APPLICATION & INFORMATION PACKET

APPLICATION & INFORMATION PACKET 2016 2017 MEDICAL RADIOGRAPHY (Cmmnly Referred t as X-Ray Technlgy) Assciate in Applied Science Degree in Medical Radigraphy

108 N. 40th Street Phenix, AZ 85034 (602) 286-8000 www.gatewaycc.edu Medical Radigraphy Prgram Dear Prspective Student: Thank yu fr yur inquiry int ur Medical Radigraphy prgram at GateWay Cmmunity Cllege. The attached 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 Medical Radigraphy prgram at GWCC cntinues t enjy the respect f the medical cmmunity and the supprt f ur affiliate hspitals. Our standards are high and as a result s are the quality f ur graduates. Our reputatin in the cmmunity will attest t that fact. Additinally, ur graduates have cnsistently passed the A.R.R.T. natinal registry examinatin and have gne n t be very cmpetent technlgists and valued emplyees. Please feel free t cntact an advisr at the Center fr Health Educatin Careers, 602.286.8600. Please nte that prgram curriculum and prerequisites will be revised peridically. It is the applicant s respnsibility t check fr changes that may ccur. Sincerely, Mary J. Carrill, MBA/HCM, R.T. (R)(M)CDT Prgram Directr, Medical Radigraphy carrill@gatewaycc.edu A Maricpa Cmmunity Cllege learn mre. live better.

TABLE OF CONTENTS Medical Radigraphy Missin... 5 Career Overview... 5 Prgram Overview... 5 Prgram Effectiveness Gals... 6 Assessment Student Learning Outcmes... 7 Prgrammatic Academic Achievement Outcmes... 7 Degree Requirements Medical Radigraphy Prgram... 8 Admissin Criteria... 8 Placement Testing... 8 Prerequisites fr Assciate f Applied Science Degree... 8 Prgram Prerequisites... 8 Prgram f Study Medical Radigraphy (by semester subject t change)... 9 Prgram Crequisite Curses... 11 Estimated Prgram Csts... 12 Immunizatins, Testing, and Backgrund Requirements... 13 Frequently Asked Questins... 13 Accreditatins... 14 Cnfidentiality Statement... 14 Plicies, Rules, Requirements, and Regulatins Cmpliance... 14 Cllege Cmmunicatin... 15 Cntact Infrmatin... 15 Medical Radigraphy Prgram Infrmatin & Checklist... 16 Hw t Apply & Enrll... 17 Student Services... 19 Admissin Applicatin fr Medical Radigraphy Prgram... 21 Cmpleted Applicatin Pre-requisite Curses - Medical Radigraphy Prgram... 23 Admissin Applicatin Disclaimer - Medical Radigraphy Prgram... 24 Medical Radigraphy Admissin Applicatin Checklist/Advisr Review... 25 MCCCD Summary f Criminal Backgrund Check Requirements... 27 MCCCD Acknwledgement f Criminal Backgrund Check Requirements... 29 Medical Radigraphy 4 June 2016-1

MEDICAL RADIOGRAPHY MISSION The Medical Radigraphy prgram will prvide educatinal activities leading t the preparatin f its graduates fr emplyment as radigraphers in the health care cmmunity. The prgram will ffer cntinuing educatin pprtunities t enhance and/r prvide new skills fr the qualified practitiner. CAREER OVERVIEW The Medical Radigraphy prgram missin is t prvide educatinal activities leading t the preparatin f its graduates fr emplyment as radigraphers in the health care cmmunity. The prgram will ffer cntinuing educatin pprtunities t enhance and/r prvide new skills fr the qualified practitiner. Radigraphy is the art and science f using radiatin t prvide images f the tissues, rgans, bnes and vessels that cmprise the human bdy. These images may be recrded n film r displayed n a vide mnitr r videtape. A Radilgist (a physician with specialized training in interpreting x-ray images) reads r makes a diagnsis utilizing these images. The Radigrapher is respnsible fr prducing accurate and precise radigraphic examinatins. A Radigrapher is a health care prfessinal wh prvides a service that is essential fr the diagnsis and subsequent treatment f all types f injuries and diseases. A Radigrapher takes images (radigraphs) f the human bdy fr use in diagnsing medical prblems: prepares patients fr radilgic examinatin; psitins the patients s that the crrect parts f the bdy can be radigraphed; perates radigraphic equipment/machines and ensures apprpriate radiatin safety. As a registered Radigrapher, yu will find a wide market fr yur acquired prfessinal skills. Opprtunities fr emplyment are available thrughut the cuntry as well as abrad. Graduates are needed in hspitals, clinics, surgical and urgent care facilities prviding services t patients arund the clck r n varius shift assignments. Qualified Radigraphers can als find jb pprtunities in Educatin, Civil Service, Industry and Cmmercial Sales. Graduates f the Assciate f Applied Science in Medical Radigraphy Prgram at GateWay Cmmunity Cllege may cntinue n t earn a Bachelr f Science at ther clleges after cmpleting selected curses. With cntinuing educatin, a Radigrapher can becme a Nuclear Medicine Technlgist, a Radiatin Therapist, and/r a Diagnstic Medical Sngrapher. Als, cntinuing educatin and/r clinical experiences are ffered t becme an Interventinal Technlgist, Magnetic Resnance Imaging Technlgist, Cmputed Tmgraphy Technlgist and/r Mammgraphy Technlgist. PROGRAM OVERVIEW The Medical Radigraphy prgram usually begins in early August. The prgram is based n 40 hurs per week in classes at the cllege and clinical practice at affiliated hspitals in the valley. In January f the first year the 40-hur per week clinical prtin f the prgram begins. Clinical practice may include sme weekends, sme evenings, and perids f time between semesters. Limited persnal leave will be granted fr sickness and vacatins. The Medical Radigraphy prgram is academically rigrus in nature, invlving science, math, and technical aspects f Radilgic Technlgy. The ttal length f the prgram is 21.5 mnths. Cmpleting ENG 102, MAT 122, Scial Sciences, and the Humanities and Fine Arts electives prir t starting the prgram, will lighten yur curse lad. Drug screening fr all Medical Radigraphy students is a requirement. The cst f this test is apprximately $25-35 and will be the respnsibility f the student. The urine drug screen will test fr alchlic beverages, illegal drugs, r drugs which may impair judgment while in the clinical agency. If a Medical Radigraphy 5 June 2016-1

