INFORMATION AND ADMISSIONS PACKET 2013

CENTRAL ARIZONA COLLEGE Superstition Mountain Campus Diagnostic Medical Sonography Associate in Applied Science (AAS)/Certificate INFORMATION AND ADMISSIONS PACKET 2013 Revised and updated for 2013 Admissions

Thank you for your interest in the Diagnostic Medical Sonography program at Central Arizona College. Our two year program begins in the fall of each year. We are located in Apache Junction and our clinical placements are in both Pinal and Maricopa counties. We look forward to meeting you in one of our information sessions here on campus or during the DMS 101- intro to sonography course held in the spring semester. If you have any questions please contact DMS faculty at (480) 677-7716. Thank you! 2

Diagnostic Medical Sonography ( DMS) Welcome to the exciting field of Diagnostic Medical Sonography and the updated DMS program information and application packet for 2012 Admissions. The DMS program is located at Central Arizona College (CAC) Superstition Mountain Campus (Apache Junction, AZ). CAC is accredited by the Higher Learning Commission /North Central Association of Colleges and Schools. The program prepares graduates to be entry level Sonographers with expertise in Abdomen and OB/GYN applications along with some Vascular experiences. Medical Sonography is an operator dependent health care profession that requires a high level of skills and abilities. Therefore the Diagnostic Medical Sonography Program (DMS) only accepts applicants who: are over 18 years of age; have a health care background in direct patient care; a (2 year) AAS degree level or higher; and current health care work experience. The program starts in the fall of each year and is a point based competitive admissions process which includes completion of the DMS 101 Intro to Sonography class offered in the spring semester. The number of students selected is dependent on available clinical sites. The Diagnostic Medical Sonographer is described as a member of the health care team who provides patient services to detect various conditions and diseases in the body. Sonographers are professionals who are trained to operate complex equipment that produces images of the patient using high frequency sound waves (ultrasound). Under the supervision of a Physician, Sonographers: you will take an in-depth history, scan the patient, record images, and create technical worksheets for interpretation. In addition, Sonographers keep up with their certifications by completing mandatory continuing education requirements. Diagnostic Sonographers who work in the profession will tell you the tasks they perform daily are exciting, challenging, and that no two days are the same. The Sonographic examination is usually not painful for the patient and generally takes about an hour to complete. Some examples of the types of examinations performed by Sonographers include: detection of blood flow in large and small vessels; demonstrate how the heart is functioning; determine whether a patient is pregnant or not; identify whether organs such as the liver are normal or abnormal in size and shape. Visit the Society of Diagnostic Medical Sonographers web site for more information on this exciting health care career: http://www.sdms.org/career/career.asp Employment Outlook The U.S. Department of Labor publishes that the job outlook for Diagnostic Medical Sonographers is estimated to be above average from 2010-2014. In Arizona it is predicted that the demand for Sonographers is higher than the national average due to population growth. 3

This projection holds true based on the increasing numbers of hospitals and clinics being built particularly in East Maricopa and Pinal Counties. Salaries according to the 2010-2011 Department of Labor s Occupational Employment Statistics predict the hourly mean wage for Diagnostic Medical Sonographers nationally is approximately: $32.00/hour. In Arizona this wage is approximately $32.43/hour. For more detailed information on Diagnostic Medical Sonographers or to learn more about this profession, employment outlook, or salaries you may want to visit the Department of Labor web site. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-2012 Editions, for Sonographers accessed 8/6/11. http://www.bls.gov/oco/ocos273.htm#outlook; http://www.bls.gov/oes/current/oes292032.htm Mission Statement To provide a competency based education for students in Diagnostic Medical Sonography that focuses on sound educational standards; stimulating clinical experiences; concern and care for patients; and graduates who will serve the needs of the healthcare community as Registered Diagnostic Medical Sonographers (RDMS). In accordance with the Joint Review Committee on Education in Diagnostic Medical Sonography recommendations, our mission statement is reviewed on a regular basis and documentation is reflected in the meeting minutes of committees. VISION Cultivate a Sonography Program at CAC that meets the needs of the health care community for competent registered Sonographers. Program Outcomes Graduates of the Diagnostic Medical Sonography AAS Degree Program will have the following Cognitive, Psychomotor and Affective Learning Domain Outcomes: Possess problem solving and critical thinking skills ( Cognitive) Function as clinically competent entry level Diagnostic Sonographers (Psychomotor) Develop into valued members of the health care community ( Psychomotor) Successfully complete the ARDMS certification examinations ( Cognitive) Value diversity ( Affective) 4

