NUCLEAR MEDICINE TECHNOLOGY

INFORMATION & APPLICATION PACKET 2016 2017 NUCLEAR MEDICINE TECHNOLOGY Assciate in Applied Science Degree in Nuclear Medicine Technlgy

108 N. 40th Street Phenix, AZ 85034 (602) 286-8000 www.gatewaycc.edu Nuclear Medicine Technlgy Dear Prspective Student: Thank yu fr taking the time t cnsider an excellent career pprtunity in GateWay Cmmunity Cllege s Nuclear Medicine Technlgy Prgram. This Infrmatin and Applicatin packet will prvide yu with answers t mst f yur questins. Please be advised that the cntents f this packet are subject t change thrughut the year. It wuld be prudent t peridically check fr mre current versins. The prgram cnsists f a cmbinatin f didactic, labratry, and clinical classes. This ffers ur students a means f achieving the cncepts and skills necessary t perfrm the duties f this exciting prfessin. New as f June 2015, Nuclear Medicine Technlgists, with the prper training and certificatin can be licensed in Cmputed Tmgraphy (CT). Our fully accredited prgram begins every August and runs fr seven (7) cnsecutive semesters. Applicatins are accepted at any time, please nte that admissin t the prgram is n a first applied, first accepted basis. Prerequisites must be cmpleted befre yu will be assigned a number in the prgram queue. It is als imprtant t nte that if prgram prerequisites change while in the queue yu will ntified and will be required t cmplete the changes in prerequisites but will NOT lse yur number n the queue. The applicatin can be fund at the end f this packet alng with a step by step applicatin prcess. It is highly recmmended that students take the prerequisite curse NUC100, which is an verview f the prfessin t see if this is the prfessin fr yu. We ffer this class in persn which encmpasses 2 evenings in the classrm, nline didactic curse wrk and 8 hurs f shadwing in a lcal nuclear medicine department. Since yu g int a hspital the Maricpa Cmmunity Cllege backgrund check is required at a cst f $67.00, dcumentatin f a flu sht fr the current seasn (between September and March) and yu must be at least 18 years f age. We are nw ffering a cmpletely nline versin f NUC 100 that cntains nline lessns and discussin bards as well as a series f virtual shadwing experiences that d NOT require the backgrund check r the flu sht. Chse the ptin that best fits yu, t find ut mre abut ur prgram. I think yu will find the infrmatin in this packet very helpful but if yu have any further questins, please feel free t cntact any f us: Carlyn Delgad, Health Sciences advisr at 602.286.8183 r email Delgad@gatewaycc.edu Lucy Granill, Health Sciences advisr at 602.286.8185 r email Luciella.Granill@gatewaycc.edu Patricia Felix (PK) Health Sciences/Nursing advisr at 602.286.8536 r email Felix@gatewaycc.edu Jeanne Dial, Prgram Directr at 602.286.8512 r email Dial@gatewaycc.edu Sue Gdfrey, Clinical Crdinatr at 602.286.8513 r email Susan.Gdfrey@gatewaycc.edu Visit ur website at www.gatewaycc.edu/nuclear-medicine-technlgy fr additinal prgram infrmatin. I wish yu success in yur educatinal and career gals. Sincerely, Jeanne Dial M.Ed., CNMT, RSO Directr f Nuclear Medicine Technlgy 602.286.8512 Dial@gatewaycc.edu A Maricpa Cmmunity Cllege learn mre. live better.

TABLE OF CONTENTS Career Descriptin... 5 Degree Requirements Nuclear Medicine Technlgy... 5 Admissin Criteria... 5 Prerequisites fr Assciate f Applied Science Degree... 5 Placement Testing... 5 Prgram Prerequisites... 5 Prgram f Study Nuclear Medicine Technlgy (by semester subject t change)... 7 Prgram f Study Nuclear Medicine Technlgy (cntinued)... 8 Estimated Prgram Csts... 9 Immunizatins, Testing, and Backgrund Requirements... 10 Mental & Physical Demands... 10 Frequently Asked Questins... 11 Accreditatins... 13 Cnfidentiality Statement... 13 Plicies, Rules, Requirements, and Regulatins Cmpliance... 13 Cntact Infrmatin... 14 Cllege Cmmunicatin... 14 Hw t Apply & Enrll... 15 Student Services... 17 Applying t the Nuclear Medicine Technlgy Prgram... 18 Applicatin fr Admissin Nuclear Medicine Technlgy Prgram... 19 Admissin Applicatin Disclaimer... 21 Nuclear Medicine Technlgy Admissin Applicatin Checklist... 23 MCCCD Summary f Criminal Backgrund Check Requirements... 25 MCCCD Acknwledgement f Criminal Backgrund Check Requirements... 27 Nuclear Medicine Technlgy 4 June 2016-1

CAREER DESCRIPTION As a Nuclear Medicine Technlgist (NMT), yu will administer radipharmaceuticals t patients t assess their physilgical respnses. NMTs use sphisticated detectin devices that btain qualitative and quantitative data that assist physicians as they diagnse and treat diseases. A number f skills and capabilities are required in this prfessin, including basic patient care techniques, interpersnal cmmunicatin skills, a slid understanding f algebraic analysis, and cmputer literacy. Yu will find mst jb pprtunities in hspitals, but psitins als exist in physicians ffices, utpatient clinics and mbile units. Fr infrmatin abut careers in Nuclear Medicine Technlgist, visit O*NET OnLine @ http://www.netnline.rg/link/summary/29-2033.00 fr detailed jb descriptins, educatin requirements, wage and emplyment trend infrmatin. DEGREE REQUIREMENTS NUCLEAR MEDICINE TECHNOLOGY ADMISSION CRITERIA 1. Frmal applicatin and admissin t the prgram. 2. Backgrund Check Requirements: Admissin t an Allied Health prgram requires that students be in cmpliance with the Maricpa Cunty Cmmunity Cllege District Backgrund Check standards. Upn cnditinal prgram enrllment, the student must cmply with all requirements f the MCCCD backgrund check plicy. 3. Clinical Health and Safety requirements must be met. Upn cnditinal prgram enrllment, the student must cmply with all requirements f the clinical health and safety plicy. 4. Inability t cmply with backgrund check requirements and/r Clinical Health and Safety requirements at the start f classes may result in cancellatin f enrllment. PREREQUISITES FOR ASSOCIATE OF APPLIED SCIENCE DEGREE PLACEMENT TESTING Placement test is designed t identify yur skill levels in English language usage, reading and mathematics. Placement tests are scheduled at a variety f times in GateWay s Testing Center and are free f charge. Please cntact GateWay s Testing Center r visit the website t get updated requirements and hurs f peratin. PROGRAM PREREQUISITES The fllwing cllege curses must be cmpleted with a cumulative grade pint average (GPA) f 3.0 r higher and with a final grade f C r better. All previus cllege semester credits must be frm a reginally accredited institutin recgnized by GateWay Cmmunity Cllege with a cumulative grade pint average (GPA) f 2.5 r higher. Students must earn a grade f B r better in ENG102 r ENG108 r ENG111, MAT150 r MAT151 r MAT152, and NUC100. NOTE: Until prgram prerequisites are cmpleted, students are nly eligible fr cnditinal admissin t the prgram. All prerequisites must be cmpleted prir t starting the Nuclear Medicine Prgram f Study. Nuclear Medicine Technlgy 5 June 2016-1