drug test is psitive with n prescriptin indicatrs, the student will be drpped frm the prgram. This test will be administered n a specific date during the first semester, r fr cause anytime after. Prgram graduates must cmply with the ARRT Rules f Ethics. One issue addressed by the Rules f Ethics is the cnvictin f a crime, including a felny, a grss misdemeanr, r a misdemeanr with the sle exceptin f speeding and parking vilatins. All alchl and/r drug related vilatins must be reprted. Cnvictin, as used in this prvisin, includes a criminal prceeding where a finding r verdict f guilt is made r returned but the adjunctin f guilt is either withheld r nt entered, r a criminal prceeding where the individual enters a plea f guilty r nl cntendre. Individuals wh have vilated the Rules f Ethics may request a review by the ARRT f the vilatin in rder t btain a ruling f the impact n their eligibility fr the pst-graduate ARRT examinatin. This review may be dne either befre r after entry int GateWay s prgram. Cntact: American Registry f Radilgic Technlgists at 651.687.0048. Please be advised that fingerprinting and criminal backgrund checks are a prgram requirement and a level 1 fingerprint clearance card must be btained prir t entrance t the freshman class. Mental & Physical Demands It is essential that Medical Radigraphy students be able t perfrm a number f physical activities in the clinical prtin f the prgram. At a minimum, students will be required t lift patients, stand fr several hurs at a time and perfrm bending activities. Medical Radigraphy als places students under cnsiderable mental and emtinal stress as they undertake respnsibilities and duties impacting patients lives. Students must be able t demnstrate ratinal and apprpriate behavir under stressful cnditins. Individuals shuld give careful cnsideratin t the mental and physical demands f the prgram prir t making applicatin. Use f Cnfidential Infrmatin Students enrlled in prgram pathways f the Health Care Integrated Educatinal System (HCIES) will have learning experiences in a health care setting where they will have access t cnfidential infrmatin. Prir t beginning any clinical studies, the students will be asked t sign an agreement t adhere t the requirements f thse clinical sites and applicable law, including the Health Insurance Prtability and Accuntability Act f 1996 (HIPAA). PROGRAM EFFECTIVENESS GOALS 1. Students will be able t perfrm examinatins cmpetently. 2. Students will cmmunicate effectively. 3. Students will develp critical thinking skills. 4. Students will demnstrate prfessinalism. Medical Radigraphy 6 June 2016-1