5 Program Description The Diagnostic Medical Sonography (DMS) is part of Central Arizona College and the program, was originally funded by the Department of Labor (CBJT) grant. The program begins in the fall semester each year. The Associate of Applied Science Degree and Certificate in Diagnostic Medical Sonography is a two year full time program (six sequential semesters including summers) designed to prepare students for entry-level positions in the Sonography General Concentration The generalist Sonographer is registered in Abdominal as well as Obstetrics and Gynecology. The 63 theory and clinical credits in Sonography include: cross sectional anatomy, ethics, ergonomics, legal, patient care, pathology, physics and instrumentation, clinical case studies, abdominal imaging, OB/Gyn, small parts, and other specialized topics. The DMS courses taken at CAC are recognized by other schools and colleges and may be accepted as electives for students interested in furthering their education. If you have earned an AAS degree in a direct patient care health care occupation from an accredited institution please make sure you have completed all the General Education requirements before applying for admission to the program. General Education credits required to fulfill the AAS degree requirements include classes in Biology, Humanities, Mathematics, and Communications. If you have never taken a Physics course in the course of your health care career, it is recommended you take a 100 level or higher course to better prepare you for the rigors of the Physics and Instrumentation courses in the DMS program. The DMS program is competency based and classes may be offered face to face, online, or a combination of the two (hybrid). All labs will be hands on at the college; and clinical rotations will be out in hospitals and clinics. The core curriculum mirrors the essentials and guidelines recommended by the Joint Review Committee in Diagnostic Sonography (JRC- DMS),http://www.jrcdms.org/;NationalEducationCurriculum, http://www.jrcdms.org/nec/index.htm; and the American Registry of Diagnostic Medical Sonographers (ARDMS) http://www.ardms.org certification requirements. The 1682 hours essential for the clinical component of the program require a commitment of approximately 4 to 5 days each week for 8.5 hours (generally day shift). There may be travel over long distances and clinical/shifts may include nights and/or weekends. So reliable transportation and a flexible schedule are important considerations. Students who complete the program with a grade of C or better in all courses will be eligible to graduate and sit for the ARDMS examination in Physics and Instrumentation (SPI) as well as the Abdominal, and OB/GYN certifications. The AAS degree in Diagnostic Medical Sonography awarded by CAC will meet the ARDMS minimum standards for students to sit for General Sonography certifications if you have previous health care certification and experience. Please refer to the ARDMS web site for the particulars on the minimum standards required. http://www.ardms.org/downloads/prerequisite_chart.pdf

Graduates of the DMS program are eligible to: Receive an AAS degree in Diagnostic Medical Sonography Qualify for a certificate in Diagnostic Medical Sonography Sit for the ARDMS Certification examination **** see paragraph above Apply for jobs as entry level Diagnostic Medical Sonographers AAS Curriculum General Education Required Credits for AAS degree *** Semester Credits Arts and Humanities Course 3 Bio 201 and 202 Human Anatomy and Physiology 8 Computer Competency *** (may be waived effective 2013) 3 Oral Communication Course 3 Written Communication Course 3 Mathematics 121 Intermediate Algebra or higher 4 Social and Behavioral Science Course 3 Physical Education Activity *** (may be waived effective 2013) 1 Sub-total General Education Credit Hours 28 *** 100 level or higher Physics is recommended if you have never taken a physics course. (Must be completed prior to graduation) DMS Courses and Sequence 2 Year Program DMS 101Intro to Sonography; strongly recommended in Spring 2013 prior to admission or must have approval from program director; a required course. 3 Fall 2013 DMS 120 Cross Sectional Anatomy 3 DMS 130 Physics and Instrumentation 2 DMS 132 Abdominal Imaging I 3 DMS 133 Abdominal Imaging Lab 1 DMS 150 Clinical I 2 160 hours** DMS 158 Case Studies Introduction 1 Total 15 credits 6

Spring 2013 DMS 131 Physics Lab 1 DMS 135 Small Parts Imaging 1 DMS 140 OB/GYN Imaging I 2 DMS 149 Pathology 3 DMS 151 Clinical II 3 270 hrs DMS 154 Abdominal Imaging II 2 Total Spring 2013 12 credits Summer 2014 DMS 152 Clinical III 4 300 hrs DMS 159 Case Studies II 2 Total Summer 2013 6 credits YEAR TWO Fall 2014 DMS 234 Physics II 2 DMS 242OB/GYN Imaging: (High Risk) II 2 DMS 254Clinical IV 4 300 hrs DMS 273 Advanced Procedures 3 DMS 260 OB/GYN lab 1 Total Fall 2014 12 credits Spring 2015 DMS 255 Clinical V 4 300 hrs 7