Curses are Required but the Schedule is Suggested Semester 1: Fall Credits Curse N. Curse Title 14 + BIO 201 Human Anatmy and Physilgy I (4) 4 + CHM 130 Fundamental Chemistry (3) AND + CHM 130LL Fundamental Chemistry Labratry (1) OR + CHM 130AA Fundamental Chemistry with Lab (4) 4 + ENG 101 First-Year Cmpsitin (3) OR + ENG 107 First-Year Cmpsitin fr ESL (3) 3 HCC 145 Medical Terminlgy fr Health Care Wrkers 3 Semester 2: Spring Credits Curse N. Curse Title 12 16 + BIO 202 Human Anatmy and Physilgy II (4) 4 + ENG 102 First-Year Cmpsitin (3) OR + ENG 108 First-Year Cmpsitin fr ESL (3) OR + ENG 111 Technical and Prfessinal Writing (3) 3 NUC 100 Intrductin t Nuclear Medicine Technlgy 1 + PHY 101 Intrductin t Physics (4) OR + PHY 111 General Physics I (4) AND + PHY 112 General Physics II (4) 4 8 Semester 3: Summer Credits Curse N. Curse Title 6 11 Any apprved general educatin curse frm the Oral Cmmunicatin area except COM225 Public Speaking. 3 + CRE 101 Cllege Critical Reading (3) OR + CRE 111 Critical Reading fr Business and Industry (3) OR Equivalent as indicated by assessment 0 3 + MAT 150 Cllege Algebra/Functins (5) OR + MAT 151 Cllege Algebra/Functins (4) OR + MAT 152 Cllege Algebra/Functins (3) OR Equivalent curse r satisfactry cmpletin f a higher level mathematics curse 3 5 Nuclear Medicine Technlgy 6 June 2016-1

PROGRAM OF STUDY NUCLEAR MEDICINE TECHNOLOGY (by semester subject t change) Semester 4: Fall Credits Curse N. Curse Title 12 + NUC 110 Radiatin Safety fr Nuclear Medicine Lec 3 + NUC 112 Nuclear Medicine I Lab 1 + NUC 114 Fundamentals f Nuclear Medicine I Lec 3 + NUC 116 Nuclear Medicine Imaging I Lec 3 + NUC 130 Patient Care Lab fr the Nuclear Medicine Technlgist 2 Semester 5: Spring Credits Curse N. Curse Title 14 DMI/DMS/ICE 220 Sectinal Anatmy 3 + NUC 113 Nuclear Medicine II - Lab 2 + NUC 126 Nuclear Medicine Imaging II Lec 3 + NUC 212 Clinical Practicum I Lab 2 + NUC 213 Nuclear Medicine Image Evaluatin I Lab 1 + NUC 214 Fundamentals f Nuclear Medicine II Lec 1.5 + NUC 224 Fundamentals f Nuclear Medicine III Lec 1.5 Semester 6: Summer Credits Curse N. Curse Title 6 7 + NUC 222 Clinical Practicum II Lab 3 + NUC 223 Nuclear Medicine Image Evaluatin II Lab 1 Any apprved general educatin curse in Humanities and Fine Arts area 2 3 Semester 7: Fall Credits Curse N. Curse Title 15 + NUC 232 Clinical Practicum III Lab 3 + NUC 233 Nuclear Medicine Image Evaluatin III Lab 1 + NUC 234 Fundamentals f Nuclear Medicine IV Lec 2 + NUC 236 Nuclear Medicine Imaging III Lec 3 + NUC 260 Imaging Research Methds and Design Lec 3 + NUC 276 Nuclear Medicine Cardiac Imaging - Lec 3 Semester 8: Spring Credits Curse N. Curse Title 12 + NUC 240 Clinical Pathlgy f Nuclear Medicine Lec 3 + NUC 242 Clinical Practicum IV Lab 3 + NUC 243 Nuclear Medicine Image Evaluatin IV Lab 1 + NUC 244 Fundamentals f Nuclear Medicine V Lec 3 + NUC 261 Emerging Technlgies Lec 2 + NUC 272 Cardiac Practicum (restricted elective) 0 1 + NUC 280 Nuclear Medicine PET & PET/CT Lec 3 Nuclear Medicine Technlgy 7 June 2016-1

PROGRAM OF STUDY NUCLEAR MEDICINE TECHNOLOGY (cntinued) Semester 9: Summer Credits Curse N. Curse Title 8 + NUC 250 Fundamentals f Cmputed Tmgraphy fr Nuclear Medicine Technlgist 2 + NUC 252 Clinical Practicum V Lab 3 Scial and Behaviral Sciences (any apprved general educatin curse frm the Scial and Behaviral Sciences area) Suggested schedule placement nt required 3 Semester 10: Fall Credits Curse N. Curse Title 6 + NUC 262 Capstne Practicum Lab 1.5 + NUC 283 PET/CT Practicum Lab 1.5 + NUC 290 Nuclear Medicine Certificatin Preparatin Seminar Lec 3 Optinal CT r MRI prgram curses are available. TOTAL PROGRAM CREDITS 108 119 Please see the cllege catalg fr full descriptin f prgram requirements. Nuclear Medicine Technlgy 8 June 2016-1

