Test Self-Analysis Review Sheets

Student: __________________________   Completed on date: _____________

Directions:

When completing this form, first list the number of each test question that you missed & the topic in the first column. Then, mark an X under the description that best explains why you missed the question. You may mark more than one reason for a question. If you missed a question for a reason other than those listed, clearly specify the reason in the “Other” column on the right side of the chart. Next, add the number of X’s under each reason. These numbers indicate the areas of study on test-taking strategies that need more attention.

Complete this page with # of questions missed, the exam grade, an attainable goal, 3 strengths and at least one priority learning target.  

Submit a copy to the assigned instructor. 

©Loma Linda University

Official transcripts will be mailed directly by Ukiah Adult School. 

Please send a sealed copy of my official transcripts to:

Name: __________________________________________ Date:______________     

Address: ___________________________________________________________

Phone number: _________________________ Fax number: __________________

I attended your school under the name of (please print):

__________________________________________________________________

Last   First Middle

From: _____________________ To: _______________________

        month/year month/year

Date of Birth: ______________ Social Security Number: ___________________

(Last 4 Digits)

Signature: _________________________________________________________

Current Name (please print): __________________________________________

Last First

Current Address: ___________________________________________________

Current Phone Number: ______________________________________________

• All complaints must be in writing and must contain a concise statement of the facts. The complainant must sign and date the complaint and submit it to the superintendent or the compliance officer of the district.
• Within three days of receiving the complaint, the compliance officer may discuss informally with the complainant the possibility of referring the matter to mediation. The compliance officer shall, within five working days following the receipt of the complaint, or following unsuccessful mediation, commence an investigation of the complaint.
• Within 60 days from complaint, the compliance officer shall complete the investigation and the Superintendent shall prepare a written decision based on the findings.

• The school is alarmed by an independent security company to ensure appropriate and safe use of facilities.
• Fire extinguishers and first aid kits are in each classroom.
• Fire safety procedures and escape plans are posted in the classrooms and offices, and fire extinguishers are inspected annually.
• Policies regarding smoking and tobacco use, alcohol and drug use, weapons, dress codes, sexual harassment, and a uniform, complaint procedure are in place.
• A direct line to the police department is maintained in the office. An intercom system enhances communication to every room.
• The custodian conducts a monthly safety check for the entire facility.
• Restrooms are maintained and resupplied daily. A disaster/school safety plan is in place.
• The parking lot is well lit and close to classrooms and the office.
• Ukiah Adult School fills out a Ukiah Unified School District Report of Hazard or Safety Issue form if there is a safety issue the maintenance department needs to rectify. Imminent hazards or concerns are addressed immediately.

• Disrespectful use of words, volume, or tone of voice, verbally or written.
• Snide comments
• Physical intimidation
• Verbal intimidation
• Manipulating this process in an attempt to derail another student’s success in the program

1. Any occurance of bullying amongst peers will be reported through the chain of command:
   1. The supervising LVN Instructor
   2. Program Director
   3. UAS Principal
2. Verbal Warning will be given for the first offense and documented in the student record. Subsequent offenses will be written and documented in the student record.
3. Students may be dismissed from class or clinical, at the instructor’s discretion, if they have persistent bullying behavior after receiving a verbal warning. This will be counted as an unexcused absence and the hours will not be eligible to be made up.
4. Students witnessed engaging, on 3 or more separate occasions (3 offenses), in bullying behaviors will meet in person with the Program Director, Principal, and involved instructors. An appropriate remediation plan will be implemented at the discretion of UAS Staff, and the student will be placed on probation for 1 month or the end of the term, whichever comes first. 

• Ceil blue color scrub top, with appropriate school patch and white slacks. Only approved, ceil blue color cardigans should be worn with the uniform.
• Scrubs must be clean, well-fitting, unstained without holes. Pants must fit appropriately so cuffs do not touch the ground.
• No lab coats
• Solid white turtlenecks or tops may be worn under the scrub top.
• Appropriate clean white socks and white shoes with soft soles and heels.
• Hair should be clean, worn in a style that is away from the face so that it does not fall on the patient or have to be touched during patient care.
• Facial hair may be worn if short and neatly trimmed.
• A watch with a second hand is required.
• Simple facial jewelry is appropriate. No earrings longer than 1 inch. Wedding rings are acceptable.
• Clinical uniforms are to be worn only for clinical rotations.