GATEWAY COMMUNITY COLLEGE RADIOLOGY PROGRAMS APPLICATION. * You may only apply to one program*

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1 GATEWAY COMMUNITY COLLEGE RADIOLOGY PROGRAMS APPLICATION Applications by mail must be postmarked by the appropriate date (see Admission Requirements). Applications received after this date will not be accepted. No applications will be processed unless all requested information is complete and legible. Banner Name: Last First MI Former Name if Applicable Date of Birth: _ _ Address: Street City State Zip Home Phone: _ Work Phone: Cell Phone: * You may only apply to one program* Program: Diagnostic Medical Sonography AS Nuclear Medicine Technology AS Nuclear Medicine Technology Certificate Radiation Therapy AS Radiography AS If applicable, please check here if you hold any current national health care certification and/or registration and/or current state license. Please attach a copy of the certification/registration/state license. Date of attendance of Program-specific information session: month/date/year If admitted, the applicant agrees to abide by all rules and regulations of the College and recognizes that any misleading information given in the application may be cause for dismissal. Signature of Applicant: Date: DOCUMENTATION OF HEALTH CARE EXPERIENCE TO BE COMPLETED BY APPLICANT S SUPERVISOR: Name and address of facility: _ Hours per week: Length of employment or volunteer (including dates): Title/Duties: Signature of supervisor: _ of supervisor: Phone number of supervisor: _ *Once the application is received by the Enrollment Services Assistant, it will be date stamped Received and a copy will be mailed to you as a confirmation.*

2 GATEWAY COMMUNITY COLLEGE RADIOLOGY PROGRAMS ADMISSION REQUIREMENTS For more information on the Radiology Programs, please visit the Allied Health page of our web site at or look in the GCC Catalog. The application process for the Radiology Programs (Diagnostic Medical Sonography, Nuclear Medicine Technology, Radiation Therapy, Radiography) has been revised effective August 1, Applicants for admission in Programs beginning in June 2013 and thereafter must use the application dated 08/01/2012. Those applicants who have applied in the past as well as those applicants who intend to apply for entry into their Program of interest during the fall 2013 semester are required to follow this revised procedure. Applications for the Radiology Programs (Diagnostic Medical Sonography, Nuclear Medicine Technology, Radiation Therapy, Radiography) are available on the College web site; in the Gateway Community College Admissions Office located in the North Building, second floor, room N-207; and in the Allied Health Department Office, South Building, fourth floor, Room S-405. All students must attend a Program-specific information session within 12 months of the application deadlines in order to be considered for admission into a Program. Readmit students cannot use their time as a student in another program in place of attending an information session. Application Requirements *Applicants who do not meet the following requirements by the application deadline WILL NOT be considered for admission. Placement testing is required of applicants who have not completed college-level English and/or Mathematics with a grade of C or better. Placement testing must be completed before the application deadline. As appropriate, applicants whose primary language is not English are required to take the ESL Accuplacer Placement Test. To apply to the Radiology Programs, an applicant must be eligible to register for ENG* 101. Completion of developmental studies classes as indicated by placement test. These may include ENG* 043, ENG* 063, ENG* 073, MAT* 075, MAT* 095. A transcript(s) with the grade(s) for the course(s) must be submitted by the application deadline. Prior to evaluation for possible acceptance into the Diagnostic Medical Sonography, Nuclear Medicine Technology, Radiation Therapy or Radiography Program applicants must have completed BIO* Anatomy & Physiology I and BIO* Anatomy & Physiology II and 1 of 5