ASSESSMENT STUDENT LEARNING OUTCOMES Gal: Students will be able t perfrm examinatins cmpetently. Students will select apprpriate technical factrs Students will demnstrate psitining Students will apply radiatin safety Gal: Students will cmmunicate effectively. Students will demnstrate ral cmmunicatin skills Students will use writing skills Students will interpret rders Gal: Students will develp critical thinking skills. Students will adjust psitining and prcedure prtcl fr trauma patients. Students will evaluate images fr diagnstic quality. Students will analyze issues and prblems. Gal: Students will demnstrate prfessinalism. Students will determine imprtance f cntinued prfessinal develpment. Students will demnstrate prfessinal behavir PROGRAMMATIC ACADEMIC ACHIEVEMENT OUTCOMES 1. Prcess and evaluate radigraphic images fr prcessing quality. Required Curse(s): DMI 103 2. Psitin patients fr radigraphic examinatins f the chest, hand, ft, lwer leg, and frearm. Required Curse(s): DMI 102, 104 3. Emply basic bdy mechanics, first aide patient care skills, and ral and written cmmunicatins during a radigraphic examinatin. Required Curse(s): HCC 200, DMI 100 (as f spring 2015), DMI 104 4. Psitin patients fr radigraphic examinatins f the upper and lwer limbs, abdmen, pelvis, bny thrax, and cntrast media prcedures. Required Curse(s): DMI 112, 118 5. Determine expsure factrs t achieve ptimum radigraphic techniques with minimal radiatin expsure t the patient. Required Curse(s): DMI 105, 107 6. Prduce diagnstic images fr all types f patients, using different equipment, cntrast media, and accessry devices. Required Curse(s): DMI 104, 114, 204, 214, 224 7. Explain basic physical cncepts, equipment malfunctins, and safe limits f peratin. Required Curse(s): DMI 105 8. Psitin patients fr radigraphic examinatins f the spine and skull. Required Curse(s): DMI 112 9. Evaluate medical imaging prcedures independently and recmmend technical mdificatins t ensure diagnstic quality. Required Curse(s): DMI 106, 216 10. Demnstrate knwledge f quality assurance prcedures. Required Curse(s): DMI 105, 221 11. Explain advanced physics and radiatin bilgy principles. Required Curse(s): DMI 215 12. Apply principles f radiatin prtectin fr patient, self, and thers. Required Curse(s): DMI 101, 221 13. Describe the radigraphic appearances and risks assciated with specific frms f pathlgy. Required Curse(s): DMI 222 14. Describe and/r perfrm selected advanced radigraphic prcedures. Required Curse(s): DMI 212, 221, 224 15. Apply jb applicatin and interviewing techniques. Required Curse(s): DMI 227 Medical Radigraphy 7 June 2016-1

DEGREE REQUIREMENTS MEDICAL RADIOGRAPHY PROGRAM ADMISSION CRITERIA 1. Frmal applicatin and admissin t the prgram. 2. Backgrund Check Requirements: Admissin t an Allied Health prgram requires that a student 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 MCCCD 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. PLACEMENT TESTING Placement test are designed t identify yur skill levels in English language usage, reading and mathematics. Assessment tests are scheduled at a variety f times in GateWay s Testing Center and are free f charge fr the initial testing. Please cntact GateWay s Testing Center r visit the website t get updated requirements and hurs f peratin. PREREQUISITES FOR ASSOCIATE OF APPLIED SCIENCE DEGREE PROGRAM PREREQUISITES Students must earn an average GPA f 3.0 r better in all curses within the Prgram Prerequisites area that are utlined in Semesters ne (1) & tw (2) n page nine (9) f this packet. There are tw (2) ptins available t students t enter the medical radigraphy prgram. Optin 1 is fr entry-level students with n prir medical radigraphy experience. Optin 2 is nly available t medical Certified Practical Technlgist in Radigraphy (CPTR) with current state Medical Radilgic Technlgy Bard f Examiners (MRTBE) licensure wh are currently licensed and wrking in the radigraphy field with minimum six (6) mnths f experience in a hspital acute care setting OR ne (1) year experience in an utpatient imaging setting. Medical Radigraphy 8 June 2016-1

PROGRAM OF STUDY MEDICAL RADIOGRAPHY (BY SEMESTER SUBJECT TO CHANGE) There are tw (2) ptins available t students t enter the medical radigraphy prgram. Optin I is fr entry-level students with n prir medical radigraphy experience. Optin II is nly available t medical Certified Practical Technlgist in Radigraphy (CPTR) with current state Medical Radilgic Technlgy Bard f Examiners (MRTBE) licensure wh are currently licensed and wrking in the radigraphy field with minimum six (6) mnths f experience in a hspital acute care setting OR ne (1) year experience in an utpatient imaging setting. ALL SEMESTERS ARE COMPETENCY-BASED. ALL DMI COURSES IN EACH SEMESTER MUST BE COMPLETED WITH A "C" OR BETTER BEFORE THE STUDENT CAN ENROLL IN THE NEXT SEMESTER. Medical Radigraphy grading plicy is as fllws: 93% 100% = A 84% 92% = B 75% 83% = C 74% r Belw = F SEMESTER 1 CREDITS: 10-19 (PART 1) Students must earn a GPA f 3.0 r better in all curses within the Prgram Prerequisites area. After cmpletin f Part I (Semester 1) prgram prerequisites, the student is eligible t cmplete the applicatin prcess fr the Medical Radigraphy prgram t be placed in the Medical Radigraphy queue. Students selecting BIO201 & BIO202 must cmplete the prerequisite curses BIO156 OR BIO181 + BIO156 Intrductry Bilgy fr Allied Health (4) OR + BIO181 General Bilgy (Majrs) I (4) OR One year high schl bilgy with a grade f C r better (0) 0 4 BIO160 Intrductin t Human Anatmy and Physilgy (4) OR + BIO201 Human Anatmy and Physilgy I (4) 4 COM100 Intrductin t Human Cmmunicatin (3) OR COM110 Interpersnal Cmmunicatin (3) OR + COM225 Public Speaking (3) OR COM230 Small Grup Cmmunicatin (3) 3 + ENG101 First-Year Cmpsitin (3) OR + ENG107 First-Year Cmpsitin fr ESL (3) 3 + MAT090 Develpmental Algebra (5) OR + MAT091 Intrductry Algebra (4) OR + MAT092 Intrductry Algebra (3) OR + MAT093 Intrductry Algebra/Math Anxiety Reductin (5) OR satisfactry scre n District Placement exam OR satisfactry cmpletin f a higher level mathematics curse 0 5 SEMESTER 2 CREDITS: 0-7 + BIO202 Human Anatmy and Physilgy II (4) **must take BIO202 with BIO201 t cmplete Bilgy requirement 0 4 + CRE101 Cllege Critical Reading (3) OR Equivalent by Assessment (Reading Placement Test) OR + CRE111 Critical Reading fr Business and Industry (3) OR Equivalent by Assessment 0 3 Medical Radigraphy 9 June 2016-1

