Kilgore College Radiologic Science Program Admission Packet. Thank you for your interest in the Radiologic Science Program at Kilgore College.

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1 Kilgore College Radiologic Science Program Admission Packet Dear Prospective Student: Thank you for your interest in the Radiologic Science Program at Kilgore College. The Radiologic Science Program is an Associate of Applied Science program offered on the Kilgore campus of Kilgore College. Students enrolled in this program are prepared to assume a professional role in the field of Radiography. The program is accredited through SACS, and as such is recognized as an accredited educational program in Radiography by the American Registry of Radiologic Technologists (ARRT) and the Texas Department of State Health Services (TDSHS). Upon successful program completion and meeting the specified ARRT and TDSHS standards, the graduate will be eligible to take the national certification examination for Radiography offered by the ARRT, and will be eligible for a temporary Medical Radiologic Technologist certificate from the Texas Department of State Health Services. A passing score on the ARRT examination will grant the graduate ARRT Registry status and eligibility for certification as a Medical Radiologic Technologist by The Texas Department of State Health Services. The program is a 24-month program providing clinical and didactical (classroom and laboratory) education in the field of Radiologic Science. The program begins a new class each Fall semester. There is a limited number of applicants admitted to the program due to limited space in the classroom and available clinical assignments. To be considered for admission to the Fall class application materials should be submitted by March 15. If after reviewing this packet you have questions, please feel free to contact me. Ursula Dyer, MS,RT(R)(CT) Radiologic Science Program Director (903) To be considered for admission to the Radiologic Science Program, the student must first be admitted to Kilgore College. If not currently enrolled at Kilgore College, the following is required: 1. An Application for Admission to Kilgore College form must be completed and submitted. The following is the link to KC application information: 2. An appointment with the Health Sciences Counselor (Counseling Office (903) ) REV 6/2010

2 After admission to Kilgore College, the program application instruction steps (included in this packet) must be taken for application to the Radiologic Science Program. All application information MUST be submitted in full by March 15. Incomplete applications or failure to follow application instructions may result in the applicant not being considered. Applicants will be ranked based on information submitted and applicable scores and/or data. The top 25 applicants from the applicant pool will be scheduled for an interview with the interview committee during the latter portion of April. Applicants will be notified of acceptance status by mail around mid-may. Listed below are some items of interest that should be considered prior to making application. As many pre-admission courses as possible should be completed prior to application. Preadmission courses are those general education courses in the curriculum that are not RADR courses. Since Biology 2402 is a pre-requisite to RADR 1411, priority consideration is given to those applicants who have/or will have completed Biology 2402 prior to Fall program courses. A personal visit with the Program faculty is strongly recommended. An observation day at a local facility is required and should be scheduled during the month of February by contacting Renee Golden, Health Science Administrative Assitant, in the TV building office 113, or (903) A minimum of the Radiologic Science Program Application form should be on file in the Radiologic Science Program office prior to scheduling an observation. (Applicants may submit application materials in sections as they are completed.) Students must receive a C or better in all Math and Science and Computer courses. A minimum cumulative GPA of 2.0 must be achieved in order to be considered for admission to the Radiologic Science program. All general education remediation requirements must be satisfied prior to admission to the program. Applicants must be at least 18 years of age and be in sufficient mental and physical health to meet the minimum clinical performance standards. Priority will be given to students who have completed at least 12 hours of study at Kilgore College. Applicants are required to pass a physician s physical examination and present evidence of tuberculosis screening and hepatitis B vaccination. THIS IS REQUIRED ONLY IF YOU ARE ACCEPTED INTO THE PROGRAM. (Hepatitis B vaccinations may be obtained at the start of the Fall semester through the campus nurse. Payment for the vaccination will be assessed with Fall tuition. Cost is approximately $150) Students are responsible for their own transportation including to classes and clinical sites. (See Clinical Affiliate list in this packet for possible clinical site assignments.) Clinical assignment hours are not limited to traditional day time hours. Students are required to attend clinicals during evening hours as scheduled. Applicants who have convictions for any felony or misdemeanor other than minor traffic citations are required to seek clarification of eligibility of the ARRT registry examination prior to enrollment in this course of study. The ARRT maintains standards of conduct and a conviction may exclude an applicant from being eligible to become registered. Note that Registered status with the ARRT is a requirement of most employers. Eligibility to take the ARRT examination based on conviction can only be determined by the ARRT. See additional information in this packet about Background and Drug Screening. Applicants will be required to undergo and submit to the program results of the Nelson-Denny Test. Results should be current within 1 year. The test will be administered by the Radiologic Science Department during the Spring semester. Details regarding test administration such as dates offered are to be announced. After the start of the Spring semester, applicants may contact Renee Golden, Health Science Administrative Assitant, at Office 113 TV building 113, or (903) for more details and scheduling availability.