ESTIMATED PROGRAM COSTS The estimated cst fr the (7) seven semester prgram is utlined in the chart belw, which includes tuitin, fees, bks and liability insurance fr Maricpa Cunty residents. The student is respnsible fr prviding transprtatin, husing, and unifrms. In the last semester, the student will be respnsible fr csts f his/her natinal bard exam and state licensing. AAS Degree Prgram Tuitin* (71 credit hrs @ $86 a credit hr) 1... $ 6,106 Prgram Prerequisite Tuitin (32-41 credit hrs @ $86 a credit hr) 1... 2,752 3,526 General Educatin Tuitin (5-6 credit hrs @ $86 a credit hr) 1... 430 516 Restricted Elective Tuitin (0-1 credit hrs @ $86 a credit hr) 1... 0 86 Registratin fees ($15 per semester (10 semesters)... 150 Curse / Lab Fees... 2,070 Equipment / Supplies... 190 Bks... 2,606 Other Prgram Csts: Pre-Clinical Requirements, etc. 2... 217 882 ADDITIONAL COSTS AFTER PROGRAM COMPLETION/GRADUATION Ttal Estimated Csts $ 14,521 16,132 Arizna Medical Radilgic Technlgy Bard f Examiners (MRTBE) Licensure... $ 60 American Registry f Radilgic Technlgists (ARRT) Certificatin... (nte: the NMTCB fee is included in NUC290 curse fee) Out-f-Cunty residents pay $383* / Out-f-State residents pay $327** a credit hr 1 $ 200 * Rates are set accrding t Arizna Revised Statute. Applies nly t cunties with n cmmunity clleges. ** Accrding t Arizna Revised Statute, 15-1802 F, "A persn wh is a member f an Indian tribe recgnized by the US Department f the Interir whse reservatin land lies in this state and extends int anther state and wh is a resident f the reservatin is entitled t classificatin as an in-state student." Therefre, unclassified and ut f state surcharges d nt apply t such students. Students must als plan n the expense f driving t clinical lcatins acrss the metrplitan Phenix and utlying areas. Several clinical affiliates are nt n bus rutes s ne s wn private transprtatin vehicle is necessary. 1 Tuitin and fees are set by the Maricpa Cmmunity Cllege Gverning Bard and apprved by the State Bard f Directrs fr Cmmunity Clleges; all fees are subject t change. Tuitin is higher fr nn-cunty residents; visit www.gatewaycc.edu fr mre infrmatin. 2 Other Prgram Csts may be less r mre than listed based n a student s individual health recrd in respect t being in cmpliance with the immunizatin and safety requirements fr the clinical experience. IMPORTANT Tuitin/registratin fees are all due 35 days prir t the start date f each semester. If 34 days r less, all fees are due at the time f registratin r yu will be drpped frm yur classes and lse yur seat in the prgram fr nn-payment. Nuclear Medicine Technlgy 9 June 2016-1

IMMUNIZATIONS, TESTING, AND BACKGROUND REQUIREMENTS IMMUNIZATION AND TB TESTING REQUIREMENTS Please review the health and safety packet available at http://www.gatewaycc.edu/sites/default/files/imce/images/infpacket_alliedhealthprgrams.pdf The health and safety requirements are subject t change based n the requirements f ur clinical partners. The mst up t date infrmatin is lcated at the afrementined website. MCCCD BACKGROUND CHECK POLICY REQUIREMENTS Students seeking admissin t an MCCCD Allied Health r Nursing Prgram (Prgram) will be required t btain a valid Level-One Arizna Department f Public Safety Fingerprint Clearance Card (FCC Card) AND a passing scre n an MCCCD backgrund check. This plicy precludes MCCCD faculty r staff frm assigning students t a clinical experience wh cannt meet the new requirements. Upn admissin t the prgram, students are required t present a cpy f the DPS card and apply fr the MCCCD Backgrund Check. Students bear the financial csts fr bth the MCCCD Backgrund Check and the AZ Fingerprint Clearance Card. Students will receive Infrmatin regarding the MCCCD Backgrund Check after admissin, but prir t the beginning f the prgram. We encurage students t apply fr the card early in the applicatin prcess. Please allw a minimum f eight weeks prcessing time fr the DPS Level-One Fingerprint Clearance card. The card is valid fr six years frm the date f issue. DRUG SCREENING Each student must g thrugh a preclinical drug screen prir t beginning the first clinical rtatin. The cst fr tests will be the respnsibility f the student. The urine drug screen will test fr alchlic beverages, illegal drugs, r drugs that may impair judgment while in the clinical agency. If the drug test is psitive fr the illegal drugs r undcumented prescriptin drugs, the student will nt be able t cntinue in the prgram. Readmissin is at the discretin f the cllege and the prgram. Sme clinical sites als require screening fr nictine. Students wh test psitive fr nictine are allwed t cntinue in the prgram, but may be limited t clinical agencies that d nt test fr nictine. MENTAL & PHYSICAL DEMANDS Ability t walk and stand fr lng perids f time Abve-average manual dexterity and hand/eye crdinatin Gd visin and hearing (r crrectable t gd) Ability t lift 40 punds Excellent verbal and written cmmunicatin skills Lifting and mving ill r injured patients Ability t wrk under stress Althugh these activities are nt requirements fr entry int the Prgram, we prvide them t give yu an idea as t what the jb f Nuclear Medicine Technlgist entails. Yu will nt be refused entry if yu cannt perfrm these activities. Nuclear Medicine Technlgy 10 June 2016-1

FREQUENTLY ASKED QUESTIONS 1. What is Nuclear Medicine? Nuclear Medicine is part f Diagnstic Medical Imaging. We primarily inject ur imaging agents, called radipharmaceuticals, t lk at the physilgical prcesses ccurring in the rgan f interest at the mlecular level. The radipharmaceutical is an unstable nucleus that underges nuclear decay and is tagged tgether with a pharmaceutical r drug. The pharmaceutical ges t the rgan f interest and the radinuclide emits a gamma ray. Under the gamma camera, the gamma rays emitted frm the patient accumulate int an image n the screen, and the pattern shws mrphlgy and functin f the rgan. We als perfrm radiactive therapy under the directin f a physician t treat disease. PET (psitrn emissin tmgraphy) is part f nuclear medicine as well. PET currently assesses patients fr cancer, heart disease, and neurlgical prblems such as Alzheimer s disease. This special area f nuclear medicine is grwing rapidly and is expected t cntinue the grwth trend due t new radipharmaceuticals nw in develpment. Many f ur cameras are nw hybrid meaning while acquiring a Nuclear Medicine image the equipment can acquire a Cmputed Tmgraphy (CT) r Magnetic resnance imaging (MRI) image t see anatmy at the same time. 2. When is the deadline t apply fr the Nuclear Medicine Technlgy Prgram? We d nt have a deadline; we accept applicatins at any time. The Prgram begins each fall semester, s we clean up the list nce a year in September by sending an email t everyne n the wait list t see if they wuld like t be rlled int the next selective admissins perid. We can als infrm students n the list f any changes in the Prgram at this time. 3. D I need all my prerequisites befre I turn in my applicatin? N, yu can turn in yur applicatin at any time even if yu d nt have all yur prerequisites, but yu will nt be assigned a number in the queue until all yur prerequisites are cmplete. Wait list numbers are assigned in the rder in which applicatins are submitted and prerequisites are verified. It is als imprtant t nte that if prgram prerequisites change while in the queue yu will ntified and will be required t cmplete the changes in prerequisites but will NOT lse yur number n the queue. 4. Hw many students are admitted t the prgram each year? We d nt exceed 25 students per chrt. A chrt will start each fall semester. Having said that, yu shuld als knw we email between 33 and 87 prspective students n the wait list t fill the 25 seats in each chrt. 5. Hw des the cllege cmmunicate with students? Once yu submit yur applicatin, yu will receive a district-wide Ggle-pwered email accunt. We use this system t send all fficial cllege cmmunicatins cncerning selective admissins, class enrllment, financial aid, tuitin due dates, and ther imprtant student infrmatin. All students will need t check their new student e-mail accunts regularly r frward that e- mail t a persnal email accunt t ensure that all fficial cllege cmmunicatin is received. Students may access their new e-mail accunts thrugh the Student Email link, lcated in the upper right side f the navigatin bar at www.my.maricpa.edu. Gmail lgin is via the student email lg in GgleApps@Maricpa. G t my.maricpa.edu and lg in t yur accunt. Click First Time Users Start Here Need a MEID and passwrd t lg in. t set up yur student accunt. Yu may als edit yur infrmatin (such as address, phne, etc.) here. Students may register fr classes, add/drp classes, make payments, print class schedules, and view financial aid status and grades here as well. Yu may call 1-888-994-4433 if yu need help. Nuclear Medicine Technlgy 11 June 2016-1

