San Jaquin General Hspital Schl f Radilgic Technlgy 2014 Prerequisite Verificatin Dear Applicant: Thank yu fr yur interest in the Schl f Radilgic Technlgy. T be cnsidered fr selectin, the attached prerequisite verificatin frm (PVF) and supprting dcuments must be cmpleted and submitted t the schl ffice between Jan 1 st and Friday, February 14 th. Send all materials at ne time in a single packet befre February 14. Packets must be received in the Schl ffice by the cutff date. Verificatin packets received after the February 14 deadline will nt be accepted. Nr will supprting dcumentatin be cnsidered after this deadline date. Mail the prerequisite verificatins t: San Jaquin General Hspital Schl f Radilgic Technlgy P.O. Bx 1020, Stcktn, CA 95201 As part f the prerequisite verificatin packet the fllwing dcuments are required: 1. A cmpleted PVF (prerequisite verificatin frm). 2. Official sealed cpies f transcripts fr all cllege cursewrk cmpleted, including thse frm Delta Cllege, if attended. 3. Prf f high schl graduatin, GED equivalency, r a cllege degree. 4. A letter stating why yu wish t becme a radilgic technlgist. 5. A cpy f yur CPR card (If yu d nt currently hld a CPR card, yu will need t btain ne prir t beginning the prgram). This must be American Heart Assciatin, prfessinal level. 6. Cmpleted Residency Dcumentatin Frm and supprting dcumentatin (fr in district residents). A lcal driver s license is mandatry. 7. Cmpletin f a Prir Knwledge Test. Applicants whse applicatins are received by the cutff date and rated eligible will be invited t sit fr a prir knwledge test. Tw Saturday mrning test sessins will be scheduled between the applicatin cutff date and the lttery (typically this testing will ccur in March) all applicants must attend ne f these tw sessins. The results f this test will be included in the scring f yur applicatin and subsequent placement in the lttery. If yu tk the Prir Knwledge Test last year and were subsequently placed in an upper tier then yu need nt retake the test. If yu tk this test last year and were placed in a lwer tier then yu will have the ptin f retaking the test t imprve yur verall scre. The higher f the tw test scres will be applied. A maximum f three 1
ttal attempts will be allwed in successive years. Yu will be ntified f this ptin alng with yur scheduled test date nce yur applicatin has been rated. Indicate n yur applicatin whether yu are applying under ptin A r ptin B. Assure that yur transcripts indicate that yu have cmpleted entrance requirements fr ne f the fllwing tw ptins. All f the required prerequisite curses must have been cmpleted with a C grade r better and the 7 cre classes must demnstrate a cumulative GPA f 2.5. Optin A Applicant has an Assciate Degree r higher and has cmpleted the 7 specific prerequisite cre classes listed (r their equivalents). Students with an assciate degree r higher will have t cmplete nly the 7 cre classes: Eng 1A (English Cmpsitin), Bi 31 (Human Anatmy), Bi 32 (Human Physilgy), Math 82 (Intermediate Algebra) r higher, HS 36 (Medical Terminlgy), Psych 01 (Intr t Psychlgy) r Sc 1A (Intr t Scilgy), and CS11 (Fundamentals f Cmputer Science). Optin B Applicant des nt have an assciate degree and has cmpleted in additin t the 7 prerequisite cre classes listed abve, the remaining Delta Cllege Assciate Degree, general educatin requirements. These are curses that will assure cncurrent graduatin at the end f tw years frm bth the Schl and Delta Cllege. Students withut an Assciate Degree will have t cmplete 3 additinal general educatin classes t satisfy Delta Cllege s Assciate Degree, general educatin requirements. Their 2013-14 catalg has listed these as: Humanities (multiple chices) Area 3 American Institutins (Specified American Histries r Plit. Sci.) Area 4 COM ST 001A (Oral Cmmunicatin) Funds. f Speech Area 1C Yu must prvide apprpriate dcumentatin fr all required curses. Yu must be at least 18 years f age by July 1 st f the year. If yur prerequisite verificatin (applicatin) is lacking any f the required infrmatin, it will nt be cnsidered. The respnsibility fr seeing that all prerequisite verificatin materials are received n time belngs t the applicant. 2
If yu meet the entrance requirements, yu will be invited t cmplete a Prir Knwledge test at the French Camp Campus. Yur cumulative applicatin scre will determine hw yur name will be entered int the lttery. Each successful applicant will be randmly assigned a number. Numbers will be drawn in 3 tiers t fill a ttal f 12 seats. The first tier r 50% f seats t be filled will be randmly selected frm thse scring abve the cutff and residing within the lcal educatinal regin (i.e., applicants prviding the individual s verificatin f residency within the cntract cllege s educatinal district fr a minimum f ne year and ne day prir t the beginning f the academic term f entry). Then the numbers f thse applicants frm utside f the regin wh scred abve the cutff will be added t the pl and the next 25% will be randmly drawn. Then all remaining numbers will be added t the pl and the final 25% will be randmly selected (withut cnsideratin f residency). Once the class has been selected all f the remaining numbers/names will be drawn and cnsidered respectively as alternates. In the event that ne f the riginal selectees shuld decline an ffer f a seat in the prgram, their space will be ffered t the next persn n the list. Typically the first tw alternates are required t attend ur first mandatry rientatin meeting with the rest f the class in May. As sn as packets are prcessed and infrmatin becmes available, yu will be ntified exactly when and where the lttery will take place shuld yu