School of Health, Education and Human Services Florida State College at Jacksonville 4501 Capper Road, Room A224 Jacksonville, Florida 32218

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1 Personal Information: Student Name: School of Health, Education and Human Services Florida State College at Jacksonville 450 Capper Road, Room A224 Jacksonville, Florida 3228 Please Print EMPL # (number on back of student ID) Last Four of Social Security #: In compliance with Florida State Statute 9.07(5), students should be aware that Florida State College at Jacksonville collects and uses social security numbers (SSNs) if specifically required by law to do so or if necessary for the performance of the College's duties and responsibilities. The College takes appropriate measures to secure SSNs from unauthorized access and does not release SSNs to other parties except as required to fulfill the College's duties and responsibilities. View full list of SSN collection purposes. Street Address: City, State, Zip Personal FSCJ Home Phone: Cell Phone: Birthdate: Gender: Male Female Race: Black American Indian Alaskan Native White (Not Hispanic Origin) Asian Or Pacific Islander Hispanic Have you observed a Radiation Therapist (Recommended, not required) Yes No Certification: I, certify that all information given in this application is true and accurate to the best of my knowledge. I understand that if I have falsified any information, I am subject to immediate dismissal from the School of Health, Education and Human Services program for which I am selected. I understand that all correspondence regarding the program will be sent to my Florida State College at Jacksonville account. All applicants will be notified once all completed applications have been reviewed. Signature: Date Participation in any health science program requires a medical history and physical examination, including a record of immunizations. For programs that have clinical training components, students must complete a background check and drug screening. Students selected for admission into a program will be provided with the necessary health and screening forms. Students who are unable to complete the clinical requirements after acceptance into selective access programs are not eligible for refunds of tuition and fees. Radiation Therapy

2 School of Health, Education and Human Services Florida State College at Jacksonville 450 Capper Road Jacksonville, Florida 3228 Thank you for your interest in the School of Health and Human Services at Florida State College at Jacksonville. Please read the instructions carefully and complete the application in its entirety. The application deadline for admission into Radiation Therapy program is: Fall term, every even year (ex: 208, 2020, 2022) - May 5 th How to apply to the college: You must be a student of the college before applying to the program. If you are applying to the college, be sure to follow the instructions below:. Go to 2. Click on Apply button 3. Click on Create a new application. Complete the form to create an account 2. There is a $25 fee for each type of admission application submitted to the college (No fee for program applications) 4. If you graduated from a public high school in Duval County (after June 989), St. Johns County (after June 993) or Clay County (after June 992) county, the College will request an official transcript after we receive your application. If our request is not honored by the high school, students will be notified by mail to request their own official transcript. If you graduated from a public or private high school outside of Duval, St. Johns or Clay counties, please have your high school send an official transcript indicating your graduation date to: Admissions Office Florida State College at Jacksonville P.O. Box 4055 Jacksonville, FL If you have attended any other college or university, please request each school to forward your official transcript to the above address. All post-secondary transcripts must be received and evaluated before a student can attend college credit orientation through FSCJ Smart Start. All transcripts must be received and evaluated to be approved for financial aid. 7. Apply for Residency 8. Complete College Assessment 9. Apply for Financial Aid and Scholarships 0. Schedule orientation through FSCJ Smart Start How to apply to the program It is highly recommended that an applicant observe a Radiation Therapist to learn more about the profession before making the decision to apply to the program. Successful completion of the following prerequisites is necessary before applying to the program. o Anatomy & Physiology I (BSC 2085C) o College Algebra (MAC 05 or higher o Introduction to Information Technology (CGS 060) o Or Microcomputer Application for Business and Economics Include the following with the Health Program Application: o BLS Provider CPR Card o Verification of healthcare experience, if applicable