6. Hw is the prgram structured? This is a full-time day prgram f seven (7) cnsecutive semesters. The first semester is cmpletely at GateWay, the remaining six (6) semesters will be a cmbinatin f classrm at GateWay and clinical at Arizna Nuclear Medicine facilities. 7. I already have an Assciate s Degree; I m lking fr a Bachelr s degree nw. D yu have an ptin fr me? Yes we d, we have articulatin agreements with many universities clinical n this link t see ur partners. Maricpa University Partner List We have an advisr frm Nrthern Arizna University here n the GateWay Campus that can tell yu abut their Bachelr f Health Sciences: Diagnstic Medical Imaging and Therapy. NAU will take yur Nuclear Medicine cursewrk as yur third year t cmplete this Degree. All classes are nline, and yu can start it while yur name is n the wait list at GateWay fr the Nuclear Medicine Technlgy Prgram. Fr mre infrmatin n this degree, call NAU s GateWay satellite lcatin at 602.286.8194 8. Can I wrk while taking the NMT Prgram? We have restructured the prgram with the wrking student in mind. Fall and spring semesters will cnsist f 12 t 13 credits and the summer semesters will be 4 credits t give students time t wrk if they need t. Still full time wrk is nt recmmended due t the rigrus nature f this prgram. 9. I live utside Maricpa Cunty; is it pssible fr me t g t a clinical site clser t where I live? We d have clinical sites in Tucsn, Yuma, Presctt, Cttnwd, and Flagstaff. We can make arrangements fr yu t d yur clinical rtatins at ne f these sites. D nt cntact any hspital withut ur permissin; it must be a site we are cntracted with and be apprved by ur accreditatin. Yu are still respnsible fr having all the prerequisites. If yu like, yu may cntact the Prgram Directr fr an Out-f-Cunty Request Frm. Email Jeanne Dial, Prgram Directr, at dial@gatewaycc.edu. These psitins must be apprved by January 15th t be cnsidered fr the fllwing fall semester. 10. I heard abut a Flex Psitin in the Nuclear Medicine Technlgy Prgram; what s that? Yes, this is available fr students n the wait list wh can be flexible abut where they will gain their clinical experience. Here is hw it wrks: First we cunt ur Out-f-Cunty -apprved students, then accept the number f students that crrespnds with the number f available incunty sites. Once we have the ttal number f in-cunty and ut-f-cunty students, we can ffer the next students n the wait list psitins in the didactic (classrm and lab) part f the prgram withut knwing if they will be in-cunty r ut-f-cunty fr the clinical experience, t bring ur chrt ttal up t 25 students. Flex students might even have their clinical experience pstpned if n clinical sites are available. This ptin is pssible because f prgram attritin and the fact we are always recruiting new clinical sites. This is nt an ptin fr everyne. 11. If I have a criminal recrd, will that prhibit me frm being successful in this career? Pssibly, since ur clinical agreements with the healthcare facilities require that ur students receive a Level-ne Fingerprint Clearance Card issued by the Arizna Department f Public Safety and pass the Maricpa Cmmunity Cllege District backgrund check. Additinally, a student must nt be listed n the Federal Gvernment s Office f the Inspectr General s Exclusin List. The Fingerprint Clearance Card must be btained befre the prgram begins but after yu have been have received yur acceptance letter and infrmatin packet. If yu are cncerned abut yur past It is recmmended that yu cntact the American Registry f Radilgic Technlgists and/r the Nuclear Medicine Certificatin Bard t see if yu will be permitted t sit fr bard exams nce yu have graduated. Yu ll find their URLs belw. 12. Is there a natinal certificatin r a state license fr Nuclear Medicine Technlgists? Yes, t wrk in Arizna as a Nuclear Medicine Technlgist yu must first graduate f a nuclear medicine prgram, then sit fr a certificatin exam, then apply fr state licensure. T keep yur license yu must cmplete 24 hurs f cntinuing educatin in Nuclear Medicine every tw years as part f the renewal prcess. With prper training, certificatin, and licensure a Nuclear Medicine Technlgist can als be a Cmputed Tmgraphy (CT) Technlgist. Students in the Nuclear Medicine Technlgy 12 June 2016-1

GateWay Nuclear Medicine prgram have the ptin t graduate prepared t be bth a Nuclear Medicine and Cmputed Tmgraphy Technlgist. After successful cmpletin f the prgram, students are eligible t sit fr either f the fllwing natinal primary nuclear Medicine exams which bth ffer pst primary exams in Cmputed Tmgraphy fr Nuclear Medicine Technlgist and students: American Registry f Radilgic Technlgists (ARRT) (N) www.arrt.rg Nuclear Medicine Certificatin Bard (NMTCB) www.nmtcb.rg Upn natinal certificatin yu will be eligible fr Arizna State licensure fr the certificatins yu hld, Nuclear Medicine and CT 13. Where can I find mre infrmatin abut Nuclear Medicine? The GWCC library has many bks and peridicals n Nuclear Medicine Technlgy. Bureau f Labr Statistics Sciety f Nuclear Medicine Nuclear Medicine Technlgy Certificatin Bard The American Registry f Radilgic Technlgists 14. If I am a military veteran, what will GateWay d fr me t get int the Nuclear Medicine prgram? As a military friendly prgram, we mve (3) three military veterans t the tp f ur wait list fr admissins int the prgram each Fall semester, a cpy f yur DD214 will be required. ACCREDITATIONS GateWay Cmmunity Cllege is a Maricpa Cmmunity Cllege, accredited by the Higher Learning Cmmissin, a Cmmissin f the Nrth Central Assciatin f Clleges and Schls (30 N. LaSalle Street, Suite 2400, Chicag, IL 60602-2504, 800-621-7440), and its curses are apprved by the Scial Security Administratin fr Veterans training. This schl is authrized under federal law t enrll nn-immigrant alien students. The GateWay Nuclear Medicine Technlgy Prgram is accredited by the Jint Review Cmmittee n Educatin in Nuclear Medicine Technlgy (JRCNMT). CONFIDENTIALITY STATEMENT Students enrlled in prgram pathways f the HCIES will have learning experiences in health care settings where they will have access t cnfidential infrmatin. Prir t beginning any clinical studies, the students will be asked t sign agreements t adhere t the requirements f thse clinical sites and applicable law, including the Health Insurance Prtability and Accuntability Act f 1996 (HIPAA). POLICIES, RULES, REQUIREMENTS, AND REGULATIONS COMPLIANCE Plicies, curses, prgrams, fees, and requirements may be suspended, deleted, restricted, supplemented, r changed thrugh actin f the Gverning Bard f the Maricpa Cmmunity Clleges. The Maricpa Cmmunity Clleges reserves the right t change, withut ntice, any materials, infrmatin, curriculum, requirements, and regulatins. Admissin r graduatin frm any Allied Health prgram at GateWay Cmmunity Cllege des nt guarantee the student s prfessinal certificatin, licensure, r emplyability. The student must cmply with legal requirements f the prfessin. This may include prvisins frm Arizna Revised Nuclear Medicine Technlgy 13 June 2016-1