DMS 259 Case Studies III 2 DMS 271 Vascular Imaging 2 DMS 272 Vascular Imaging Lab 1 DMS 280 Physics Review 1 DMS 290 Capstone Seminar 2 Total Spring 2015 12 credits Summer 2015 DMS 256 Clinical VI 4 300 hrs DMS 281 Abdomen Review 1 DMS 282 OB/Gyn Review 1 6 credits TOTAL PROGRAM CERTIFICATE CREDITS 63 total Detailed DMS COURSE DESCRIPTIONS Course Course Name Description Number DMS 101 Introduction to Sonography The basic sonographic positioning, principles of instrumentation, and terminology used in Diagnostic Ultrasound of the upper abdomen will be presented in lecture and lab. The lecture portion of the course will be taught as a hybrid using Blackboard format. Hybrid courses have both online and face to face components. The lecture/lab format will be used to demonstrate competency with Sonographic equipment, positioning and anatomy. DMS 120 Cross Sectional Anatomy Diagnostic Imaging correlation using coronal, axial, transverse planes of section to demonstrate human anatomy of the head, neck and spine; chest; abdominal & pelvic cavities; and extremities for Medical Imaging Professionals. DMS 130 Physics and Introduction to the physical principles of Instrumentation I ultrasound including analysis of routine terminology and functions used in the creation of the diagnostic ultrasound beam and ARDMS testing requirements. Utilization of ultrasound equipment and transducers for the production of sound waves and their interaction with tissue; workplace safety; quality assurance and quality control; patient well being; bioeffects and risks. DMS 131 Physics and Introduction to the physical principles of 8

Instrumentation Lab ultrasound in a lab setting, including analysis of image acquisition used to create diagnostic ultrasound images recommended by ARDMS. Utilization of ultrasound equipment and transducers for the production of sound waves and their interaction with tissue; workplace safety; quality assurance and quality control; patient history; technical worksheets; bioeffects and potential risks. DMS 132 Abdominal Imaging I Lecture course designed to introduce the student to the basics of Sonography and Abdominal scanning including physiology, terminology, anatomy and technique. DMS 133 Abdominal Imaging Lab Laboratory course designed to augment the didactic information presented in Abdominal Imaging (DMS 132). Lab provides the environment for the student to gain basic competencies when scanning the entire abdominal contents including proper scanning technique, imaging terminology, anatomy, physiology, and completion of technical worksheets. DMS 135 Small Parts Imaging Introduction to advanced applications of Sonographic small parts imaging. Topics include normal and abnormal presentations of the thyroid, breast, prostate, extremities, pediatric applications, interventional and emergency procedures, contrast agents, and emerging modalities. DMS 140 OB/GYN Imaging Introduction to Diagnostic Sonography in obstetrics and gynecology (OB/GYN), including normal, abnormal, pathology of the non gravid and gravid female pelvis. DMS 149 Pathology Causes of disease and the impact on the body, including cultural implications in the prevention and treatment of disease. Role of Diagnostic Imaging in diagnosis, therapy, and treatment on body systems. DMS 150 Clinical Practicum I The initial rotation in a series of six, this Novice DMS supervised practicum introduces students to policies and procedures in a clinical setting, including hospitals, MD offices and clinics, and orientates students to imaging, department scanning protocols, and abdominal scanning. DMS 151 Clinical Practicum II Second DMS clinical rotation in a series of six. This Beginner level practicum continues to reinforce policies, procedures, and protocols in a Diagnostic Sonography clinical setting. Students gain scanning competencies in the abdomen, pelvis, and small parts. Students require a high level of supervision at the clinical sites, including hospitals, MD offices, and clinics. 9