3 Background and Drug Screening Prior to final admission into the Radiologic Science Program each applicant is required to satisfactorily pass both a Drug Screening and a Background Screening in accordance with the Kilgore College Health Science Programs Criminal Background Check and Drug Screen Policies. A copy of the Kilgore College Health Science Programs Criminal Background Check and Drug Screen Policies are available upon request. The Background Screening and Drug Screening are the sole financial responsibility of each student. The cost is approximately $54 for the background screening and $16 for the drug\screening. The results must be returned to Kilgore College Radiologic Science Program by the company completing the screenings. The student must use the vendors selected by Kilgore College. THE SCREENINGS ARE PERFORMED ONLY ON SUCCESSFUL APPLICANTS WHO ARE ACCEPTED TO ENTER THE PROGRAM. Entry is contingent upon the screening results. If a disqualifying history is identified in the results of the screening, the student will be removed from the admissions list and will be required to submit a Pre-Application Review to the American Registry of Radiologic Technologists. Additional information about the Pre-Application Review process can be found on the following webpage: https://www.arrt.org/ Select Ethics from the left side of the page, then click Pre-Application Process Students who are required to submit a Pre-Application Review to the American Registry of Radiologic Technologists due to a potentially disqualifying background history must present to the Program Director an official letter from the American Registry of Radiologic Technologists stating that the student is an eligible candidate for the certification exam. Only then will the student be admitted to the program or placed on the current list of applicants requesting admission to the program. This will depend on the timing of when the letter is received by the Program Director in relation to the start of a new class. A positive drug screen disqualifies student from admission to the program. Employment upon graduation is dependent on the rules and regulations of the employing agency and Kilgore College does not ensure employment.

4 First Year Kilgore College Radiologic Science Program Curriculum SECOND SUMMER TERM Course Course Name Lec Lab Ext Cont Cred SRGT 1301 Medical Terminology MATH 1333 Mathmatical Topics II (or MATH 1314 College Algebra) Total Hours FIRST SEMESTER Course Course Name Lec Lab Ext Cont Cred BIOL 2401 Human Anatomy and Pysiology I ENGL1301 Grammar and Composition BCIS 1305 Business Computer Applications RADR 1411 Basic Radiographic Procedures RADR 1309 Intro. To Radiography and Patient Care Total Hours SECOND SEMESTER Course Course Name Lec Lab Ext Cont Cred BIOL 2402 Human Anatomy and Physiology II RADR 1360 Clinical I RADR 2217 Radiographic Pathology RADR 2309 Radiographic Imaging Equipment RADR 1313 Principles of Radiographic Imaging I Total Hours FIRST SUMMER TERM Course Course Name Lec Lab Ext Cont Cred RADR 1261 Clinical II Total Hours SECOND SUMMER TERM Course Course Name Lec Lab Ext Cont Cred RADR 1262 Clinical III Total Hours Second Year FIRST SEMESTER Course Course Name Lec Lab Ext Cont Cred RADR 2313 Radiation Biology and Protection RADR 2366 Practicum I RADR 2331 Advanced Radiographic Procedures SPCH 1318 Interpersonal Communication (or SPCH 1311 Intro. To Speech Communication) (or SPCH 1321 Business and Professional Speaking) Total Hours SECOND SEMESTER Course Course Name Lec Lab Ext Cont Cred PSYC 2314 Human Growth and Development RADR 2333 Advanced Medical Imaging RADR 2305 Principles of Radiographic Imaging II RADR 2367 Practicum II Humanities/ Fine Arts Elective Total Hours FIRST SUMMER TERM Course Course Name Lec Lab Ext Cont Cred RADR 2235 Radiologic Science Seminar RADR 2167 Practicum III Total Hours PROGRAM TOTALS LEC LAB EXT CONT CRED Rev 1/2011