Statutes 41-1758.03 (sectins B and C) regarding the denial f a fingerprint clearance card r being listed n the US gvernment s Office f Inspectr General s Exclusin List. Students with related health care experiences nt listed in the Prgram (Health Cre Curriculum curses) Prerequisites/C-requisite ptins, may request an evaluatin fr curse cmpetency equivalence by cntacting GateWay's Health Cre Curriculum Crdinatr Charlene Thiessen by calling 602-286-8509 r emailing her at Thiessen@gatewaycc.edu CONTACT INFORMATION If yu have any questins abut the enclsed prgram material, please feel free t cntact any f the fllwing: Jeanne Dial, Prgram Directr / Phne 602.286.8512 / Email: Dial@gatewaycc.edu Sue Gdfrey, Clinical Crdinatr / 602.286.8513 / Email Susan.Gdfrey@gatewaycc.edu Carline Delgad, Health Sciences Academic Advisr / Phne: 602.286.8183 / Email: Delgad@gatewaycc.edu PK Felix, Health Sciences Academic Advisr / Phne: 602.286.8536 / Email: felix@gatewaycc.edu Lucy Granill, Health Sciences Academic Advisr / Phne: 602.286.8185 / Email: luciella.granill@gatewaycc.edu COLLEGE COMMUNICATION The fllwing infrmatin is very imprtant s yu d nt miss any ntices: We cmmunicate with students strictly thrugh yur Maricpa Cllege email, nt yur persnal email accunt. We have a district-wide Ggle pwered email system. This system is the way we send all fficial Cllege cmmunicatins cncerning selective admissins, class enrllment, financial aid, tuitin due dates and ther imprtant student infrmatin. All students will need t check their new student e-mail regularly r frward the new student e-mail t a persnal e-mail t ensure that all fficial cllege cmmunicatin is received. Students may access their new e-mail accunts directly frm their Student Center nce they lg in at my.maricpa.edu. 1st sectin Student Cmmunicatin Center. The benefits t yu include: Quicker respnse Cnvenience. Yu can receive & read email even if ut-f-twn Saves trees! G t my.maricpa.edu & lg in t yur accunt. Click n create an accunt in the paragraph abve the picture f the students t set up yur student accunt. Yu may edit yur infrmatin, such as address, phne, etc. here als if yu need t. This is a self-service fr students, which includes registering fr classes, adding/drpping classes, making payments, printing yur class schedules, viewing financial aid & viewing yur grades. If yu have any technical issues, please call 1-888-994-4433. Nuclear Medicine Technlgy 14 June 2016-1

HOW TO APPLY & ENROLL STEP 1: STEP 2: STEP 3: GET ADMITTED Create MEID Accunt and Apply fr Admissins maricpa.edu/admissins Prvide prf f identity t the cllege at which yu applied. Fr tuitin purpses, verify yur residency status by prviding a gvernment issued ID. Submit prir educatin (if applicable) i.e. high schl and/r cllege/university fficial transcript. Undecided n a majr? Cnnect with Cunseling and Career Services at yur cllege. Visit the campus t familiarize yurself with the services and resurces. Cmplete the FAFSA and schlarship applicatins at: maricpa.edu/paying-fr-cllege. TAKE THE PLACEMENT TEST Prepare, Study, and Schedule Test maricpa.edu/testing Prepare by reviewing the sample questins at maricpa.edu/testing. Placement test will ensure apprpriate level f classes fr enrllment. The Placement Test is nt a pass/fail exam. The Placement Test is untimed and FREE. Bring yur gvernment issued pht ID n the day f testing. T review yur test scre results, ask fr a Curse Placement Chart. GET ENROLLED Seek Academic Advisement maricpa.edu/advisement Advisrs will help with identifying curses and creating an Educatinal Plan t meet yur academic gals. Meet with a Health Sciences Academic Advisrs every semester prir t class registratin. The Health Sciences Academic Advisrs are available by phne, email, r in persn at the CH Center fr Health Careers Educatin Building, n the nrth side f campus during the fllwing business hurs: Walk-in basis Fr an appintment call 602.286.8600 Mndays frm 8 a.m. t 5 p.m. Tuesdays-Wednesdays-Thursdays. Fridays frm 8 a.m. t 1 p.m. Decrease yur waiting time by (but clsed n Fridays in the Summer) scheduling an appintment. Befre yu meet with an advisr, we recmmend yu check ut the current Catalg t learn mre abut the prgrams that interest yu. Let yur advisr knw if yu have any questins r cncerns. If yu have taken a class fr cllege credit and yu are interested in transferring credits t GateWay, yu may better prepare fr yur meeting if yu bring a cpy f yur transcripts t review with yur advisr and then: Nuclear Medicine Technlgy 15 June 2016-1