DMS 152 Clinical Practicum III Third clinical rotation in a series of six. Advanced Beginner level practicum continues to reinforce policies, procedures, and protocols in a Diagnostic Sonography clinical setting. Students continue to gain scanning competencies in the abdomen, pelvis, Obstetrics, and small parts under direct supervision in clinical instructor. DMS 154 Abdominal Imaging II Reinforcement of beginning DMS and introduction to advanced applications of Sonographic scanning in the Abdominopelvic cavity. Topics include normal and abnormal presentations, pediatric applications, interventional and emergency procedures, use of contrast agents, and emerging DMS 158 Case Studies I The first in a three seminar series that introduces students to critical thinking through Diagnostic Medical Sonography case studies. Cases include anatomy, pathology, physics, imaging, and terminology used in Diagnostic Sonography as well as discussions on imaging protocols and scanning guidelines. The lecture will be taught as a hybrid using a Blackboard format. DMS 159 Case Studies II Case Studies II focuses on students presenting cases of the complexity and caliber expected of an entry level Sonographer. DMS 234 10 Physics & Instrumentation Lab Advanced application of Sonographic physical principles and instrumentation; artifacts, bioeffects, quality control, hemodynamics and Doppler; new trends; equipment features and benefits; quality control, safety; and preparation for ARDMS examination. DMS 242 High Risk OB Advanced applications of OB/GYN imaging of the gravid and non gravid patient; safety and bioeffects; new trends; high risk OB patients; interventional procedures; laboratory values and correlative imaging; preparation DMS 254 DMS 255 IV V Clinical Practicum Clinical Practicum The fourth clinical rotation in a series of six, this Intermediate level practicum continues to reinforce policies, procedures, and protocols in a Diagnostic Sonography clinical setting, including hospitals, MD offices, and clinics. Under limited supervision, students continue to gain scanning competencies in the abdomen, pelvis, Obstetrics, and small parts and vascular imaging studies in the clinical setting The fifth clinical rotation in a series of six, this Advanced Intermediate level practicum continues to reinforce policies, procedures, and protocols in a Diagnostic Sonography clinical setting, including hospitals, MD offices, and clinics. Under minimal supervision, students continue to gain scanning competencies in the abdomen, pelvis, Obstetrics, and small parts and vascular imaging, interventional, and other studies in the clinical

setting. DMS 256 Clinical Practicum The sixth and final rotation is an Advanced level VI practicum that reinforces policies, procedures, and protocols in a Diagnostic Sonography clinical setting, including hospitals, MD offices, and clinics. Under minimal supervision, students gain competencies in abdomen, pelvis, Obstetrics, small parts, vascular imaging, interventional, and other studies and perform at the level of an entry level Sonographer. DMS 259 Case Studies III Case Studies III focuses on students presenting cases of the complexity and caliber expected of the entry level Sonographers. DMS 260 Ob/GYN Lab Applications of OB/GYN imaging of the female patient in a lab setting; safety and bioeffects; transabdominal and endovaginal scanning; technical worksheets; and preparation for ARDMS examination. DMS 271 Vascular Imaging Vascular applications of Sonography in the cerebrovascular, abdominal, Ob/Gyn, arterial and venous systems of the body including hemodynamics, Doppler, Color Flow, Duplex and triplex imaging protocols. DMS 272 Vascular Imaging Vascular applications of Sonography in the Lab cerebrovascular, abdominal, arterial and venous systems of the body in a lab setting. DMS 273 DMS 280 Advanced Sonography Applications Physics Registry Review Advanced applications and emerging trends of Sonography worldwide including interventional, surgical, portable, vascular, pediatric, musculoskeletal, breast, prostate/male pelvis, and ethical issues. Review of physical principles of ultrasound and instrumentation; including bioeffects, safety, artifacts, imaging, and analysis to create diagnostic ultrasound images in alignment with ARDMS examination content specifications. DMS 281 DMS 282 Abdomen Registry Review OB/GYN Registry Review Applications of abdominopelvic and small parts imaging review to include normal, abnormal, pathology, patient care, bioeffects, pediatrics, interventional and emergency procedures in alignment with ARDMS examination content outlines Review of Sonography in obstetrics and gynecology (OB/GYN), including normal, abnormal, pathology of the non gravid, and gravid female pelvis per ARDMS examination content specifications. 11