5 ESTIMATED RADIOLOGIC SCIENCE PROGRAM COST ANALYSIS PRE-ADMISSION (GENERAL EDUCATION) COSTS IN DISTRICT OUT OF DISTRICT Tuition and fees $1,617 $3,432 Books (required only) $1,295 $1,295 Total $2,912 $4,727 PROGRAM CORE COSTS (RADR COURSES) First Year Summer (after acceptance, prior to entry) Background/Drug Screening $70 $70 Hepatitis B vaccination/tb Screening $165 $165 Total $235 $235 Fall Semester Tuition and fees $538 $923 Books $467 $467 Liability Insurance $30 $30 Rad Tech Club and Professional Society Dues $20 $20 Uniforms- includes name tags, markers, etc. (to be purchased in November) $275 $275 Total for Semester $1,330 $1,715 Spring Semester Tuition and fees $760 $1,365 Books $475 $475 Total for Semester $1,235 $1,840 Summer I Tuition and fees $133 $243 Uniforms $100 $100 Total for Semester $233 $343 Summer I I Tuition and fees $133 $243 TB Screening $15 $15 Total for Semester $148 $258 Second Year Fall Semester Tuition and fees $551 $1,046 Books $365 $365 Rad Tech Club and Professional Society Dues $20 $20 Liability Insurance $30 $30 Uniforms $100 $100 Total for Semester $1,066 $1,561 Spring Semester Tuition and fees $566 $1,061 Books $110 $110 ARRT Application Fee $150 $150 Graduation Expenses $70 $70 Total for Semester $896 $1,391 Summer I Tuition and fees $212 $377 Books $200 $200 TDSHS MRT Application Fee $32 $32 Total for Semester $444 $609 RADR Total $5,587 $7,952 Total for Program $8,499 $12,679 Costs are estimated. All costs including tuition, fees and books are subject to change. Placement test and remediation course fees are not included in cost analysis. Drug Screening, Background Screening are included, but are also subject to change. Out of state tuition costs are at a higher rate than out of district and are stated per semester hour in the Kilgore College Catalog. * Last estimate assessed June 2010

6 RADIOLOGIC TECHNOLOGISTS SEEKING A DEGREE Registered Radiologic Technologists may be granted college credit which will apply toward the completion of the A.A.S. degree in Radiologic Science. Interested persons may apply to the Program Director for credit by presenting evidence of current certification by the American Registry of Radiologic Technologists (ARRT). At least 15 semester hours must be completed at Kilgore College in addition to the credit granted for ARRT Certification. The A.A.S. degree will be awarded upon completion of full curriculum as specified in the Kilgore College catalog. ARTICULATION AGREEMENT Kilgore College maintains an articulation agreement with Midwestern State University, Wichita Falls. This means students completing the Radiologic Science Program at Kilgore College who are interested in pursuing a Bachelor s degree will be considered for candidacy for such through MSU. Some course work may be done through online means. Contact MSU Radiologic Sciences Department for specific details. According to The Bureau of Labor Statistics, Employment of radiologic technologists is expected to increase by about 17 percent from 2008 to 2018, faster than the average for all occupations. - Information obtained from edition of the Occupational Outlook Handbook on The Bureau of Labor Statistics website: The courses of study for the Radiologic Science Program include: Orientation to Radiography Medical Ethics and Law Methods of Patient Care Human Structure & Function Medical Terminology Radiation Physics Principles of Radiation Protection Principles of Radiographic Exposure Imaging Equipment Radiographic Film Processing Evaluation of Radiographs Radiographic Procedures Radiobiology Radiographic Pathology Introduction to Computer Science Introduction to Quality Assurance Each student is responsible for his/her own transportation to and from the clinical sites as well as to Kilgore College- Kilgore campus. Clinical Affiliates Diagnostic Clinic of Longview East Texas Medical Center- Henderson East Texas Medical Center- Carthage Good Shepherd Medical Center- Longview Good Shepherd Medical Center- Marshall Longview Cancer Center Longview Regional Medical Center University of Texas Health Center at Tyler