Arrange t have yur fficial transcripts (frm all clleges & schls previusly attended) sent t: Attn: Admissins & Recrds 108 N 40th Street Phenix, AZ 85034-1704 Bring a cpy f yur transcripts t review with yur advisr. Yur advisr can help yu chse curses that will apply t mst degrees and give yu an intrductin int yur areas f interest. Register fr Classes maricpa.edu/register Register fr classes early t ensure the best schedule, maximize financial aid ptins, and t get prepared fr a successful semester. Knw when yur tuitin is due. Attend New Student Orientatin maricpa.edu/new-student-rientatin All new t cllege students must attend New Student Orientatin. Research shws that thse wh participate, have higher rates f attaining their gals. STEP 4: STEP 5: STEP 6: PAY TUITION AND FEES Explre Payment Optins maricpa.edu/paying-fr-cllege Mnitr yur Student Center fr current balance and pay n r befre due date. Explre paying fr cllege at maricpa.edu/paying-fr-cllege. Cmplete the Free Applicatin fr Federal Student Aid (FAFSA) at fafsa.gv. Explre cllege websites fr schlarships, such as the Presidents Schlarship and mre. REVIEW PROGRAM REQUIREMENTS Each f ur Health Science prgrams has unique requirements. We strngly encurage yu t review the prgram packets and the current catalg fr any specialties that yu might cnsider. These resurces will prvide yu with detailed prgram infrmatin regarding prerequisite curses and applicatin prcedures. PROGRAM APPLICATION Many f GateWay Cmmunity Cllege s Health Science prgrams have a special admissins prcedure. The Nuclear Medicine Technlgy Prgram infrmatin packet cntains detailed infrmatin regarding this prcess. Please be sure t review this infrmatin t ensure that yur applicatin materials are cmplete. Yu will receive ntificatin f yur acceptance via e-mail. This will arrive thrugh the Maricpa email accunt set up when yu received yur MEID. S yu will want t check this accunt regularly, r have it frwarded t an accunt which yu d check ften. Keep yur cntact infrmatin current with GateWay Cmmunity Clleges Admissins and Recrds department. Nuclear Medicine Technlgy 16 June 2016-1

STUDENT SERVICES Sme f the services available t students are: Advising Meeting with a Health Sciences academic advisr in the Center fr Health Careers Educatin (CHCE) is n a walk-in basis n Mndays frm 8 a.m. t 5 p.m. and n Fridays frm 8 a.m. t 1 p.m. (but clsed n Fridays in the Summer). Fr an appintment n Tuesdays-Wednesdays-Thursdays, yu may call 602.286.8600. Bkstre Textbks and supplies fr classes. Call 602.286.8400 r visit www.efllett.cm and select Cllege Textbks. Cunseling Academic, persnal, r career cunseling available. Call 602.286.8900. Emplyment Upn cmpletin f the Nuclear Medicine Technlgy Prgram, cntact Career and Re- Entry Services at 602.286.8500 fr assistance. Financial Aid Available fr qualified students. Cntact the Financial Aid Office at 602.286.8300 r visit the fllwing link: Financial Aid Student Assessment Center Services include instructr makeup exams, the English, Math, and Reading COMPASS placement tests, and selected instruments required fr acceptance int the Health Science r Nursing prgrams. Call 602.286.8160 fr specific days and times tests are available. Tutring Assistance Available thugh the Learning Center; call 602.286.8800. Fr a cmplete listing f student services, please refer t the Cllege Catalg, r the cllege website www.gatewaycc.edu, r call Cllege Infrmatin at 602.286.8000. Nuclear Medicine Technlgy 17 June 2016-1

APPLYING TO THE NUCLEAR MEDICINE TECHNOLOGY PROGRAM Step 1: Step 2: Step 3: Step 4: Step 5: Step 6: Step 7: G t My.Maricpa.edu and apply fr cllege admissins Cmplete the prgram applicatin. Fllw these instructins. The applicatin is in the applicatin and infrmatin packet Thrughut the applicatin prcess all cmmunicatin will be thrugh yur My. Maricpa email accunt It is highly recmmended that yu take NUC 100 when cnsidering Nuclear Medicine as yur career chice. This 1 credit prerequisite is an intrductin t Nuclear Medicine Applicatins are accepted at any time and yu will be entered int the prgram queue If there is any infrmatin abut the prgram it will be shared with all prgram applicants in the queue thugh the My.Maricpa email address Official transcripts must be sent t the Admissin and Recrds Department at GWCC If yur prerequisites are nt cmplete at the time f applicatin yu must email selectiveadmissins@gatewaycc.edu as yu cmpete each class s yur applicatin can be updated Mid-January we begin sending acceptance letters and acknwledgement frms t applicants in the queue. We accept a maximum f 25 students per fall chrt. The acknwledgement frm must be returned by the date stated in the acceptance letter. NOTE: Students are accepted thugh the queue, and are given a number in the queue as they finish their prerequisites. There are 2 exceptins t this rule. The Out f Cunty plicy and the Military Friendly plicy. Since we d nt have enugh clinical sites in the metr Phenix area we have an Out f Cunty plicy that mves students wh live utside the metr Phenix area r are will t attend the clinical rtatins utside the metr Phenix area (Maricpa Cunty) the pprtunity t mve up the list. This ptin has a maximum f 5 students. T apply fr an Out f Cunty prgram seat cmpete the Out f Cunty frm and return it t the prgram directr. It is available during NUC 100 r by emailing the prgram directr Jeanne Dial and requesting a frm. Dial@gatewaycc.edu This frm must be received by January 15 th, prir t the start f selective admissins fr the fall start date. We are a Military Friendly prgram. Fr each prgram chrt we will mve a maximum f 3 military applicants wh have dcumented their applicatin apprpriately and included a cpy f their DD214 t the tp f the queue. We have anther designatin f students during the admissin prcess call the flex student. Once we have filled the prgram with ur Out f Cunty students, Military students, and applicatin queued students fr the remaining number f within the Metr Phenix area clinical slts, we accept flex students. These students are guaranteed a didactic seat in the prgram but their clinical sites might be within r utside the Metr Phenix area. They need t be Flexible abut where they will attend clinical. Once all the seats are filled fr the fall chrt and letter frm the prgram directr will be sent an email giving details abut prgram rientatin mentined in the acceptance letter. We have tw (2) sessins f prgram rientatin. One at the end f April and the 2nd in mid August. Prgram begins with the fall semester. The applicants in the queue receive emails t see if they want t remain in the queue, and applicants are given their new number in the queue. Nuclear Medicine Technlgy 18 June 2016-1

APPLICATION FOR ADMISSION NUCLEAR MEDICINE TECHNOLOGY PROGRAM GATEWAY COMMUNITY COLLEGE 108 N 40th Street Phenix, AZ 85034-1704 / 602.286.8000 An fficial transcript frm each attended cllege must be sent t the GWCC Admissins & Recrds Office. Please print clearly. LEGAL NAME (LAST) (FIRST) (MIDDLE) ADDRESS (STREET) (CITY) (STATE) (ZIP) FORMER NAME(S) which may appear n transcript(s) CELL PHONE NUMBER ALTERNATE PHONE NUMBER PERSONAL E-MAIL ADDRESS MARICOPA COLLEGE EMAIL STUDENT ID DATE OF BIRTH Are yu currently enrlled in cllege? Yes N If yes, where Are yu a United States veteran? Yes N Attached a cpy f DD214 Nuclear Medicine Technlgy 19 June 2016-1