SEMESTER 3 SPRING CREDITS: 6-6.5 (PART 2) The cre classes in this term are nly ffered in the Spring. HCC130 requirement must be met by the 3-credit curse in rder t be eligible fr graduatin. After acceptance int prgram and befre the start f required curses, students must cmplete the fllwing curses: HCC130 Fundamentals in Health Care Delivery 3 HCC146 Cmmn Medical Terminlgy fr Health Care Wrkers 2 DMI100 Intrductin t Diagnstic Medical Radigraphy: Prfessinalism & Patient Care 1 EMT/HCC/ RES109 CPR fr Health Care Prvider (0.5) OR American Heart Assciatin Health Care Prvider CPR Certificatin (0) 0 0.5 OPTION I SEMESTER 4 FALL CREDITS: 16.5-17.5 The cre classes in this term are nly ffered in the Fall. + DMI101 Radiatin Safety 2 + DMI102 Radigraphic Psitining I 3 + DMI102LL Radigraphic Psitining I 1 + DMI103 Intrductin t Imaging 1.5 + DMI105 Fundamentals f Radiatin Physics 3 + DMI107 Digital Imaging 4 Any apprved general educatin curse in the Humanities/Fine Arts area 2 3 OPTION II SEMESTER 4 FALL CREDITS: 7-8 The cre classes in this term are nly ffered in the Fall. Students wh have been admitted int Optin II in lieu f enrlling in DMI101, DMI102 lecture, DMI103, and DMI105 are required t take Credit by Evaluatin fr 9.5 credits thrugh the Integrated Cmpetency Assessment Netwrk (ICAN). + DMI102LL Radigraphic Psitining I 1 + DMI107 Digital Imaging 4 Any apprved general educatin curse in the Humanities/Fine Arts area 2 3 SEMESTER 5 SPRING CREDITS: 16 The cre classes in this term are nly ffered in the Spring. + DMI104 Practicum I (40 hurs/week) [280 hurs] 3.5 + DMI106 Radigraphic Image Evaluatin I 1 + DMI112 Radigraphic Psitining II 3 + DMI114 Radigraphy Practicum II (24 hurs/week) [288 hurs] 3 + DMI118 Cntrast Media Prcedures 2.5 Any apprved general educatin curse frm the Scial & Behaviral Sciences area 3 Medical Radigraphy 10 June 2016-1

SEMESTER 6 SUMMER CREDITS: 9-11 The cre classes in this term are nly ffered in the Summer. + MAT120 Intermediate Algebra (5) OR + MAT121 Intermediate Algebra (4) OR + MAT122 Intermediate Algebra (3) OR Equivalent curse OR Satisfactry Cmpletin f a higher level mathematics curse 3 5 + DMI124 Radigraphy Practicum III (40 hurs/week) [208 hurs] 3 + DMI204 Radigraphy Practicum IV (40 hurs/week) [240 hurs] 3 SEMESTER 7 FALL CREDITS: 13 The cre classes in this term are nly ffered in the Fall. + DMI212 Advanced Radigraphic Prcedures 1 + DMI214 Radigraphy Practicum V (24 hurs/week) [384 Hurs] 4.5 + DMI215 Radiatin Bilgy 2 + DMI216 Radigraphic Image Evaluatin II 1 + DMI222 Advance Radigraphic Pathlgy 1 + HCC218 Venus Access fr Diagnstic Agents 0.5 + ENG102 First Year cmpsitin (3) OR + ENG108 First-Year Cmpsitin fr ESL (3) 3 SEMESTER 8 SPRING CREDITS: 12.5 The cre classes in this term are nly ffered in the Spring. + DMI221 Advanced Digital Imaging 2.5 + DMI224 Radigraphy Practicum VI (24 hrs / wk + 40 hrs) [424 hurs] 5 + DMI227 Radigraphy Seminar 1 + DMI/ICE220 Sectinal Anatmy 3 + DMI/ICE223 Intrductin t Cmputed Tmgraphy 1 Please see the Center fr Curriculum & Transfer Articulatin fr the full descriptins f prgram requirements. + Pre-requisites and/r c-requisites required. * Refer t prgram calendar PROGRAM COREQUISITE COURSES The curses listed belw are cnsidered c-requisites and may be taken alng with the Medical Radigraphy Prgram. These curses may be cmpleted prir t entry int the prgram (check if cmpleted): ** ENG102 First Year Cmpsitin... ** Humanities and Fine Arts Elective (2.0 3.0 credit hurs)... ** Scial and Behaviral Sciences Elective (3.0 credit hurs)... ** MAT122 Intermediate Algebra r equivalent... ** Meets A. A. S. degree requirements... Medical Radigraphy 11 June 2016-1