7 The Radiologic Technologist, also known as a radiographer, is primarily responsible for applying ionizing radiation to demonstrate portions of the human body in a radiographic image on a film, computer monitor, fluoroscopic screen or other imaging system for the purpose of assisting physicians (the Radiologist and other Physicians) in diagnosis of disease and injury. A typical staff radiographer job description is included below. These duties should match the prospective Radiologic Science student s interests, motivation, and physical abilities. STAFF RADIOGRAPHER JOB DESCRIPTION Title: Reports to: Position Summary: Other Duties: Staff Radiographer or Radiologic Technologist Director or Supervisor of Imaging Department Provides patient services using imaging modalities Performs radiographic procedures Applies principles of radiation protection Evaluates radiographic images for technical quality Exercises professional judgment in the performance of procedures Provides patient care essential to radiographic procedures Recognizes patient conditions requiring immediate action and initiates life support measures 1. Perform diagnostic radiographic services: A. Operate imaging equipment (technologist must be physically able to reach and manipulate the X-ray tube head) B. Operate other equipment devices as appropriate C. Position patients D. Immobilize patients as necessary E. Calculate exposure factors F. Assume care for physical and psychological needs of patients during examinations and procedures G. Practice aseptic technique as necessary H. Assist with administration of contrast media (may include performing venipuncture) I. Verbally communicate with the patient in order to obtain pertinent clinical history J. Input data utilizing a keybord, mouse or barcode scanner 2. Maintain patient records and confidentiality 3. Assume responsibility for assigned area 4. Provide input for equipment and supply purchase decisions 5. Instruct specific clinical education for students in Radiologic Science 6. Assume responsibility for portions of the quality assurance program 7. Pursue ongoing continuing education Qualifications: 1. Graduate of an accredited Radiologic Science Program. 2. Radiography certification by the American Registry of Radiologic Technologists (ARRT) 3. Valid state certification Career Advancement: Supervisor; Specialty area technologist

8 KILGORE COLLEGE RADIOLOGIC SCIENCE PROGRAM PROGRAM MISSION AND GOALS The mission of the Department of Radiologic Science at Kilgore College is to prepare qualified imaging technologists. Through didactical learning, laboratory preparation, and clinical experiences, students will develop professional knowledge, ethical patient care and technical skills. GOALS: 1. To provide students with a broad educational background by using a variety of educational resources and experiences. 2. To provide a strong undergraduate curriculum based on current needs. 3. To develop in students the professional attitudes and ethics required of Radiologic Technologists. 4. To educate students in the merits of continuing professional development. 5. To prepare students to graduate with an Associate of Applied Science Degree and for employment in the Radiologic Technologist field. 6. To prepare students to pass the national certification examination for radiography administered by the American Registry of Radiologic Technologists (ARRT). 7. To provide the community with competent and educated Radiologic Technologists. 8. To promote independent thinking and life-long learning. 9. To present state of the art medical imaging to Radiologic Science students. 10. To meet and exceed medical imaging educational standards as required by the State of Texas. Revised Aug 2007 Clinical Philosophy The Radiologic Science Program was developed under the philosophy that clinical experience should be in combination with academic preparation. In the classroom, the student will learn theoretical information necessary to develop and perform as a technologist. In the laboratory, this information is used to practice patient care and procedures. In the clinical environment, the student will have the opportunity to perfect the technological skills and progressively develop professional skills and independence so that they are ready to enter the profession following program completion. The ultimate goal of the program is to prepare students to become outstanding staff radiologic technologists who have the potential to become effective supervisors, instructors, or specialty technologists. The ability of graduates from a Radiologic Science program to enter the profession and to assume the role and responsibilities of staff technologists depends on the quality of their academic and clinical experience. This program provides students opportunity to gain proficiency in diagnostic radiology. In order to achieve this proficiency, students are integrated into the normal operation of a radiology department. Initially, close supervision is essential; however, the quicker the student learns to function under limited supervision, the easier it is for the student to become an independent technologist upon program completion. Students are integrated into the department's work schedules with scheduled rotations through all work centers. During the first semester of clinical education, students must be supervised closely and contribute little toward the workload of the department. Each semester, the student should gain more experience, knowledge, and confidence, so that during later semesters of enrollment in the program the student perfects his or her clinical skills and prepares for the transition from student to technologist by assuming more patient care responsibility.