STARTING WITH MOST RECENT AND WORKING BACKWARD, LIST EMPLOYERS OR VOLUNTEER WORK: OCCUPATION EMPLOYER FROM TO ADDRESS NAME OF SUPERVISOR REASON FOR LEAVING OCCUPATION EMPLOYER FROM TO ADDRESS NAME OF SUPERVISOR REASON FOR LEAVING VOLUNTEER EXPERISNCE EMPLOYER FROM TO ADDRESS NAME OF SUPERVISOR REASON FOR LEAVING PREVIOUS COLLEGES OR TECHNICAL SCHOOLS ATTENDED: NAME OF INSTITUTION CITY AND STATE DATE OF ENTRANCE DIPLOMA OR DEGREE RECEIVED DATE OF EXIT COLLEGE MAJOR Attach separate sheet if additinal space is needed CERTIFICATION: I certify that the abve answers are true, crrect and cmplete. I understand that any falsificatin r intentinal misrepresentatin f infrmatin n this applicatin may be cause fr dismissal frm the Nuclear Medicine Prgram and frm the cllege. I understand that it is my respnsibility t keep the Admissins/Selective Admissins Office ntified f any changes f infrmatin stated n this applicatin Signature Date RETURN APPLICATION AND THE ADMISSION APPLICATION DISCLAIMER TO: GateWay Cmmunity Cllege Selective Admissins 108 N 40th Street / Phenix, Arizna 85034-1704 Nuclear Medicine Technlgy 20 June 2016-1

ADMISSION APPLICATION DISCLAIMER Yur admissin t the GateWay Cmmunity Cllege Nuclear Medicine Technlgy Prgram is n guarantee that yu will receive an Assciate in Applied Science Degree in Nuclear Medicine Technlgy frm the Cllege. Cmpletin f the Nuclear Medicine Prgram is nt the sle criterin fr btaining certificatin t practice. Licensing requirements are the exclusive respnsibility f the ARRT (American Registry f Radilgic Technlgy) r the NMTCB (Nuclear Medicine Technlgy Certificatin Bard), and yu must satisfy thse requirements independently f graduatin requirements fr the Cllege. State licensure is als independent f prgram cmpletin. I have read and understand the Admissins Applicatin Disclaimer. Signature Date Print yur name here This Disclaimer will becme a part f yur permanent Prgram recrd. Nuclear Medicine Technlgy 21 June 2016-1

Nuclear Medicine Technlgy 22 June 2016-1

NUC ADMISSION APPLICATION CHECKLIST Last Name First Name Student ID NOTES: 1) Until prgram prerequisites are cmpleted, students are nly eligible fr cnditinal admissin t the prgram. All prerequisites must be cmpleted prir t starting the Nuclear Medicine Prgram f Study. (Ttal Prerequisites Credits: 32 41) 2) These cllege prerequisite curses must be cmpleted with a cumulative grade pint average (GPA) f 3.0 r higher and with a final grade f C r better. All previus cllege semester credits must be frm a reginally accredited institutin recgnized by GateWay Cmmunity Cllege with a cumulative grade pint average (GPA) f 2.5 r higher. 3) Students must earn a grade f B r better in ENG102 r ENG108 r ENG111, MAT150 r MAT151 r MAT152, and NUC100. 4) Any changes in prerequisites will be the respnsibility f the student t cmplete prir t the start f the prgram. We encurage students t cmplete an applicatin s we can keep yu infrmed f any prgram changes. Bx Curse # Curse Title / Credits Curse # Taken r Transferred r Assessment Semester Cmpleted Grade + BIO 201 Human Anatmy and Physilgy I (4) + BIO 202 Human Anatmy and Physilgy II (4) + CHM 130 + CHM 130LL + CHM 130AA Fundamental Chemistry (3) AND Fundamental Chemistry Labratry (1) OR Fundamental Chemistry with Lab (4) COM 110 Interpersnal Cmmunicatin + ENG101 ENG107 First Year Cmpsitin (3) OR First Year Cmpsitin fr ESL (3) HCC145 Cmmn Medical Terminlgy fr Health Care Wrkers (3) + + + ENG 102 ENG 108 ENG 111 First Year Cmpsitin (3) OR First Year Cmpsitin fr ESL (3) OR Technical and Prfessinal Writing (3) NUC 100 Intrductin t Nuclear Medicine Technlgy + + + PHY 101 PHY 111 PHY 112 Intrductin t Physics (4) OR General Physics I (4) AND General Physics II (4) + CRE 101 + CRE 111 Cllege Critical Reading (3) OR Critical Reading fr Business and Industry (3) OR Equivalent as indicated by assessment + + + MAT 150 MAT 151 MAT 152 Cllege Algebra/Functins (5) OR Cllege Algebra/Functins (4) OR Cllege Algebra/Functins (3) OR Equivalent curse r satisfactry cmpletin f a higher level mathematics curse Student Signature Date Nuclear Medicine Technlgy 23

Nuclear Medicine Technlgy 24 June 2016-1

Allied Health and Nursing Prgrams Maricpa Cunty Cmmunity Cllege District Summary f Criminal Backgrund Check Requirements effective September 1, 2011 (Student Cpy) Overview f the Requirements In rder fr students t be admitted t r maintain enrllment in gd standing in Maricpa Cunty Cmmunity Cllege District s ( MCCCD ) Allied Health and Nursing prgrams ( Prgrams ) beginning n September 1, 2011, students must prvide with their applicatin t a Prgram all f the fllwing: A cpy f an Arizna Department f Public Safety Level One Fingerprint Clearance Card ( Card ). Students are required t pay the cst f applying fr the Card. Cards that are NOT Level One status will nt be accepted. An riginal versin f the Criminal Backgrund Check Disclsure Acknwledgement frm attached t this Summary signed by the student. At all times during enrllment in a Prgram, students must btain and maintain BOTH a valid Level One Fingerprint Clearance Card and passing dispsitin n supplemental backgrund check perfrmed by MCCCD authrized vendr. Admissin requirements related t backgrund checks are subject t change as mandated by clinical experience partners Implementatin f the Requirements 1. Students that are denied issuance f a Card may be eligible fr a gd cause exceptin thrugh the Arizna Department f Public Safety. It is the student s respnsibility t seek that exceptin directly with the department. Until the student btains a Card and meets the ther requirements fr admissin, he r she will nt be admitted t a Prgram. 2. Students admitted t a Prgram whse Card is revked r suspended must ntify the Prgram Directr immediately and the student will be remved frm the Prgram in which they have been admitted r are enrlled. Any refund f funds wuld be made per MCCCD plicy. 3. The Criminal Backgrund Check Disclsure Acknwledgement directs students t disclse n the data cllectin frm f the MCCCD authrized backgrund check vendr all f the requested infrmatin as well as any infrmatin that the backgrund check may discver. Hnesty is imprtant as it demnstrates character. Lack f hnesty will be the basis fr denial f admissin r remval frm a Prgram if the infrmatin that shuld have been disclsed but was nt wuld have resulted in denial f admissin. Failure t disclse ther types f infrmatin cnstitutes a vilatin f the Student Cde f Cnduct and may be subject t sanctins under that Cde. Students have a duty t update the infrmatin requested n the [backgrund check vendr] data cllectin frm prmptly during enrllment in a Prgram. The [backgrund check vendr] data cllectin frm may ask fr the fllwing infrmatin but the frm may change frm time t time: Legal Name Maiden Name Other names used Scial Security Number Date f Birth Arrests, charges r cnvictins f any criminal ffenses, even if dismissed r expunged, including dates and details. Pending criminal charges that have been filed against yu including dates and details. Participatin in a first ffender, deferred adjudicatin r pretrial diversin r ther prbatin prgram r arrangement where judgment r cnvictin has been withheld. The authrized MCCCD backgrund check vendr will be asked t pass r fail each student based n the standards f MCCCD s clinical experience partners that have established the mst stringent requirements. The sle recurse f any student wh fails the backgrund check and believes that failure may have been in errr is with the backgrund check vendr and nt MCCCD. Summary f Criminal Backgrund Check Requirements.dcx 25