3 HIM* Medical Terminology, or a transferable equivalent, with a final grade of C or higher. BIO* Anatomy & Physiology II, or a transferable equivalent, with a final grade of C or higher, must be completed within five (5) years prior to application deadline (January 6 th or May 24 th ). Five years prior is defined as having completed the course between December 2007 and May 24, 2013). 2.7 GPA based only on the college courses that meet the Radiology Programs admission and Radiology Programs curriculum requirements. In addition to the College s general requirements, the Programs require a minimum grade of C in each and all mathematics, science, pre-requisite, and Program-specific courses. A student who has received a grade of failure (F) or unsatisfactory in the clinical component of any course in a health career program is not eligible for admission into any/all of the Radiology Programs at Gateway Community College. A health career program is defined as any allied health or nursing program whose curriculum has both a classroom and a clinical component. Mandatory attendance at a Program-specific information session: All students must attend a Program-specific information session within 12 months of the application deadlines in order to be considered for admission into a Program. Readmit students cannot use their time as a student in another program in place of attending an information session. Attendance at a general allied health information session DOES NOT meet this requirement. Applicants must attend an information session that is devoted solely to the Program that he/she is interested in entering. Applicants who do not reside in Connecticut are not required to attend a Program-specific information session. However, the applicant must spend at least 2 hours in a Program-specific department (i.e. radiography department, radiation therapy department, etc.) at a local hospital or physician s office, and send signed documentation from a technologist/therapist in the department stating that the applicant observed in their department (with the technologist/therapist s name, the name of the institution, and the date). The documentation must be submitted by the application deadline for the applicant to be considered for possible admission. *Applicants who do not meet these requirements by the application deadline WILL NOT be considered for admission. Application Deadline For Summer 2013 admittance, there are 2 application deadlines: January 6 th and May 24 th. Those applicants who have met all admission requirements and pre-requisites must submit their Program application by January 6 th, applications postmarked after January 6 th will not be processed. All required information (Gateway Community College application and fees, all applicable transcripts, and Program application) must be complete and legible. Those applicants who have NOT met all admission requirements and pre-requisites by January 6 th must submit their Program application by May 24 th for consideration based on space availability. Applications postmarked after May 24 th will not be processed. All required information (Gateway Community College application and fees, all applicable transcripts, and Program application) must be complete and legible. 2 of 5

4 Important Notes Students who are accepted into their Program of interest will be required to travel to ANY/all of the clinical sites that are affiliated with that Program. The rotation assignments are subject to change. GCC reserves the right to affiliate with additional clinical sites at any time. Students are responsible for arranging their own transportation to and from assigned clinical sites. Assignment of clinical sites is at the discretion of the program faculty. Clinical sites could be within an hour and a half (1.5) radius of the College, and may require a mandatory parking fee. All applicants who meet the Program pre-requisite courses will be ranked by the Gateway Community College s Allied Health Department. If applicable, include a copy of an allied health or nursing current national certification and/or current national registration and current state license. Acceptable documentation must be the result of the completion of at least a 2-year allied health or nursing associate degree, diploma or certificate Program. The College/Program must be accepted by a United States of America nationally recognized accreditation body (i.e.: NEASC). All records, including high school and college transcripts, must be received prior to the deadline date. It is the responsibility of the student to ensure all transcripts are received by the Admissions Office and the Enrollment Services Assistant prior to the deadline date. A pattern of withdrawals/failures constituting 25% or more of pre-requisite courses and Program specific general education courses completed may affect application status (an explanation of extenuating circumstances will be taken into consideration). Admissions DMS NMT RAD RDT Calculation Health care related 10% 10% 10% 10% experience * Program general 30% 30% 30% 30% education courses completed/number of credits GPA 60% 60% 60% 60% Total: 100% 100% 100% 100% *In order to obtain credit for health care experience, on the bottom of the application, the applicant s supervisor must document that the applicant has experience in formal direct human patient care (as a volunteer or employee). It must also be documented that the applicant has worked a minimum of 3 consecutive months, 4 hours per week within the last 3 years. The total minimum requirement is 48 hours. Prior clinical experience from any educational program and/or completion of a PCA and/or a CNA program does not satisfy as examples of health care experience. Clarification/acceptance of an applicant s health care experience is at the discretion of the Program Coordinator. What is direct patient care? Direct patient care involves hands-on care of human patients. This includes, but is not limited to, phlebotomy, taking of vital signs, providing assistance with personal hygiene, patient transport-in the hospital setting only, radiology tech aide, medical assistant, EMT/paramedic, nurse, CNA, occupational therapist (OT), occupational therapy assistant (OTA), physical therapist (PT), and physical therapy assistant (PTA). What is NOT direct patient care? Jobs that do not include direct human patient care. These include, but are not limited to, pharmacy technicians, recreational therapists, receptionists, filing, billing and coding, medical records, medical transcription, private in-home health care, working in supply departments or hospital gift shops, veterinary hospital workers, and food service workers including dietary aides, cooks, and dishwashers. 3 of 5