9 RADIOLOGIC SCIENCE PROGRAM GRADING POLICIES Final course grades are calculated by specifications made in each course outline. To satisfy degree requirements, students are required to MAINTAIN a C average, in all RADR courses. This average must be maintained for the student to remain eligible to be enrolled in the program and eventually attain program completion. The grading scale is as follows: Academic (Didactical) Course Grading Scale: A B C D Below 67 F Clinical/Practicum Course Grading Scale: A B C D Below 70 F Failure to achieve a C or better overall grade in any RADR course will result in dismissal or suspension from the program. However, this does not mean that a student is ineligible to register for other courses at Kilgore College. NOTE: A grade of "C" or higher is required in all math and science and computer courses. The grading scale in these courses is in accordance with the current Kilgore College Catalog.

10 Radiologic Science Program Application Instructions In addition to admission to Kilgore College, a student must submit additional materials as part of an application packet for the Radiologic Science Program. The deadline for all applications is MARCH 15th. This means that all application packets must be postmarked or hand-delivered by March 15th or delivered to the office on the next business day if the 15th falls on the weekend or during campus closure. The Radiologic Science Program application packet requires that the following be submitted in entirety to: RADIOLOGIC SCIENCE PROGRAM Kilgore College 1100 Broadway Kilgore, TX To make application to the Radiologic Science Program, submit the following completed materials in their entirety to the above address. 1. The Radiologic Science Program Application For Admission Form (included in this packet) will need to be on file in the Radiologic Science office prior to scheduling an observation day. You may submit your packet in sections as you complete them. 2. If you have attended or are attending college, submit official copies of all college transcript(s). This includes attendance at Kilgore College. The Office of Admissions and Records will not automatically send them. You must make request to the KC Office of Admissions and Records. Most institutions require a written request along with a fee for official transcripts. The Registrar of the college or university will send a sealed envelope with a seal of the institution on the transcript. Allow sufficient time for transcripts to be sent. You may have them sent to you or the Radiologic Science Program at the above address. If you have transcripts sent directly to you, DO NOT OPEN THESE TRANSCRIPTS OR THEY MAY BE INVALIDATED. ENCLOSE THEM IN YOUR PACKET IN THEIR SEALED ENVELOPES or have them sent directly to the Radiologic Science Program. 3. Two Applicant Reference Forms must be submitted (included in packet). Applicants will need to complete only the upper portion of the form. Ask the person completing the reference form to mail the form directly to the Radiologic Science Program. As a suggestion, you may want to provide a stamped envelope with the program address on it for the convenience of the person completing the reference form. One reference must be from an employer or a teacher. The other can be from another employer, co-worker, teacher, counselor, pastor, or friend. 4. A typed, double-spaced, well-developed one-to-two page essay that explains your interest in the Radiologic Science Program. Comment on previous work, personal experiences, influences and/or hobbies that demonstrate a strong interest in the field of Radiologic Science. Include ideas about how the Radiologic Science Program will assist you in your personal/professional goals. Indicate why you want to become a Radiologic Technologist. 5. An observation day in the radiology department of a local facility is required of all applicants. The observation should be scheduled by contacting Renee Golden, Health Science Administrative Assistant, in the TV building office 113 or (903) , during the month of February. It is your responsibility to schedule the observation assignment. The Clinical Instructor at the facility will complete an observation evaluation form on the day of your visit. The Clinical Instructor will submit the form to the program. 6. Applicants will be required to undergo and submit to the program results of the Nelson-Denny test. Results should be current within 1 year (scores used from previous year s application process will be accepted). The test will be administered by the Radiologic Science Department (dates and specific details TBA). After the start of the Spring semester, applicants may contact Renee Golden, Health Science Administrative Assitant, at Office 113 TV building 113, or (903) for details and scheduling availability. 7. Applicant should read, sign and submit the Essential Job Functions form (included in packet). You should contact the Program Director regarding any task listed which you have concern about or would like more detailed clarification. Applicants without all of the above information submitted by the March 15 th deadline (or first business day campus is open following March 15 th ) will not be considered. Please read the above instructions carefully. Failure to follow instructions may affect your acceptance into the program.