ESTIMATED PROGRAM COSTS The estimated cst fr the prgram is utlined in the chart belw. The student is respnsible fr prviding transprtatin, husing, and unifrms. AAS Degree Prgram Tuitin* (56 credit hrs @ $86 a credit hr) 1... $ 4,816 Prgram Prerequisite Tuitin (16-32.5 credit hrs @ $86 a credit hr) 1... 1,344 2,730 Prgram General Tuitin (11-14 credit hrs @ $86 a credit hr) 1... 924 1,176 Registratin fees ($15 per semester)... 120 Clinical Tracking System... 150 Curse / Lab Fees... 660 790 Equipment / Supplies... 200 Bks 2... 1,280 2,373 Other Prgram Csts: Pre-Clinical Health & Safety Requirements, etc. 2... 477 1,142 Ttal Estimated Csts $ 9,875 13,440 Out-f-Cunty residents pay $383* / Out-f-State residents pay $327** a credit hr 1 * 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. 1 Tuitin and fees are set by the Maricpa Cmmunity Cllege District Gverning Bard and subject t change. All ther fees are als subject t change. All Tuitin and fees are the respnsibility f the student 2 Bk csts/fees may change withut ntice 3 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 requirements fr the clinical experience. 4 Fr ARRT examinatin and the Arizna State license: Medical Radilgic Technlgy Bard f Examiners (MRTBE). *** DRUG SCREENING FOR ALL MEDICAL RADIOGRAPHY STUDENTS IS A REQUIREMENT. THE COST FOR THIS TEST WILL BE THE RESPONSIBILITY OF THE STUDENT. **** Any rejectin after the appeal prcess will disallw entrance int clinicals unless reversed n appeal. Sme clinical facilities have additinal backgrund testing. THE COST FOR THIS TEST WILL BE THE RESPONSIBILITY OF THE STUDENT. 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. Medical Radigraphy 12 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. FREQUENTLY ASKED QUESTIONS IS THERE A POSSIBILITY OF AN EVENING OR PART-TIME PROGRAM? N. Due t the recent changes in health care a full-range f clinical experiences is nt available in the evening hurs. Nrmal hurs f peratin are frm 7:00 a.m. t 9:00 p.m. There is NO Part-time prgram! The curriculum is sequential and cmpetency-based; meaning that ne semester builds n the next semester and must be cmpleted befre the student can enrll fr the next semester. Thirty t thirty-tw (30-32) clck hurs per week will be the minimum time a student will spend in the prgram between didactic and clinical curses. BESIDES CO-REQUISITE COURSES, WHAT OTHER CLASSES COULD A STUDENT TAKE WHILE WAITING TO START THE PROGRAM? Nrthern Arizna University nw ffers a Bachelr s Degree in Health Science: Diagnstic Medical Imaging and Therapy. If this interests yu, yu will need t take curses that will transfer and meet university requirements. A Gateway advisr will assist yu with this prcess. In additin yu will need t speak an NAU advisr at 602.286.8194. Other classes yu can take while n the waiting list include: NCE 242 - Twelve Lead Electrcardigram (EKG) Interpretatin, HSM - Health Supervisin Mgmt, NCE 168 - End f Life Care Training, NCE 173 - LPN- Venipuncture, NCE 203 - Interpretatin f Labratry Diagnstic Examinatins, NCE 214 CA - Interpretatin f Cardiac Arrhythmias, and SPA 117 - Health Care Spanish (fr Medical Persnnel). Medical Radigraphy 13 June 2016-1