5 Possible options for health care experience opportunities if employment in these areas is not an option include, but are not limited to, volunteer work in hospitals, nursing homes, rehabilitation centers, doctors offices and Hospice care. When volunteering, it is important that applicants are able to OBSERVE and/or PARTICIPATE in direct human patient care. Documentation from the supervisor of the facility must be provided on OFFICIAL office letterhead stationery and must be attached to the application. Please note that documentation provided by an immediate relative will not be accepted. Transfer Credits Transfer applicants must have official transcripts from other colleges sent to the Admissions Office and official or unofficial transcripts sent to the Enrollment Services Assistant at Gateway Community College prior to the deadline date. Transfer applicants submitting transcripts from a country outside the United States must submit an official evaluation (i.e.: World Education Service and Center for Educational Documentation) of their transcript(s) by the application deadline to the Admissions Office and the Enrollment Services Assistant. Failure to submit all transcripts may result in a denial into the Program of interest. If applicant retakes a course either at GCC or another accredited college, the higher grade will be used for the Admissions Calculation. The Admissions Office is not able to copy official transcripts. Information for Accepted Radiology Program Students In order for a student to continue in any Radiology Program, she/he is required to participate in a mandatory Patient Care Orientation (PCO), which is held during the summer before the first semester (see second paragraph below). In order to continue in their designated Radiology Program, each student is required to successfully complete PCO with an overall course average of 75 or higher. Students entering the Diagnostic Medical Sonography (DMS), Nuclear Medicine Technology (NMT), Radiation Therapy (RDT), or Radiography (RAD) curriculum must be available to attend a 2-week, 40 hours per week, mandatory Patient Care Orientation. This orientation is held during the summer. Acceptance will be revoked if a student fails to attend any of the orientation sessions during the summer. Accepted students are also required to attend various hospital orientations throughout the months of July and August. Acceptance will be revoked if a student fails to attend any of the orientation sessions during the summer. Accepted Diagnostic Medical Sonography students are required to complete RST Cross Sectional Anatomy, prior to the fall semester of beginning the program. Accepted Radiation Therapy students are required to complete an 8 hour shadow day in a predetermined Radiation Therapy Department prior to the first day of the pre-scheduled hospital orientations. The shadow day will be coordinated by the Radiation Therapy Program Coordinator. 4 of 5

6 Admission Process: Application Checklist (for your records) Before the application deadline, please submit the following material to Kim Shea, Director, Admissions Office: Gateway Community College application submitted to the Admissions Office with application fee of $20.00 for first time applicants. Official college and/or high school transcripts for all schools attended to the Admissions Office. Kim Shea Director, Admissions Office, Room N-207 Gateway Community College 20 Church Street New Haven, CT Before the application deadline, please submit the following material to Lauretta Swiderski, Enrollment Services Assistant: Radiology Programs Application form to the Enrollment Services Assistant. No application fee required. Health Care Experience Documentation portion on the application has been completed by supervisor. Official or unofficial high school and/or college transcripts for all schools attended to the Enrollment Services Assistant. Program-specific information session verification. (Date: _month/date/year) Lauretta Swiderski Allied Health Department, Room S-405 Gateway Community College Telephone: (203) Church Street Fax: (203) New Haven, CT of 5

7 GENERAL COURSES Please complete the grid below to assure all completed courses are considered for the summer 2013 radiology application process. BIO* A&P I (pre-req. - DMS/NMT/RDT/RAD) BIO* A&P II (pre-req. - DMS/NMT/RDT/RAD) HIM* Medical Terminology (pre-req. - DMS/NMT/RDT/RAD) COM* Fundamentals Of Human Communication ENG* Composition MAT* Math for Science and Technology (DMS/RDT/RAD) MAT* College Algebra (NMT only) PHY* Physics for the Life Sciences PSY* General Psychology I CSC* Introduction to Computers (DMS only) CHE* Concepts of Chemistry (NMT only) Humanities elective Fine Arts elective Course Name and Number (or name of test completed) Grade (or test score) College/University Where Course Was Taken Year Completed

8 RADIOLOGIC TECHNOLOGY PROGRAMS TECHNICAL STANDARDS The Gateway Community College Radiology Programs have established technical standards that must be met by each student admitted into the program. Each student must be able to: 1. Operate treatment equipment that may include lifting and reaching. 2. Verbally communicate in a clear and concise manner while operating equipment, positioning patients, and performing other duties as assigned. 3. Read and apply appropriate instructions in treatment charts, procedure requisitions, treatment prescriptions, notes and records. 4. Lift a minimum of fifty (50) pounds of weight (treatment cones, cassettes and ancillary aids used for patient treatment), up and over head level. 5. Move a patient and equipment into accurate positions to insure proper exposure/treatment. 6. Move immobile patients from stretcher to treatment table with assistance from departmental personnel. 7. Understand and apply clinical instructions given. 8. Input clinical data into treatment console and computers. 9. Monitor patients during treatment procedures. 10. Monitor audio and video equipment during treatment procedures. 11. Monitor equipment and background sounds during equipment operations. 12. Complete all required competencies in a manner that demonstrates accuracy, consistency, and retention of learned skills and information.