DMS 290 Sonography Capstone Seminar Capstone seminar prepares the student for workplace skills, research, employment, ARDMS examinations, and ICD 10 coding and billing knowledge expected of entry level Sonographers. DMS 289 RVT Exam Review Registry review course for those planning to take the Registered Vascular Technologist certification examinations given by the American Registry of Diagnostic Medical Sonographers. Estimated Costs for the Diagnostic Medical Sonography Program ** Tuition @ $ 70.00/credit (Major Core Courses approx) $4750.00* Textbooks ++++ $1200.00* Netbook/Notebook ### $300.00* Background check $85.00* Drug Screen $75.00* Liability Insurance per practicum per year $50.00* Uniform and Shoes $200.00* Student Health Insurance $125.00* Physical Exam and Immunizations $100.00* Ergonomic Scanning Kit for Clinicals $80.00* Clinical Online Tracking System $150.00* ARDMS Examination Fees $750.00* Total Estimated Cost of Program $7,850.00 ### Any notebook, laptop, or portable personal computer is acceptable as long as it is WIFI compatible for in class and at home use. **Fees are subject to change by the Central Arizona Community College Governing Board. All other costs quoted are subject to change and were current at time of printing. ++++ Textbooks and e books are changing all the time. A complete booklist including prices and ISBN numbers are included with packets provided to students admitted to the DMS program. 12

Steps to Apply for Admission: Read carefully and complete the following steps. Applications are accepted May 1st through July 1 st, 2012 and notification of applicants based on the point system criteria will be made by July 15 th, 2012. Classes start full time in August (fall semester). An application for Admission includes the following: Health Care Professionals, over 18 years of age who have an AAS Degree; are currently working; and hold a valid licensure/certification in a direct patient care health care profession such as Radiologic Technology (RT), Registered Nurse (RN), Registered Respiratory Therapist (RRT), Physical Therapy Assistant, etc. Copies of current license/certifications from above health care professional categories Completion of 28 credits of General Education. Completion of DMS 101Introduction to Sonography (hybrid course) offered each spring. Submission of professional attributes checklist. Admission Application to CAC (new students only) Application for Admission to Diagnostic Medical Sonography Program Complete a Financial Aid Application (required for all accepted students under the grant requirements which funded the start up of this program). FAFSA All relevant transcripts of completed general education requirements. All forms must be complete and legible when they are submitted. Students must reapply to the program each year, there is no waiting list. This is your application to the DMS program therefore the Diagnostic Medical Sonography Program Director will not be able to assist you with the actual application. Incomplete applications or those that miss the July 1 st deadline will not be considered. Each year students must reapply to the program, there is no waiting list. There are no provisions for advanced placement of students in this program; or for transfer options to other programs. Applicants must keep copies of their submitted documents. We will not be able to return your documents to you. If you have questions related specifically to the program please email the Director: Dionne Winter at dionne.winter@centralaz.edu Submit your application and checklist to: Health Careers Secretary, SMC Campus ATTENTION SONOGRAPHY APPLICATION Central Arizona College /SMC campus 273 Old West Highway Apache Junction, AZ 85119-5231 Note: Please speak with a CAC Advisor if you need any assistance regarding financial aid, FAFSA forms, fees, general education, or any other college related questions. Advisors can also help you along the way to complete the steps in this application process before you submit this application: 480-677-7732. 13

NOTE: These additional admission requirements are to be completed once you have been accepted into the program: Proof of Health Care Insurance is required by the clinical sites. This can be purchased through various insurance companies. Immunization Checklist/Proof of Immunizations *** Drug testing (ordered by the Director prior to the start of clinicals; students will be given explicit instructions on where and when to take this test.)*** Background check *** AZ DPS Fingerprinting/Criminal Background Check Fingerprinting (DPS Cards) Possess the ability to perform basic physical tasks as required (Health Care Provider Signature form) Health Care Provider CPR Current certification Purchase Uniforms and textbooks FAFSA application for financial aid Meet with an Advisor to go over transcripts and register for cohort classes *** These items are handled by a 3 rd party verification agency: Certified Background. Additional details will be provided when the student has been accepted into the program. You must have a clean background check in order to obtain clinical placement. Zero Tolerance Guidelines The Central Arizona College Diagnostic Medical Sonography Program supports Zero Tolerance Guidelines according to the CAC student code of conduct whether you are in class, lab, or at your clinical site(s). The college catalog details this information for your reference: http://www.centralaz.edu/documents/catalogs/2009-2010_catalog_web.pdf Examples include: Intentionally or recklessly causing physical harm to any person on the campus or at a clinical site, or causing reasonable apprehension of such harm. Unauthorized use or possession of any weapon or explosive device on the campus or at a clinical site. Unauthorized use, distribution, or possession of any controlled substances or illegal drug for any purpose (i.e. distribution, personal use) on the campus or at a clinical site. Any Diagnostic Medical Sonography Program student engaging in misconduct is subject to immediate dismissal from classes and the program. Please refer to disciplinary action as described in the Central Arizona College Student Handbook. 14