COULD ENG 111 BE ALSO LISTED AS A CO-REQUISITE IN ADDITION TO ENG 102? ENG 111 meets A.A.S. Degree requirements and therefre culd substitute fr ENG 102. It is, hwever, nt transferable. CAN A GRADUATED STUDENT FIND CONTINUING EDUCATION CLASSES? Yes, in MRI, CT, Mammgraphy, Special Prcedures and crss-training curses. WHERE CAN I GO FOR MORE INFORMATION ABOUT THE PROFESSION? WWW.ASRT.ORG American Sciety f Radilgic Technlgists WWW.ARRT.ORG American Registry Radilgic Technlgists IF I HAVE A CRIMINAL RECORD, WILL THAT PROHIBIT ME FROM BEING SUCCESSFUL IN THIS CAREER? Pssibly, ur clinical agreements with the healthcare facilities require that ur students receive a Level 1 Fingerprint Clearance Card issued by the Arizna Department f Public Safety. Additinally, a student must nt be listed n the Federal Gvernment s Office f the Inspectr General s Exclusin List. Students that are unable t btain either f these clearances will be prhibited frm attending their clinical experience. In additin, as f 2011, all healthcare students must pass a MCCCD backgrund check within six (6) mnths f beginning their prgram f study. 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 Medical Radigraphy Prgram is accredited by the Jint Review Cmmittee n Educatin in Medical Radilgic Technlgy (JRCERT) www.jrcet.rg, r 20 N. Wacker Drive, Suite 2850, Chicag, IL 60606-3182. Phne: (312) 704-5300. 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 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 Medical Radigraphy 14 June 2016-1

equivalence by cntacting GateWay's Health Cre Curriculum Crdinatr Charlene Thiessen by calling 602-286-8509 r emailing her at Thiessen@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. CONTACT INFORMATION If yu have any questins abut the enclsed prgram material, please feel free t cntact any f the fllwing prgram cntacts: Mary Carrill, Prgram Directr / Phne 602.286.8542 / Email: carrill@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 Medical Radigraphy 15 June 2016-1

MEDICAL RADIOGRAPHY PROGRAM INFORMATION & CHECKLIST 1. Obtain and carefully read all the infrmatin abut the Medical Radigraphy Prgram (brchure, catalg, infrmatin and applicatin packet) als nte any questins. Becme as well infrmed as yu can abut the prgram. A cunselr, prgram advisr, r prgram faculty member will assist yu if yu have any questins. 2. Cmplete the Student Infrmatin Frm (fr first time visitrs nly) btained at Infrmatin Desk a. Return t Admissins and Recrds. 3. Transcripts a. Request ALL fficial cllege transcripts be sent t the Admissins and Recrds Office at 108 N 40th Street, Phenix, AZ 85034-1704. b. Official transcripts must be sent frm institutin t institutin, allw 2-4 weeks fr receipt. Please request institutin t include current name and student ID number used at GateWay Cmmunity Cllege. 4. The Health Sciences Academic Advisrs are available by phne, email, r in persn at the CHCE Center fr Health Careers Educatin Building n the nrth side f campus. Please review the Academic Advising - Healthcare & Nursing page fr hurs and schedule. 5. Schedule any necessary assessment testing. Please review the Testing Center's page fr hurs and schedule. 6. Prgram Prerequisites: a. Bilgy prerequisite BIO 160* b. English prerequisite ENG 101, First Year Cmpsitin c. Math prerequisite Intrductry Algebra (3) OR higher level mathematic curse. d. Reading prerequisite CRE 101 r 111, r equivalent by assessment. Applicants wh scre 47 r higher n the Asset Reading Placement Test r a scre f 91 n Cmpass will be allwed t waive this reading prerequisite. N credit will be given fr a waiver. e. Cmmunicatin elective prerequisite (prefer COM100 OR 110) that meets degree requirements f. DMI Pathways, Optin I r II (listed n page 10). *Nte: Students may cmplete BIO201 and 202 fr this prerequisite. An average GPA f 3.0 r better is required in applicatin prerequisite curses. 7. Applicatin t the PROGRAM T place yur name n the List f Applicants yu must cmplete A-F abve. The number f applicants admitted t this prgram varies accrding t clinical psitins available at each hspital. Cmpleted applicatins t the prgram will be accepted in the rder in which they are received n a first-cme, first-served basis. 8. A cmpleted prgram applicatin fr Medical Radigraphy cnsists f: Prgram Applicatin G.P.A. f 3.0 in A-F in #6 previus page Official Cllege Transcripts evaluated Admissins Applicatin Disclaimer 9. Student Persnal Infrmatin: Every student is respnsible fr keeping the cllege admissin s ffice updated n email addresses and best phne numbers. Acceptance letters are sent ut via email t the email address listed in the cllege system. If infrmatin is nt updated, it culd mean missing the pprtunity t enter the prgram. ALL DOCUMENTATION MUST BE SUBMITTED AT THE SAME TIME. NO PARTIAL PROGRAM APPLICATION WILL BE ACCEPTED. Medical Radigraphy 16 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: Medical Radigraphy 17 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: 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. PROGRAM APPLICATION Many f GateWay Cmmunity Cllege s Health Science prgrams have a special admissins prcedure. The Medical Radigraphy Prgram infrmatin packet cntains detailed infrmatin regarding this prcess. Please be sure t review this infrmatin t ensure that yur applicatin materials are cmplete and received at the Special Admissins ffice by the stated deadlines. 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. Medical Radigraphy 18 June 2016-1