11 After the applicant information has been reviewed, applicants will be numerically ranked. The top 25 applicants from the applicant pool will be scheduled for an interview with the admission interview committee during the latter portion of April. Applicants who are not selected for an interview will receive a notification letter which will also serve as a decline of program admission letter. Applicants who are selected to undergo the interview process will be notified of program admission status (acceptance, alternate status, or non-acceptance) by mail around mid-may. Although Kilgore College has an open-door policy, the Radiologic Science Program must limit enrollment in the program due to limited classroom space and available clinical facilities. Successful completion of the criteria provides proof of qualification for the Radiologic Science Program but does not guarantee admission to the Program. Minimum academic standards may be set. There is no restriction as to gender, age, race, color, creed or religion, national origin, sexual orientation, disability, or marital status. Applicants will be ranked for admission using the following: Cumulative GPA (2.0 minimum GPA required) Completeness of pre-requisite courses Status of completion of required Biology courses Grades received in Biology courses Scores on Applicant Reference Forms Score on Observation Evaluation Form Score on Essay Nelson-Denny Test Score Interview Scores Priority will be given to a similar ranking candidate who has 12 or more hours of course work that was completed at Kilgore College APPLICATION CHECKLIST Application and Acceptance to Kilgore College Application for Program Admission Form Completed and Submitted All College Transcripts Submitted to Program including a current KC transcript Two Applicant Reference Forms mailed by the individual completing the form (you may want to confirm these were received as the March 15 th deadline nears) Completed and Submitted an Essay of Interest Scheduled and Attended Observation Day Nelson-Denny Test Scheduled and Completed Signed Job Essentials Form

12 Kilgore College Radiologic Science Application For Admission Full Legal Name Other name(s) Home Address Mailing Adress Address Home Phone ( ) - Business Phone ( ) - Other Phone ( ) - Emergency Contact Home Phone ( ) - If you are not a U.S. citizen, what type Visa do you have? # Length of time in Texas? Have you served in the U.S. military? yes no Do you have your own transportation? yes no If yes, branch Date Entered Date Discharged Type of Discharge Member of Reserve? yes no If yes, Active or Inactive? Draft Status Have you ever been convicted of a misdemeanor or felony other than minor traffic citations? yes no If yes, you are required to seek clarification of eligibility of the ARRT registry examination prior to enrollment in this course of study. This is necessary in determination of clinical and program eligibility. Information and instructions for this process can be obtained at Education List name and location of all schools attended (most recent first), including high school. All transcripts must be submitted, with the exception of high school transcripts. Name of School Location Hours Earned Dates Attended Deadline for application is March 15. If accepted to the Radiologic Science Program, 1) you will be responsible for your own transportation to KC campus and all clinical assignments 2) you will be responsible for purchasing uniforms as arranged by Radiologic Science Program faculty 3) you will be responsible for purchasing student liability insurance that will be assessed with tuition fees each fall semester while enrolled in the program. 4) you will be responsible for purchasing for each enrolled program course any adopted texts, e-products or other required materials, fees or subscriptions Confirm by signing below that you: have read and will comply with the above information the information you have provided in this application is true and complete to the best of your knowledge understand that any misrepresentation or falsification of information is cause for denial of admission and/or expulsion from Kilgore College and may affect eligibility for the national certification examination administered by the ARRT Signature of Applicant Date Kilgore College does not discriminate on basis of race, color, religion, national origin, sex, age, handicap, marital status or veteran status.