Admissions Process and Point System Enrollment is limited and the selective admission process is highly competitive. Students must meet the minimum admission requirements of the program and those required for admission to Central Arizona College. Admission to the program is based on a 100 point value system and points are calculated by the following criteria. Selective Admissions Point System This system is based on a total of 100 possible points. In case of a tie, a lottery will be held to determine student selection. Residency within Pinal County Residency within the state of Arizona Residency outside state or country Residency 10 points 5 points 0 points Total possible points = 10 Licensed AAS Degree (or higher) Health Care Professional; such as Radiologic Technologist (RT); Registered Respiratory Therapist (RRT); Registered Nurse (RN), Registered Physical therapist, Occupational therapist etc. Total possible points = 10 Health Care Work Experience (RN, RT, RRT, PTA, etc) And currently working in health care 5+ years 25 points 1-5 years 20 points 1 year or less 15 points Total possible points = 25 Cumulative Grade Point Average (completed general education requirements) 3.50-4.00 30 points 3.25 3.49 25 points 3.00-3.24 20 points 2.75 2.99 15points 2.50-2.74 10 points Total possible points = 30 15

Completion of Introduction to Diagnostic Medical Sonography Course (DMS 101) with grade of B or higher Total possible points = 10 Hospital or Clinic Clinical Partner (Partners on CBJT GRANT) Total possible points = 10 7. Military Veteran Total possible points = 5 Health Declaration It is essential that Diagnostic Medical Sonography students be able to perform a number of physical activities in the clinical portion of the program. At a minimum, students will be required to lift patients, stand for several hours at a time, and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement direct patient care. The clinical experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties impacting patients lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program. Immunizations Students are responsible for maintaining their own health records. The Diagnostic Medical Sonography Program does not keep paper copies of immunizations, they are stored electronically. Students are responsible to be current with the immunizations mandated on their health declaration form. Copies of updates to immunization records must be submitted to the Program Director and will be placed in student files. Students may be required to obtain additional immunization/vaccinations depending on their assigned clinical sites, this could include a FLU shot for example. Due to requirements at our clinical sites, there are no waivers or exceptions to the required immunization list. 16

17 Criminal Background Check All students are required to obtain a fingerprinting background check through the DPS. Information and results are also performed and stored using a third party service: Certified Background.com that does a National Database Check. Students will open an account with Certified Background and will create this account only after notification that they have been accepted into the program. Only those students who have no discrepancy found on their background check will be admitted to/ or remain in the program. Students will be given specific instructions regarding program details such as fingerprinting, and drug screening prior to the start of the fall semester. Fingerprinting Fingerprinting is available through the CAC police department at the Signal Peak Campus and is free of charge. The fingerprint card is then sent to the DPS for clearance and DPS charges a processing fee for this service. Drug Testing (URINE) Drug testing is contracted through the Sonora Quest laboratory. Students will be notified when to do the drug testing once they have begun the program at the start of the first fall semester; and will have 48 hours to complete this requirement. NO Exceptions. If the sample is not adequate it is the responsibility of the student to pay for another test. Waiver of Licensure/Certification Guarantee Admission or graduation from the Central Arizona College School of Diagnostic Sonography does not guarantee either employment or ARDMS certification. Licensure, certification, and registration requirements and subsequent procedures are the exclusive right and responsibility of the American Registry of Diagnostic Medical Sonographers (ARDMS)). Students must satisfy the Sonography requirements of the ARDMS independently of any college or program requirements for graduation. The ARDMS has rules regarding who can apply for the examination. For example, certain types of convictions may make an applicant ineligible for registration/licensure/certification. These documents should be reviewed by prospective applicants before they enter the program by visiting the ARDMS web site: www.ardms.org/ HAZARDS and RISKS Sonographers work with patients who may be ill, have various injuries, and/or communicable diseases. Therefore prospective applicants need to be aware of the potential risks and possible hazards prior to submitting their application. Student Sonographers may be required to attend training sessions; observe safety precautions; wear protective clothing such as gowns, masks and eyewear as well as gloves. The work of a Sonographer involves risks that require special safety precautions such as handling of sharps, chemicals, or infectious

