link: 

Requirement Descriptions and Accompanying forms


Required paperwork and accompanying forms for continuously enrolled students (2nd and 3rd Year Students): Deadline for submission is August 1st. 

  • Annual Student Statement of Health (click for link)

  • Student Statement of Criminal Background (click here for form), (click here for instructions for uploading document to Certified Profile)

  • Mantoux Tuberculin Skin Test:  (TB Tine test is not acceptable) - Proof of a negative TB skin test must be obtained every year and should not expire during the clinical experience, this screening is to be renewed annually. The results of the test must be signed by a licensed health care provider showing the date of testing, date of reading, and results recorded in millimeters of indurations. Students who are known positive reactors or who cannot be tested must provide a negative chest X-ray and yearly physician documentation of negative physical signs and symptoms of tuberculosis.  (Procedure for Mantoux Tuberculin Skin Test - Give 0.1 ml 5 TU PPD intradermal injection in a forearm. Read test in 48-72 hours.  If reading (indurations) is 5mm or greater, the test is positive for certain persons at increased risk; 15mm or greater is considered positive for healthy people who are not at risk.)

  • American Heart Association CPR Card (if expired)

  • Flu Shot-due October 1st


Other Forms

To Print a copy of your "To Do List" Summary, please follow the directions below:

To print your TDL (To Do List) Summary Page you will need to log onto your CertifiedProfile Account. Once logged onto
CertifiedProfile click on your “Document Center.” From the drop down that appears you will then click on “Clinical Requirements.”
Another drop down should appear and you will click on the file labeled “Results.” Click on the “Download” button, then print your
TDL Summary Results Pages.



Acrobat Reader is required for some of the required forms.
You can download the free Adobe Reader software directly from Adobe's website.
Download Acrobat Reader

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Virginia Appalachian Tricollege Program