3 Submit Health Program Application by one of the following methods: ) all documents to hcic@fscj.edu (Preferred method) 2) Hand deliver to the Health Career Information Center, North Campus, Building A Room ) Mail to 450 Capper Rd, Room A224, Jacksonville, FL 3228 Direct all questions to the Health Career Information Center at Candidates will be notified of their status after all completed applications have been reviewed by the Admissions Committee. Notification of admission to the program will be made by FSCJ . Students who receive letters of acceptance must accept the seat within the timeframe outlined in the acceptance letter by response only. If the student does not accept the seat by the deadline, the seat will be offered to the next highest-ranked candidate on the Alternate List. NOTE: It is the applicant's responsibility to check their FSCJ frequently. Not checking may cause the candidate to lose his/her seat. Please do not send official transcripts with this application. The program faculty does not have the authority to grant transfer credit. If the credits do not show up on the FSCJ unofficial transcript, it will not be counted. Applications received with an official transcript only will be discarded without notifying the student. Official transcripts are to be sent to the college registrar. Do not include a check for payment of any kind. All fees are to be paid to Florida State College through the business office or online, not the program. Due to poor print quality, faxes are not accepted. Scan documents and to hcic@fscj.edu (preferred method). If you have any direct patient care experience, please include a letter from your employer on letterhead to include the number of years you have been with them and a brief description of your duties. Thank you for your interest in the Florida State College 2 year Radiation Therapy Program. If you have any questions or problems with the application process, please call the Health Career Information Center at (904) Status notifications will be sent to your FSCJ account only.

4 Radiation Therapy 2-year Degree Program Florida State College at Jacksonville North Campus GENERAL PROFESSIONAL INFORMATION: Radiation therapy is a fast growing allied health specialty. The radiation therapist assists in the treatment of patients with cancer. Radiation is directed at the tumor site under strictly controlled conditions in an attempt to cure or palliate the disease. The therapist positions the patient for treatment, performs the necessary calculations to determine the proper radiation dosage and, under the supervision of a physician, delivers the required radiation utilizing highly complex equipment. Therapists work closely with patients and coworkers. Graduates of the FSCJ Radiation Therapy Program are eligible to take the nationally recognized American Registry of Radiologic Technologist (ARRT) examination immediately after graduation. This credential offers the therapist excellent employment opportunities as well as a competitive salary. Students must complete all prerequisites (see enclosed curriculum) to be eligible for this program. Successful students must have a genuine desire to work with people. An aptitude in math and science is helpful, as is a willingness to devote ample time to independent study and homework. For more information concerning the program, call (904) The Program Director can arrange for you to tour the facilities, meet current students, or speak to faculty members or others working in the field. For Further Information... About the profession -contact: American Society of Radiologic Technologists 5000 Central Ave, SE Albuquerque, NM About the college -contact: Registrar's Office, Florida State College at Jacksonville 50 State Street Jacksonville, FL About the program -contact: Radiation Therapy Program Florida State College at Jacksonville 450 Capper Rd. Rm. A-224 Jacksonville, FL 3228 (904) hcic@fscj.edu

5 Application Procedure Students are accepted into this program every two years (i.e. 208, 2020). Acceptance into the limited access Radiation Therapy Program is based upon academic performance, completion of prerequisite coursework and other criteria detailed on the rubric. To be considered as a qualified applicant, individuals must complete the following by the application deadline of May 5. COURSES: All radiation therapy courses must be taken in sequence or with the permission of the Program Director. Students must achieve a "C" average in all the radiation therapy courses prior to graduation from the program. No radiation therapy course may be repeated more than twice. Any withdrawals or re enrollments must be approved by the Program Director. DENIAL OR REQUIRED WITHDRAWAL: The radiation therapy program reserves the right to deny admission or require withdrawal of any student who, in the judgment of the department, gives evidence of being unable to perform the responsibilities and tasks required of the radiation therapy profession. Students must be able to demonstrate ability to communicate, ambulate and perform fine motor coordination; and have adequate vision and auditory perception. In accordance with Chapter of the Florida Statutes, the radiation therapy program reserves the right to deny or delay admission, or require withdrawal of any student, who in the judgment of the department, gives evidence of "being unable to practice radiation therapy with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals or any other type of material, or as a result of any mental or physical condition." ESTIMATED EXPENSE: (These Figures Are Approximate and Subject to Change) TUITION Florida resident: Georgia Resident: Non-Florida/Georgia resident: $04.88 per credit hour $26.55 per credit hour $40.27 per credit hour OTHER EXPENSES Application fees for ARRT exam $ Background check $50.00 College application fee $25.00 Drug screen $60.00 FSCJ name tag $8.00 Graduation fees $25.00 Physical exam (est. cost) $25.00 Textbooks (est. cost) $ Uniforms and shoes (est. costs) $25.00 (Fees and other expenses are subject to change without notice.)