waste. Sonographers must be constantly vigilant protecting themselves and their patients from disease or injury. For more information on the hazards and risks to health care workers on the job please refer to the Center for Disease Control web site: http://www.cdc.gov/niosh/topics/healthcare/ Equal Opportunity Is the Law It is against the law for Central Arizona College, the recipient of Federal financial assistance, to discriminate on the following basis: Against any individual in the United States, on the basis of race, color, religion, sex, national origin, age, disability, political affiliation or belief; and Against any beneficiary of programs financially assisted under Title I of the Workforce Investment Act of 1998 (WIA), on the basis of the beneficiary's citizenship/status as a lawfully admitted immigrant authorized to work in the United States, or his or her participation in any WIA Title I- financially assisted program or activity. Central Arizona College must not discriminate in any of the following areas: Deciding who will be admitted, or have access, to any WIA Title I-financially assisted program or activity; Providing opportunities in, or treating any person with regard to, such a program or activity; or Making employment decisions in the administration of, or in connection with, such a program or activity. PLEASE do not phone the Program Director to check on placement status. Communication between the student and college will be conducted via e-mail, phone, or U. S. mail. APPLICATION FOR ADMISSION DIAGNOSTIC MEDICAL SONOGRAPHY PERSONAL - Please Print or Type Name (Last) (First) (Middle) Address: (Street) (City, State) (Zip Code) E mail Address : Telephone Numbers: (Home) (Work) (Cell) 18

EDUCATION Name and Location of School High School From Mo/Yr Dates Attended To Mo/Yr Degree Awarded College Other EMPLOYMENT HISTORY Current work experience ( past 5 years) Name and Address of Employer (Include Name of Supervisor) Position From Mo/Yr To Mo/Yr Reason for Leaving 1. 2. 3. 19

Current License/s or Certifications (include dates) Please use this space below to explain your interest in the field of Sonography. 20

PLEASE READ CAREFULLY AND SIGN BELOW I certify that the information on this application is complete and accurate to the best of my knowledge. I understand that withholding or providing false information could make me ineligible for admission and enrollment. I further agree to release from all liability or damages those persons, agencies, or organizations who may furnish information in connection with my application for admission. If accepted into the Diagnostic Medical Sonography Program I agree to read and abide by all school and clinical policies and procedures. Please do not phone the office to check on placement status. Students will be notified by e mail, phone, or U. S. mail. Signature: Date: 21

Immunization / CPR/TB Checklist NOTE THERE ARE NO WAIVERS OR EXCEPTIONS FOR REQUIRED IMMUNIZATIONS. Applicant Name (Please PRINT): Today s Date: Home Phone: Cell Phone: Student ID Number: email address: MMR (Measles/Rubeola, Mumps, and Rubella): Requires documented proof of two MMRs in lifetime or a positive titer for each of these diseases. 1 st MMR Date: 2 nd MMR Date: OR Date & results of titer: Measles/Rubeola Mumps Rubella Circle: Yes or NoI have attached documented proof as specified above. Varicella (Chickenpox): Requires documented proof of two (2) vaccinations or positive IgG titer. 1 st Varicella Date: 2 nd Varicella Date: OR Date & results of IgG titer: Circle: Yes or NoI have attached documented proof as specified above. Tetanus/Diphtheria (Tdap) immunization within the past 10 years or Tdap if no booster after age 19. Tdap Date: Circle: Yes or No I have attached documented proof as specified above. 22

Tuberculosis: Documentation of an annual TB skin test (PPD). If positive skin test, provide annual documentation of chest X-ray negative for evidence of disease, or written documentation of a TB disease free status from a licensed health care provider. All testing must have been completed within the previous six (6) months. PPD Date: Date of Reading: Results (circle): Negative OR Positive OR Chest x-ray Date: Results: Circle: Yes or NoI have attached documented proof as specified above. Hepatitis B: Documented evidence of completed series or positive antibody titer. If beginning series, first injection must be prior to admission and the series completed within 6 months. Date of 1 st injection: OR Hep B Titer Date: Date of 2 nd injection: Titer Results: Date of 3 rd injection: Circle: Yes or NoI have attached documented proof as specified above. F. CPR Card: Health Care Provider Date CPR card Issued: Expiration Date: Circle: Yes or No I have attached a copy of both sides of the Health Care Provider CPR Card. CPR certification must have been completed within the past 12 months and will be renewed while in the program to remain current. 23