13 KILGORE COLLEGE ESSENTIAL JOB FUNCTIONS RADIOGRAPHY TECHNOLOGY The following are essential job functions for any Radiologic Technologist as compiled from observations of a wide variety of job experience. 1. VISUAL ACUITY: Distinguish whether beam is perpendicular, horizontal, of angled through center of anatomical areas being x-rayed to the center of image receptor. Perform or assist with, as appropriate, necessary radiography procedures that involve placement of needles, catheters, etc. into proper anatomic structure of the patient. Distinguish objects both in the darkroom, radiographic room, on the imaging monitor, or electronic control panel in order to perform tasks related to radiographic and fluoroscopic procedures in light controlled areas. Read protocol for radiography procedures in the department. Perform data entry tasks using digital and computer terminals. 2. HEARING ACUITY: Hearing must be sufficient to communicate with others. Distinguish phonetic sounds either mechanically transmitted or from conversation in order to perform processing tasks and other tasks such as fluoroscopic procedures which are conducted in a dimly lighted environment. Hear and retain pertinent information to relay instructions. Hear and respond to patient questions and clinical history information while processing an examination request. 3. SPEAKING ABILITY: Speak clearly and loudly enough to be understood by a person in the radiology department, in surgery or on the phone. Good communication skills are also necessary to maintain good interpersonal relationships with patients and peers. 4. DIGITAL DEXTERITY: Grasp and manipulate small objects required to perform job function. Operate a variety of imaging equipment and accessories. Arms and hands or functional artificial limbs are essential to perform radiographic procedures and transfer patients. Legs and feet or functional artificial limbs are essential to maintain balance to accomplish required duties and transport patients. 5. PHYSICAL ABILITY: Stand for the majority of a normal work day. Maneuver through congested area(s) or unit(s) to perform positioning procedures and transport patients. Raise arm(s) while maintaining balance when positioning a patient, reaching over examination table, or adjusting x-ray tube. Maneuver between different floors of an institution. Pull/push medical equipment and adjust x-ray tubes to standard distances; transfer of patients to and from examination table and stretcher or wheelchair. Personal weight must allow free movement within small control area, move quickly during patient emergencies; maneuver in small areas while performing portable radiography procedures. 6. ADAPTIVE ABILITY: Complete tasks or job functions within deadlines. Complete required tasks/functions under stressful conditions. Track and complete multiple tasks at the same time. Perform independently with minimal supervision. Interact appropriately with diverse personalities. I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS. I MEET THE ABOVE STATED STANDARDS FOR THE RADIOLOGIC SCIENCE PROGRAM AT KILGORE COLLEGE. IF I CANNOT MEET THESE STANDARDS, I UNDERSTAND THAT I MAY BE DISMISSED FROM THE PROGRAM. Signature Date

14 KILGORE COLLEGE RADIOLOGIC SCIENCE PROGRAM APPLICANT REFERENCE FORM APPLICANT COMPLETE THE UPPER PORTION OF THIS FORM ONLY APPLICANT NAME (Please Print): Under the Federal law entitled the Family Educational Right and Privacy Act of 1974, students are given the right to inspect their records, including letters of recommendation. While we shall consider all letters of recommendation carefully, we believe that in many instances letters written in confidence in the long run are of greater use in assessment of a student s qualifications, abilities, and promise. I do do not waive my right to review the content of this form. Applicant signature: Date Only The Person Completing Reference Form is to Respond Below The applicant whose name appears above is requesting that you complete this reference form in regard to his/her application to the Radiologic Science Program. Please take the time to respond to the questionnaire as honestly as possible. Mark at least one but only one choice in each category. This applicant will not be considered for the Radiologic Science Program unless this reference form is returned. Please advise the applicant if you will not be returning it. Please mail the completed form prior to March 15 to: Kilgore College Radiologic Science Program 1100 Broadway Kilgore, TX, How long have you known this person? <6 months 6-12 months 1-3 years >3 years In what capacity have you known the applicant? Friend/Acquaintance Teacher/Counselor/Pastor Employer/Co-worker Employer/Co-worker Non-Healthcare Healthcare Profession Profession Rate this applicant s behavior in the following areas by circling the appropriate phrase: DEPENDABILITY / ATTENDANCE Frequently absent or Never absent or late late - rarely calls if either INITIATIVE / MOTIVATION / ENTHUSIASM Seldom needs Self-motivated; asks direction and appropriate prompting; questions and frequently initiates requests learning own activity opportunities Occasionally absent or late - sometimes calls Relies on direction for all actions Rarely absent or late-usually calls Occasionally initiates own activity, needing occasional direction Page 1 OF 2