STUDENT SERVICES The fllwing are sme f the services available t students. 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 Available are textbks and supplies fr classes, call 602.286.8400. Yu may visit their website at: www.efllett.cm and selecting Cllege Textbks. Cunseling Academic, persnal, r career cunseling available. Call 602.286.8900. Emplyment Upn cmpletin f the Medical Radigraphy Prgram, cntact the Career & 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 website: http://enrll.gatewaycc.edu/financialaid/applyfrfinancialaid/default.htm 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, 602.286.8800. Fr a cmplete listing f student services, please refer t the cllege catalg, r visit GateWay s website: www.gatewaycc.edu r call cllege infrmatin at 602.286.8000. Pregnancy The student, upn declaring her pregnancy in writing, has the ptin f remaining in the prgram and cntinuing her educatin withut ntificatin r interruptin. This decisin shuld be made in cnsultatin with her physician. If the student chses t take a leave f absence frm the prgram during the pregnancy, she will be allwed t re-enter the prgram nce the perid f cnvalescence is cmplete. Based upn the length f absence frm training, the student may be required t re-certify in specific clinical cmpetencies prir t graduatin. Placement int the riginal clinical site is nt guaranteed, but anther training site will be prvided fr the student. The student must cmplete all prgram and institutinal graduatin requirements prir t graduatin as utlined in the cllege catalg. (See prgram plicies fr mre details). The student can withdraw her declaratin in writing at any time. Medical Radigraphy 19 June 2016-1

Medical Radigraphy 20 June 2016-1

ADMISSION APPLICATION FOR MEDICAL RADIOGRAPHY PROGRAM Please print clearly GATEWAY COMMUNITY COLLEGE 108 N 40th Street Phenix, AZ 85034-1704 / 602.286.8000 Page 1 f 4 An fficial transcript must be sent t GWCC Admissin and Recrds Office frm each attended cllege r yur applicatin cannt be prcessed. Failure t maintain this infrmatin may result in disqualificatin frm the admissin prcess. LEGAL NAME (LAST) (FIRST) (MIDDLE) ADDRESS (STREET) (CITY) (STATE) (ZIP) FORMER NAME(S) which may appear n transcript HOME PHONE NUMBER CELL PHONE NUMBER E-MAIL ADDRESS REQUIRED STUDENT ID NUMBER PERSON TO NOTIFY IN CASE OF EMERGENCY PHONE ADDRESS Are yu a United States veteran? Yes N Attached a cpy f DD214 Are yu currently enrlled in cllege? Yes N If YES, where? What classes are yu enrlled in? Medical Radigraphy 21 June 2016-1

Page 2 f 4 STARTING WITH MOST RECENT AND WORKING BACK, LIST EMPLOYERS: OCCUPATION EMPLOYER FROM TO ADDRESS NAME OF SUPERVISOR REASON FOR LEAVING OCCUPATION 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 LEAVING COLLEGE MAJOR NAME OF INSTITUTION CITY AND STATE DATE OF ENTRANCE DIPLOMA OR DEGREE RECEIVED DATE OF LEAVING COLLEGE MAJOR NAME OF INSTITUTION CITY AND STATE DATE OF ENTRANCE DIPLOMA OR DEGREE RECEIVED Attach separate sheet if additinal space is needed DATE OF LEAVING COLLEGE MAJOR Medical Radigraphy 22 June 2016-1

COMPLETED APPLICATION PRE-REQUISITE COURSES - MEDICAL RADIOGRAPHY PROGRAM Page 3 f 4 COURSE NUMBER DATE COMPLETED GRADE SCHOOL ATTENDED +MAT092 +ENG101 +CRE101/111 +BIO160 +COM ELE. +HCC130 +HCC/RES109 +HCC146 Listed belw are the acute care lcatins where students can ptentially cmplete clinical rtatins Banner Baywd Medical Ctr / Pwer Rd & Bradway Banner Bswell Medical Ctr / 103rd Ave & Thunderbird Banner Desert Medical Ctr / Suthern & Dbsn Rd Banner Estrella Medical Ctr / Thmas Rd & 101 Banner Gateway Medical Ctr / Higley & US 60 Banner Gd Samaritan Hspital / 11th St & McDwell Banner Thunderbird Medical Ctr / 55th Ave & Thunderbird Chandler Reginal Medical Ctr / Frye Rd & Dbsn Rd HnrHealth N. Muntain Hspital / Dunlap & 3rd St HnrHealth Deer Valley Hspital / I-17 & W Beardsley Rd Maricpa Medical Ctr / N 24th St & E Rsevelt St May Clinic & Hspital / 134th St. & Shea Mercy Gilbert Medical Ctr / S 202 & Val Vista Dr HnrHealth Osbrn Med Ctr / N Drinkwater Blvd & E Osbrn Rd HnrHealth Shea Med Ctr / E Shea Blvd & N 90th St HnrHealth Thmpsn Peek Med Ctr / Thmpsn Peek Pkwy & N 73rd St St. Jseph's Hspital / N 7th Ave & W Thmas Rd West Valley Hspital / N Litchfield Rd & W McDwell Rd In additin, the prgram utilizes numerus utpatient imaging centers fr training. D yu have any relatives emplyed at any f these hspitals? Yes N If yes, which hspitals? Have yu ever been emplyed in a health facility? If yes, where? In what capacity? Hw lng? 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 Medical Radigraphy 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: Admissins & Recrds/Selective Admissins GateWay Cmmunity Cllege 108 N 40th Street / Phenix, Arizna 85034-1704 Medical Radigraphy 23 June 2016-1

