RESPIRATORY THERAPY ASSOCIATE OF APPLIED SCIENCE APPLICATION FOR ADMISSION. Application Deadline MAY 1 ST

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1 RESPIRATORY THERAPY ASSOCIATE OF APPLIED SCIENCE APPLICATION FOR ADMISSION Application Deadline MAY 1 ST EACH APPLICATION MUST INCLUDE THE FOLLOWING: o Application o Receipt of non-refundable $25 application fee paid to the cashiers office o Minimum 2.25 GPA in all prerequisite courses with no single grade below a C o SEALED OFFICIAL transcripts for pre-requisite classes completed to date sent directly to Program Advisor. (Can submit UNOFFICIALS if currently enrolled in prerequisites during spring semester. Upon completion of the semester you must hand in OFFICIAL transcripts.) o Personal Essay Word Processed, double spaced, 2 page MAX, and cover page with name. Answering the following: ~Why you want to become a Respiratory Therapist. ~Why you feel you would be successful in the Respiratory Therapy Program. ~The specific strategies you will use to fulfill the intensive requirements of the Respiratory Therapy Program. ~The roles and responsibilities of a Respiratory Therapist, including how a therapist s role differs from that of a nurse or other allied health professional. ~Personal and/or professional experience in health-related areas, including the length of time spent in these experiences. Students are admitted into the Respiratory Therapy program without discrimination with respect to gender, age, creed, ethnic origin, or marital status. Space in the program is limited; therefore, admission will be competitive, based on an objective point system that has been developed to predict student success. Points will be calculated and weighted from the admission criteria including: pre-requisite GPA, overall college GPA, interview, previous healthcare experience, and program essay. We admit up to 12 students every 18 months. Before applying for the program, individuals should give careful consideration to the mental and physical demands of the program and the pressures involved in undertaking the responsibilities of being a fulltime respiratory therapy student. SUBMIT COMPLETED APPLICATION AND ALL ABOVE REQUIREMENTS TO: DIXIE STATE UNIVERSITY JONI HALE HEALTH SCIENCE ADVISOR TAYLOR HEALTH SCIENCE BUILDING # S 700 E ST GEORGE, UT 84770

2 Dixie State University Respiratory Therapy Program AAS Application for Admissions 1. Personal Information DSU Student Number Dmail Username Preferred Name Birthdate First Name Last Name MI Address City State Zip Cell Phone Other Phone 2. Emergency Contact Name Relationship Phone City State 3. Program Application Requirements o I am a student in good standing OR o I am a transfer student and have completed the DSU admissions process o I have included the $25 application fee receipt o I have enclosed my essay I have enclosed sealed OFFICIAL transcripts 4. Educational History (Post High School) Institution Location Dates Attended Major Graduation Date

3 PREREQUISITE COURSE COMPLETION Be sure and include College or University name. Do NOT use MIDTERM grades. Required Courses Chemistry DSU Course Number CHEM 1010 or CHEM 1110/15 MOST RECENT ATTEMPT Semester Grade Institution Human Physiology BIOL 2420 Human Physiology Lab BIOL 2425 GENERAL EDUCATION PREREQUISITES Intro to Writing ENGL 1010 Intermediate Writing ENGL 2010 PSY 1100 or FCS 1500 or Social Science College Algebra OR Intro to Statistics OR Quantitative Reasoning PSY 1010 or SOC 1010 or SOC 1020 or SOC 1200 MATH 1050 or MATH 1040 or MATH 1030 Be sure to keep copies of all papers you submit! Incomplete applications will not be processed! Please note: To be licensed as a Respiratory Therapist [Respiratory Care Practitioner] in the State of Utah, the applicant must be in compliance with the Utah Respiratory Care Practices Act. Applicants who have been convicted of a felony or who have been treated for mental illness or substance abuse should discuss their eligibility status for licensure with the Utah State Respiratory Care Licensing Board. Acceptance into and completion of the respiratory therapy program does not assure eligibility to be licensed to practice in Utah. The Utah Respiratory Care Licensing Board makes the final decision as to whether a license will be issued to practice respiratory care in the State of Utah. If you have questions regarding this please contact the Division of Occupational and Professional Licensing, 160 East 300 South, P.O. Box , Salt Lake City, UT ; Phone number (801) Acknowledgement of Program Requirements for Personal Effort and Commitment