6 STUDENTS WHO ARE ACCEPTED TO THE RADIATION THERAPY PROGRAM:. Students must submit a current Physical form (completed by a physician), 2. Student Health Form (completed by the student) and 3. Hepatitis B Vaccine Statement. Official forms will be provided in a separate notification after all applicants have accepted their seats. FSCJ's tuition costs for the radiation therapy program include limited insurance to cover medical expenses resulting from accidental injuries incurred while participating in designated student activities only. FSCJ and the radiation therapy program do not require, but strongly encourage students to obtain more comprehensive medical insurance if they are not presently covered under an existing plan. Questions about any information contained in this package should be addressed to the Health Career Information Center at (904) Prerequisites: Radiation Therapy Program Associate Degree Anatomy & Physiology I (BSC 2085C) College Algebra (MAC 05 or higher Introduction to Information Technology (CGS 060) Or Microcomputer Application for Business and Economics General Education Requirements: 4 credits 0 Credits Medical Terminology (HSC 53) Anatomy & Physiology II (BSC 2086C) 4 credits English Composition (ENC 0) Humanities Social Science 6 credits Fall Term: Introduction to Radiation Therapy (RAT 00) Radiation Physics I (RAT 264) Radiation Biology and Safety (RAT 224) Oncology I (RAT 2242) Spring Term: 2 credits Patient Care in Radiation Therapy (RAT 223) Oncology II (RAT 2243) Observation Clinical Education (RAT 803) Radiographic Physics 2 (RAT 268) credits 0 credits Summer Term: Selected Topics in Student Life (SLS 932) 2 credits Clinical B (RAT 2832) 6 credits Trends in Radiation Therapy (RAT 02) Fall Term: 2 credits 0 credits Clinical C (RAT 2833) Dosimetry and Treatment Planning (RAT 265) 6 credits

7 Spring Term: Clinical D (RAT 2834) Seminar: Registry Review (RAT 206) 9 credits 7 credits 0 credits Total: 77 credit hours Course may be taken PRIOR to enrolling in the therapy program. If you have a record. You will be required to pre-apply to the American Registry of Radiologic Technologists (ARRT) for them to determine if you will be eligible to sit for the certification examination upon completion of the program. Contact them at (65) from 9am 5pm CST (am 7 pm EST), or download the pre-application form by going to (on the left side of their homepage, point to Ethics, click on Pre-application process then click pre-application ). 2. A copy will be sent to our clinical affiliates, and they will determine if they will allow you in their facility. Students are not denied admission to the program based on their background results, however: 3. If the ARRT deems the student ineligible, the student will not be permitted to sit for the credentialing examination. 4. If any of our clinical affiliates denies the student clinical space, the student will be unable to complete the requirements of the program, and therefore be ineligible to sit for the ARRT credentialing examination.

8 Florida State College Radiation Therapy Selection Criteria 2 Year Degree Program For student use only. This form is not part of the application. A=3 B=2 C= QUALITY POINTS BSC 2085C x5= CGS 060 OR GCS 00 x5= Mathematics x5= ALL Prerequisites = +4 points Extra Points HSC 53 x5= BSC 2086C x5= ENC 0 x4= Humanities x4= Social/Behavioral Science x4= Total Points (max: 5) Additional Information Health Care Experience Yes No