ADMISSION APPLICATION DISCLAIMER - MEDICAL RADIOGRAPHY PROGRAM Page 4 f 4 Yur admissin t the GateWay Cmmunity Cllege Medical Radigraphy Prgram is n guarantee that yu will receive an Assciate f Applied Science Degree frm the cllege. Further, cmpletin f the Medical Radigraphy prgram is nt the sle criterin fr btaining a license t practice in Arizna. Yu must als meet the licensing requirements f the Medical Radilgic Technlgy Bard f Examiners (MRTBE) 602.255.4845. Certificatin requirements are the sle exclusive respnsibility f the American Registry f Radilgic Technlgist ARRT 651.687.0048, and yu must satisfy thse requirements independently f graduatin requirements fr the cllege. Bth rganizatins, ARRT and the MRTBE, review (amng ther criteria) educatinal qualificatins and issues f mral turpitude. I have read and understand the Admissins Applicatin Disclaimer. Signature Date Student ID Number This disclaimer will becme a part f yur Medical Radigraphy Prgram recrds. Medical Radigraphy 24 June 2016-1

DMI ADMISSION APPLICATION CHECKLIST ADVISER REVIEW Last Name First Name Student ID Date The fllwing prerequisites must be cmpleted prir t submitting yur applicatin. Students must earn a GPA f 3.0 r better in all curses within the Prgram Prerequisites area. Applicatins withut this Advisr Review frm cmpleted and signed by a GateWay Cmmunity Cllege Healthcare r General Advisr will nt be accepted. Part I / Credits 10 26 Optin I is fr entry level students with n prir medical radigraphy experience. Prerequisite curses must be cmpleted befre students are eligible t apply t the prgram and be placed in the Medical Radigraphy queue. + + + + + + + + + + + + + Curse Curse Title Students selecting BIO201 and BIO202 must cmplete the prerequisite curses BIO156 r BIO181. BIO156 Intrductry Bilgy fr Allied Health (4) OR BIO181 General Bilgy (Majrs) I (4) OR One year high schl bilgy with a grade f C r better (0) BIO160 BIO201 BIO202 COM100 COM110 COM225 COM230 CRE101 CRE111 ENG101 ENG107 MAT090 MAT091 MAT092 MAT093 Intrductin t Human Anatmy and Physilgy (4) OR Human Anatmy and Physilgy I (4) AND Human Anatmy and Physilgy II (4) Intrductin t Human Cmmunicatin (3) OR Interpersnal Cmmunicatin (3) OR Public Speaking (3) OR Small Grup Cmmunicatin (3) Cllege Critical Reading (3) OR Critical Reading fr Business & Industry (3) OR Equivalent by assessment First Year Cmpsitin OR First Year Cmpsitin fr ESL Develpmental Algebra (5) OR Intrductry Algebra (4) OR Intrductry Algebra (3) OR Intrductry Algebra/Math Anxiety Reductin (5) OR satisfactry scre n District Placement exam OR satisfactry cmpletin f a higher level mathematics curse Credits Required 0 4 4 8 3 0 3 3 Cllege Semester Cmpleted r Enrlled After cmpletin f Part I prgram prerequisites, the student is eligible t cmplete the applicatin prcess fr the Medical Radigraphy prgram t be placed in the Medical Radigraphy queue. 0 5 Grade Level One Fingerprint Clearance Card (cpy required) American Heart Assciatin Healthcare Prvider CPR Card Expiratin Date Expiratin Date MCCCD Plicy Backgrund Check Acknwledgement (cpy attached) Student Signature Student Name (printed) Date Adviser Signature Adviser Name (printed) Date Medical Radigraphy 25

Medical Radigraphy 26 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 27

Summary f Criminal Backgrund Check Requirements.dcx 28

(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 Summary f Criminal Backgrund Check Requirements.dcx 29

Any inclusin n any registered sex ffender database 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 30