IMPORTANT: Students are responsible for maintaining their own health records. The Diagnostic Medical Sonography Program will accept only photocopies of all documentation of your health related materials. The Diagnostic Medical Sonography Program does not retain copies of immunization records, CPR certification, or TB skin test results in student files. Students are responsible for maintaining their own records of current CPR certification and proof of immunization and TB skin tests until they have completed the program. Copies of proof of these updates must be submitted to the Certifiedbackground.com web site. All immunization records must include your name, name and signature of the healthcare provider giving the immunization, and date. A health care provider s signature on the Health Declaration form, without proof of immunization status, is NOT acceptable. Required Immunizations NOTE THERE ARE NO WAIVERS OR EXCEPTIONS FOR REQUIRED IMMUNIZATIONS MMR (measles/rubeola, mumps, rubella) Options to meet this requirement: Attach a copy of proof of two previous MMR vaccinations to the health declaration form. OR If you had all three illnesses OR you have received the vaccinations but have no documented proof, you must have a titer drawn for each illness. If the titer results are POSITIVE, attach a copy of the results to the health declaration form. If titer results are NEGATIVE, you must get your first MMR vaccination and attach documentation to the health declaration form. The second MMR must be completed within one month and proof submitted to the nursing department. Varicella (chickenpox) Options to meet this requirement: Attach a copy of proof of a positive IgG titer for varicella. OR If the titer is NEGATIVE, attach a copy of proof to the health declaration form that you received the first vaccination. Complete the second vaccination in 4 to 8 weeks and submit proof to the nursing department. Tetanus/Diphtheria (Tdap) immunization within the past 10 years. Option: Tdap is required as a booster if it has not been given some time after age 19. Attach a copy of proof of Tdap vaccination to the health declaration form. ( New CDC guidelines) Tuberculosis Options to meet this requirement: 1. Attach a copy of proof of a TB skin test (PPD) completed within the previous 6 months and results. Records for PPD (skin testing for tuberculosis) require name and signature of the healthcare provider, and findings. OR 2. If you have a POSITIVE TB skin test you must submit a copy of proof of a chest x-ray completed within the previous 6 months and its results. Provide evidence of disease free status. 24

Hepatitis B Options to meet this requirement: Attach a copy of proof of completion of three Hepatitis B injections to the health declaration form. Attach a copy of proof of a positive HbsAB antibody titer to the health declaration form. If you have not received the injections in the past, you must obtain the first injection and attach a copy showing proof of the injection to the health declaration form. You must receive the 2 nd injection in one month and the 3 rd five months after the second. Submit documentation. Health Care Provider Signature Form Instructions for Completion of Health Care Provider Signature Form A health care provider must sign Health Care Provider Signature Form and indicate whether the applicant will be able to function as a Medical Imaging student. Health care providers who qualify to sign this declaration include a licensed physician (M.D., D.O.), a nurse practitioner, or physician s assistant. (Please Print) Applicant Name Student ID Number It is essential that Diagnostic Medical Sonography students be able to perform a number of physical activities in the clinical portion of the program. At a minimum, students will be required to lift patients, stand for several hours at a time and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement direct patient care. The clinical Diagnostic Medical Sonography experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties impacting patients lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program prior to making application. I believe the applicant WILL OR WILL NOT be able to function as a Diagnostic Medical Sonography student as described above. If not, explain: Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.) 25

Print Name: Signature: Title: Date: Address: City State: Office Phone: email address: APPLICATION CHECKLIST Complete the following by School July 1st. or Attach this sheet and any College documentation/ documents such as transcripts with your application. Completed CAC and DMS Application 18 years or older, High School Graduate or Equivalent Accredited 2 year AAS Degree Health Program or higher in direct patient care ( i.e. Nursing, Radiography, Respiratory Therapy, Sonography) Health Care CURRENT experience and certification Gen Ed Requirements ( completed) NOTE: MATH 121 (or higher) must be completed prior to start of program. General Physics course if not taken or embedded in health care program ( such as Radiology ) Cumulative GPA of 2.5 or above in GEN ED Courses Copies of official transcripts Current Health Care Provider CPR Certification Card AHA. Completion of DMS 101/ Hybrid Course at CAC with a grade of B ( 3.0 or higher) Compliance with Technical Standards & Professional Grade or GPA Date Completed/ Dates valid Attachments Included (check off) In Progress/ completion date 26

Attributes ( DMS 101) This product was partially funded by a grant awarded under the President s Community- Based Job Training Grants as implemented by the U.S. Department of Labor s Employment & Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U.S. Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, non-commercial use only. The web links referenced are not endorsed by the College or Diagnostic Medical Sonography Program; they are provided as options for those seeking information and were current at time of publication. END 27