15 MATURITY Occasionally acts immaturely Acts maturely most of the time Frequently acts immaturely Very mature in all actions NEATNESS / GROOMING Consistently Always neat and well displays poor groomed hygiene and grooming Occasionally displays poor hygiene and grooming Usually neat and well groomed ATTITUDE / PERSONALITY / INTERPERSONAL SKILLS Displays evidence of difficulty getting along with people Gets along well most of the time with most people Makes an attempt to get along but easily swayed or angered Always gets along with coworkers, supervisors, and subordinates REACTION TO STRESS Displays good Easily upset by coping skills under stressful situations stress CAPACITY FOR PROBLEM-SOLVING Needs freq. Independent thinker guidance and direction for problem solving COMMUNICATION SKILLS Frequently uses Occasionally uses poor grammar and poor grammar and terminology in terminology in verbal verbal and written and written communication communication ORGANIZATION / WORK HABITS Occasionally Completes tasks in disorganized; timely manner even requires excessive though disorganized time to complete tasks Needs freq. direction and assistance during stressful situations Needs occasional guidance and direction for problem solving Always uses proper grammar and terminology in verbal and written communication Disorganized; does not complete tasks Handles stress but shows some signs of distress during or immediately after stress Usually able to problem-solve independently needing minimal guidance Usually uses proper grammar and terminology in verbal and written communication Well organized in work habits; productive In your opinion, is this applicant suited for a career in the healthcare field? Yes or No Comments (May use back if needed): Signature Printed Name Date Phone Position/Title Business/Company Page 2 of 2

16 KILGORE COLLEGE RADIOLOGIC SCIENCE PROGRAM APPLICANT REFERENCE FORM APPLICANT COMPLETE THE UPPER PORTION OF THIS FORM ONLY APPLICANT NAME (Please Print): Under the Federal law entitled the Family Educational Right and Privacy Act of 1974, students are given the right to inspect their records, including letters of recommendation. While we shall consider all letters of recommendation carefully, we believe that in many instances letters written in confidence in the long run are of greater use in assessment of a student s qualifications, abilities, and promise. I do do not waive my right to review the content of this form. Applicant signature: Date Only The Person Completing Reference Form is to Respond Below The applicant whose name appears above is requesting that you complete this reference form in regard to his/her application to the Radiologic Science Program. Please take the time to respond to the questionnaire as honestly as possible. Mark at least one but only one choice in each category. This applicant will not be considered for the Radiologic Science Program unless this reference form is returned. Please advise the applicant if you will not be returning it. Please mail the completed form prior to March 15 to: How long have you known this person? Kilgore College Radiologic Science Program 1100 Broadway Kilgore, TX, <6 months 6-12 months 1-3 years >3 years In what capacity have you known the applicant? Friend/Acquaintance Teacher/Counselor/Pastor Employer/Co-worker Non-Healthcare Profession Employer/Co-worker Healthcare Profession Rate this applicant s behavior in the following areas by circling the appropriate phrase: DEPENDABILITY / ATTENDANCE Frequently absent or Never absent or late late - rarely calls if either INITIATIVE / MOTIVATION / ENTHUSIASM Seldom needs Self-motivated; asks direction and appropriate prompting; questions and frequently initiates requests learning own activity opportunities Occasionally absent or late - sometimes calls Relies on direction for all actions Rarely absent or late-usually calls Occasionally initiates own activity, needing occasional direction Page 1 OF 2

17 MATURITY Occasionally acts immaturely Acts maturely most of the time Frequently acts immaturely Very mature in all actions NEATNESS / GROOMING Consistently Always neat and well displays poor groomed hygiene and grooming Occasionally displays poor hygiene and grooming Usually neat and well groomed ATTITUDE / PERSONALITY / INTERPERSONAL SKILLS Displays evidence of difficulty getting along with people Gets along well most of the time with most people Makes an attempt to get along but easily swayed or angered Always gets along with coworkers, supervisors, and subordinates REACTION TO STRESS Displays good Easily upset by coping skills under stressful situations stress CAPACITY FOR PROBLEM-SOLVING Needs freq. Independent thinker guidance and direction for problem solving COMMUNICATION SKILLS Frequently uses Occasionally uses poor grammar and poor grammar and terminology in terminology in verbal verbal and written and written communication communication ORGANIZATION / WORK HABITS Occasionally Completes tasks in disorganized; timely manner even requires excessive though disorganized time to complete tasks Needs freq. direction and assistance during stressful situations Needs occasional guidance and direction for problem solving Always uses proper grammar and terminology in verbal and written communication Disorganized; does not complete tasks Handles stress but shows some signs of distress during or immediately after stress Usually able to problem-solve independently needing minimal guidance Usually uses proper grammar and terminology in verbal and written communication Well organized in work habits; productive In your opinion, is this applicant suited for a career in the healthcare field? Yes or No Comments (May use back if needed): Signature Printed Name Date Phone Position/Title Business/Company Address Page 2 of 2

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