9 CONNECTICUT COMMUNITY COLLEGES ` Schedule of Tuition and Common Fees* - Effective Fall 2012 Approved January 19, 2012* *All Tuition and Fees are subject to change Approved Effective Fall 2012 College Student Semester Hours Tuition Services Fee Activity Fee Total In-State 1.0 $ $67.25 $5.00 $ $ $72.50 $5.00 $ $ $78.00 $5.00 $ $ $83.00 $5.00 $ $ $96.75 $5.00 $ $ $ $5.00 $ $ $ $5.00 $1, $1, $ $5.00 $1, $1, $ $5.00 $1, $1, $ $5.00 $1, $1, $ $5.00 $1, or more** $1, $ $10.00 $1, Annual Full-time $3, $ $20.00 $3, Out-of-State 1.0 $ $ $5.00 $ $ $ $5.00 $1, $1, $ $5.00 $1, $1, $ $5.00 $1, $1, $ $5.00 $2, $2, $ $5.00 $2, $2, $ $5.00 $3, $3, $ $5.00 $3, $3, $ $5.00 $4, $3, $ $5.00 $4, $4, $ $5.00 $4, or more** $4, $ $10.00 $5, Annual Full-time $9, $1, $20.00 $10, NEBHE 1.0 $ $ $5.00 $ $ $ $5.00 $ $ $ $5.00 $ $ $ $5.00 $ $ $ $5.00 $1, $1, $ $5.00 $1, $1, $ $5.00 $1, $1, $ $5.00 $1, $1, $ $5.00 $2, $1, $ $5.00 $2, $2, $ $5.00 $2, or more** $2, $ $10.00 $2, Annual Full-time $4, $ $20.00 $5, ** Excess Credits Tuition Charge - An additional flat tuition charge of $100 per semester shall apply when total registered credits exceed 17 for the semester Mandatory Usage Fees*, rates effective Fall 2012: Laboratory Course Fee $78.00 Per registration in a designated laboratory course Studio Course Fee $85.00 Per registration in a designated studio course Clinical Program Fee-Level 1 $ Per semester (Fall and Spring only) - Level 1 allied health programs Clinical Program Fee-Level 2 $ Per semester (Fall and Spring only) - Level 2 allied health programs *All Tuition and Fees are subject to change Z:\SharedFiles\2012 acceptances\acceptance letter\copy of Copy of Tuition Fees BOR revised Fall12-Smr13 Tuition&Fees

10 ALLIED HEALTH DEPARTMENT INFO SESSIONS SPRING SEMESTER 2013 Allied Health Dietetic Technology / Nutrition Nuclear Medicine Technology Radiation Therapy Thursday, January 17, 1 pm Room Wednesday, January 30, 3 pm S408 Thursday, January 10, 11 am S419 Wednesday, January 9, 10 am S414 Tuesday, February 12, 2 pm Room Wednesday, February 27, 3 pm S408 Monday, February 4, 9:20 am S419 Wednesday, February 6, 10 am S414 Tuesday, March 5, 9 am Wednesday, March 20, 3 pm S408 Monday, March 4, 9:20 am S419 Wednesday, March 6, 10 am S414 Monday, April 8, 1 pm Wednesday, April 24, 3 pm S408 Monday, April 15, 9:20 am S419 Wednesday, April 3, 10 am S414 Thursday, May 2, 2 pm Wednesday, May 22, 3 pm S408 Wednesday, May 15, 9:20 am S419 Wednesday, May 1, 10 am S414 Diagnostic Medical Sonography Exercise Science Pre-Dental Hygiene Radiography Wednesday, January 16, 9 am Wednesday, February 6, 11:30 am Thursday, January 17, 2 pm Room Thursday, February 21, 1 pm Wednesday, February 13, 11 am Wednesday, March 6, 11:30 am Tuesday, February 12, 3 pm Room Thursday, March 21, 10 am Tuesday, March 12, 4 pm Wednesday, April 3, 11:30 am Tuesday, March 5, 10 am Thursday, April 18, 1 pm Thursday, April 18, 9 am S423 Wednesday, May 15, 11 am N401 Wednesday, May 1, 11:30 am Monday, April 8, 2 pm Thursday, May 2, 3 pm Thursday, May 16, 10 am For more information, please contact Lauretta Swiderski at or by at lswiderski@gwcc.commnet.edu. Sessions are free and open to the public. No admittance for late arrivals. There will be time for academic advisement following each session. Please bring unofficial copies of transcripts from all colleges, including Gateway Community College.. Applicants must attend a program-specific information session before the application deadline in order to be considered for possible admission into a program. Parking is available in the Temple Street garage. Please bring your parking ticket with you to be validated by security.