wish t bserve. All qualified applicants will be ntified by mail f lttery results. If yu are selected fr prvisinal entry, yu will be required t attend a ne-day rientatin sessin and t cmplete 24 hurs f bservatin prir t the start f classes. Attendance at rientatin is mandatry. If yu fail t attend rientatin, yur space will be ffered t alternate applicant. The 24 hur bservatin may be waived fr students wh have dcumented equivalent experience such as: - Prir vlunteer wrk r bservatin in a Radilgy r related setting. - Survey f Health Careers class (HS 39) Due t affiliatin cntracts students selected may als be required t pass backgrund checks and drug screenings prir t clinical participatin. If a student shuld nt pass ne f these tests at any time during the 2-year prgram s/he will be prhibited frm further participatin in clinical activities and subsequently drpped frm the prgram. The entering students will begin classes n r abut July 1 st at San Jaquin General Hspital. The abve infrmatin is valid fr the 2013 applicatin perid nly. Entry requirements and selectin prcedures are subject t change in subsequent years. If yu have any questins, please call me at (209) 468-6233. Sincerely, Jhn Jb, Prgram Directr * Fr additinal infrmatin please reference the current year s prgram infrmatin sheet and relative webpage dcuments.. jsj 11/13 3
Prerequisite Verificatin - 2014 San Jaquin General Hspital Schl f Radilgic Technlgy P.O. Bx 1020 Stcktn, CA 95201 Cntact Infrmatin Please neatly print r type respnses t all questins. Last Name: First Name: MI Scial Security Number Student ID Number: (if applicable) Telephne Number: Hme: Wrk: Current Address: (where we may cntact yu relative t the status f this applicatin) Permanent Address: (If different frm abve) E-mail: (please assure this is current, pertinent fllw-up may be sent t this e-address) Other name(s) used n educatin recrds: Are yu 18 years f age r lder? Yes, N Are yu a U.S. citizen? Yes N If nt, d yu have a legal right t remain in the U.S. fr the tw years f the prgram? Yes N Residency: Within S.J. Delta Cllege District? Yes N Persn t ntify in case f an emergency: Name / Relatinship: Phne #: jsj 05/13 4
Are yu applying under ptin A r ptin B? A I have an Assciate degree r higher and have successfully cmpleted the 7 prerequisite cre classes as required. B I d nt have an Assciate degree but have cmpleted in additin t the 7 prerequisite cre classes, general educatin cursewrk that will satisfy the degree requirements fr graduatin frm Delta Cllege cncurrently with cmpletin f radigraphy cursewrk at San Jaquin General Hspital. Educatin: High Schl Graduate? Yes N GED Equivalency Please list all high schls and clleges attended: r Schl Attended Address Degree/Majr List any health care related emplyment, vlunteer wrk, r bservatin time that may ptentially satisfy the bservatin requirement (Medical Imaging specific): Name f Facility Address /Phne Emplyment, vlunteer, bservatin? Type f Experience Dates f service I authrize investigatin f all statements cntained in this prerequisite verificatin. I understand misrepresentatin r missin f facts is cause fr me nt t be cnsidered fr entry int the prgram r may be cause fr dismissal frm the prgram. Signature: Date: jsj 05/13 5
San Jaquin General Hspital / Schl f Radilgic Technlgy Residency Dcumentatin (Please refer t the Radilgic Technlgy infrmatin letter and prerequisite verificatin frm fr infrmatin n the selectin and residency verificatin prcess.) In-District Resident Because we cntract with Delta Cllege fr the prvisin f academic credit, the applicant must reside and have maintained cntinuus residency within the San Jaquin Delta Cllege District fr the perid beginning with the residency determinatin date fr the term fr which the applicant is applying. District Nn Resident Applicant resides utside the San Jaquin Delta Cllege District and/r submits n dcumentatin, incmplete dcumentatin, r insufficient dcumentatin t determine an In-District Resident status, r residency classificatin was nt requested. It is yur respnsibility t assure the accuracy f this infrmatin. Residency Determinatin Date One year and ne day prir t the beginning date f the term fr which the applicant is applying. The residency determinatin date fr the summer 2014 semester is July 1, 2013. 1. Prvide the address where yu are currently residing. (A Pst Office Bx is nt acceptable.) Street Address City State Zip Cde 2. List any ther addresses where yu have resided during the perid beginning with the Residency Determinatin Date: 3. I am requesting In-District Resident classificatin: YES NO If YES, yu must prvide the fllwing as dcumentatin (3 pieces required). This infrmatin is used t determine yur classificatin: Califrnia Drivers License r ID Card (Mandatry) This dcument must shw current address within the regin.... and at least tw f the fllwing: Rental/Lease agreement, hme deed, r prperty tax statement. Residence utility bill. (Water, Electric, Gas, Telephne.) Bank Statement, Vter Registratin, Pay Stub Dcumentatin must indicate name and address and shw residency fr the entire residency perid. At least ne f the 3 required pieces will shw residency fr mre than a year and at least ne shuld indicate current residence within the district. We reserve the right t request additinal dcumentatin t verify resident status but if the required infrmatin is lacking r incmplete yu may be classified as ut f district. I herby certify under penalty f perjury that t the best f my knwledge, ALL f the abve infrmatin is crrect and cmplete. I als understand that willful missin r falsificatin may result in disqualificatin and disciplinary actin. Signature Date jsj 05/13 6