4 Acknowledgement of Program Requirements for Personal Effort and Commitment The nature of the Dixie State University Respiratory Therapy program, as with most allied health education programs, requires a substantial time commitment to fulfill the intensive requirements of the program in the classroom, laboratory, and clinical settings. The Respiratory Therapy program faculty recognizes its responsibility as facilitators of your learning and is committed to helping you succeed in the program. It is important that you are aware of your responsibilities for your own learning while in the Respiratory Therapy program. As part of your application to the program, please read the following and sign below. Your signature is an acknowledgement of your understanding of the expectations of the program. 1. There is a minimal study expectation of two hours of study per week for each credit enrolled. Each semester/term of the program has credits, therefore, a minimal study expectation for these courses would be hours of study per week (outside of class, in addition to class attendance). Most students spend more time than the minimal study expectation. 2. Although we hold an appreciation for your possible need to work to support yourself and/or a family, most students find it extremely difficult to work full time and still achieve the grades they may have received in other courses. Some students may be able to organize their schedules to work hours a week; if it is absolutely necessary for you to work full-time while a student it is unlikely that you will successfully pass all program requirements and/or successfully pass your Board examinations. 3. You are expected to be prepared for class, lab, and clinical. This may include extensive reading and/or other assignments prior to your attendance. 4. Most exams given in respiratory therapy courses are structured similarly to the Respiratory Therapy credentialing and licensing examinations. This means that most of the items on the exams are application, analysis, and synthesis type questions rather than simple knowledge and recall. These questions require a higher-order of thinking to answer correctly. We will provide you with learning strategies and test-taking strategies that will help you take the Respiratory Therapy course exams and prepare you to successfully pass your credentialing examinations. 5. You will find the Respiratory Therapy program very different and much more difficult than your past educational experiences. The Respiratory Therapy program is designed to ensure the quality of the program, to prepare you to pass your licensing examinations, and to ensure that you become a safe and competent Respiratory Therapist. I certify that all of the statements in this application and all of the documents submitted with this application are true and accurate to the best of my knowledge. I acknowledge that I have read and understand the above statements and if I am accepted into Dixie State University s Respiratory Therapy program, I agree to organize my time and personal affairs in order to meet the commitment necessary to succeed. Print name of Applicant Signature of Applicant Date

5 DIXIE STATE UNIVERSITY RESPIRATORY THERAPY PROGRAM CHECKLIST ONLY REQUIRED UPON ACCEPTANCE!!! BACKGROUND SCREEN Respiratory Therapy Code: YYGVT Cost: $59 Must be completed between acceptance date and start date! 5 PANEL DRUG SCREEN $30.00-$50.00 (DAT Express or IHC WorkMed do them for $30 locally) Allow 2 weeks for results. CPR CERTIFICATION COPY OF CARD ATTACHED Health Care Provider Level only! MUST include AED training. DSU holds classes. Contact Arvilla McInnes to enroll: or Taylor Building, room 251 VERIFICATION OF 2 MMR (Measles, Mumps, Rubella) immunizations or Titer showing immunity TDaP IMMUNIZATION MUST include Pertussis. Adult TD or childhood DPT does not meet requirement. HEPATITIS B SERIES (3) Must complete series of 3. Strongly recommended that all 3 be completed before program start. Minimum of 2 before due date mandatory (4 weeks between 1 st & 2 nd ; 6 months between 1 st and 3 rd ). It is recommended that you receive the first Hep B in the series ASAP since you will need to wait four weeks prior to receiving the second Hep B in the series. Example: First Hep B vaccination received June 10 and second Hep B received July 10 which is well before the July 31 deadline. 2 DOSE CHICKEN POX IMMUNIZATION or letter verifying you had Chicken Pox or titer showing immunity. TUBERCULOSIS Proof of 2-Step Negative Skin test, Negative BAMT (blood test), Negative chest X-ray, or verification of prior treatment for TB. A 2-step TB skin test is defined as a TB test result completed (2 visits) and then a second TB test completed at least two weeks later (2 visits). COPY OF CNA CERTIFICATE if not provided with application. Not Required Immediately: INFLUENZA VACCINE (ONLY required during Flu Season) Please mail or hand deliver to: Dixie State University ATTN: Joni Hale Russell Taylor Building #254, 225 South 700 East St. George, UT

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