Summary f Criminal Backgrund Check Requirements.dcx 26

(Student: Sign and Attach t Applicatin) ACKNOWLEDGEMENT OF CRIMINAL BACKGROUND CHECK REQUIREMENTS APPLICABLE TO STUDENTS SEEKING ADMISSION INTO ALLIED HEALTH OR NURSING PROGRAMS ON OR AFTER SEPTEMBER 1, 2011 In applying fr admissin t a Nursing r Allied Health prgram ( Prgram ) at the Maricpa Cunty Cmmunity Cllege District, yu are required t disclse n the Arizna Department f Public Safety (DPS) frm all required infrmatin and n the MCCCD authrized backgrund check vendr data cllectin frm any arrests, cnvictins, r charges (even if the arrest, cnvictin r charge has been dismissed r expunged), r participatin in first ffender, deferred adjudicatin, pretrial diversin r ther prbatin prgram n this frm. Additinally, yu must disclse anything that is likely t be discvered in the MCCCD supplemental backgrund check that will be cnducted n yu. Please cmplete the DPS frm, the MCCCD authrized backgrund check vendr frm and any clinical agency backgrund check frm hnestly and cmpletely. This means that yur answers must be truthful, accurate, and cmplete. If yu knw f certain infrmatin yet are unsure f whether t disclse it, yu must disclse the infrmatin, including any arrest r criminal charge. Additinally, By signing this acknwledgement, yu acknwledge the fllwing: I understand that I must submit t and pay any csts required t btain a Level One Fingerprint Clearance Card and an MCCCD supplemental criminal backgrund check. I understand that failure t btain a Level One Fingerprint Clearance Card will result in a denial f admissin t a Prgram r remval frm it if I have been cnditinally admitted. I understand that I must submit t and pay any csts required t btain an MCCCD supplemental backgrund check prir t the start f the class. I understand that failure t btain a pass as a result f the MCCCD supplemental criminal backgrund check will result in a denial f admissin t a Prgram r remval frm it if I have been cnditinally admitted. I understand that, if my Level One Fingerprint Clearance Card is revked r suspended at any time during the admissin prcess r my enrllment in a Prgram, I am respnsible t ntify the Prgram Directr immediately and that I will be remved frm the Prgram. I understand that a clinical agency may require an additinal criminal backgrund check t screen fr barrier ffenses ther than thse required by MCCCD, as well as a drug screening. I understand that I am required t pay fr any and all criminal backgrund checks and drug screens required by a clinical agency t which I am assigned. I understand that the bth the MCCCD supplemental r the clinical agency backgrund check may include but are nt limited t the fllwing: Natinwide Federal Healthcare Fraud and Abuse Databases Scial Security Verificatin Residency Histry Arizna Statewide Criminal Recrds Natinwide Criminal Database Natinwide Sexual Offender Registry Hmeland Security Search By virtue f the MCCCD supplemental backgrund check, I understand that I will be disqualified fr admissin r cntinued enrllment in a Prgram based n my criminal ffenses, the inability t verify my Scial Security number, r my being listed in an exclusinary database f a Federal Agency. The criminal ffenses fr disqualificatin may include but are nt limited t any r all f the fllwing: Scial Security Search Scial Security number des nt belng t applicant Any inclusin n any registered sex ffender database Summary f Criminal Backgrund Check Requirements.dcx 27

Any inclusin n any f the Federal exclusin lists r Hmeland Security watch list Any cnvictin f Felny n matter what the age f the cnvictin Any warrant any state Any misdemeanr cnvictin fr the fllwing N matter age f crime - vilent crimes - burglary - sex crime f any kind including nn - pandering cnsensual sexual crimes and sexual - any crime against minrs, children, assault vulnerable adults including abuse, - murder, attempted murder neglect, explitatin - abductin - any abuse r neglect - assault - any fraud - rbbery - illegal drugs - arsn - aggravated DUI - extrtin Any misdemeanr cntrlled substance cnvictin last 7 years Any ther misdemeanr cnvictins within last 3 years Exceptins: Any misdemeanr traffic (DUI is nt cnsidered Traffic) I understand that I must disclse n all backgrund check data cllectin frms (DPS, MCCCD backgrund check vendr and a clinical agency backgrund check vendr) all required infrmatin including any arrests, cnvictins, r charges (even if the arrest, cnvictin r charge has been dismissed r expunged), r participatin in first ffender, deferred adjudicatin, pretrial diversin r ther prbatin prgram. That includes any misdemeanrs r felnies in Arizna, any ther State, r ther jurisdictin. I als understand that I must disclse any ther relevant infrmatin n the frms. I further understand that nn disclsure f relevant infrmatin n the frms that wuld have resulted in failing the backgrund check will result in denial f admissin t r remval frm a Prgram. Finally, I understand that my failure t disclse ther types f infrmatin f the frms will result in a vilatin f the Student Cde f Cnduct and may be subject t sanctins under that Cde. I understand that, if a clinical agency t which I have been assigned des nt accept me based n my criminal backgrund check it may result in my inability t cmplete the Prgram. I als understand that MCCCD may, within its discretin, disclse t a clinical agency that I have been rejected by anther clinical agency. I further understand that MCCCD has n bligatin t place me when the reasn fr lack f placement is my criminal backgrund check. Since clinical agency assignments are critical requirements fr cmpletin f the Prgram, I acknwledge that my inability t cmplete required clinical experience due t my criminal backgrund check will result in remval frm the Prgram. I understand the Prgrams reserve the authrity t determine my eligibility t be admitted t the Prgram r t cntinue in the Prgram and admissin requirements r backgrund check requirements can change withut ntice. I understand that I have a duty t immediately reprt t the Prgram Directr any arrests, cnvictins, placement n exclusin databases, suspensin, remval f my DPS Fingerprint Clearance Card r remval r discipline impsed n any prfessinal license r certificate at any time during my enrllment in a Prgram. Signature Date Printed Name Student ID Number Desired Health Care Prgram Summary f Criminal Backgrund Check Requirements.dcx 28