For Admissions use only.
Received By:_________
Return this form to:
Date:__________________
Advising Services, Wynn Center (Building 10), room 10-200
Durham Technical Community College
Clinical Trials Research Associate: Data Management Certificate
Admissions Application
First Name: __________________________________ Last Name: ____________________________________
Durham Tech Student ID Number: _____________________________ Date: ___________________________________________
ConnectMail Email Address: _______________________________________________________________
NOTE: All official communication from the college is delivered via ConnectMail, including Health Technology admissions
decisions.
APPLICATION DEADLINE:
Fall Start: Due July 10
Submit application to: Wynn Center (Building 10), room 10-200 (Advising Services office)
or banksa@durhamtech.edu
CHECKLIST:
All steps below are required. Please initial that each item is completed.
Enroll at Durham Technical Community College
View College enrollment steps on the website.
______ I am currently admitted to Durham Tech.
Note: If you have not been enrolled with Durham Tech within the last 12 months, you must reapply to
Durham Tech using the CFNC application
.
______ I have submitted an official transcript(s) from high school and/or college.
Submit to Admissions, Registration, and Records, located in Wynn Center (Building 10), room 10-201
______ I have applied for Financial Aid (recommended but not required).
______ I have attended a ConnectSession (Student orientation)
Note: Prospective students with 12 or more college credit hours transferred to Durham Tech are not
required to attend a ConnectSession, but it is recommended.
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Meet Course Placement Requirements
Students must demonstrate they are college ready in one of the following ways (Initial each item that fulfills this
requirement):
______ Provide proof of unweighted US high school GPA of 2.8 or higher within the last ten years
______ Transfer credit for English and math (college-level algebra)
______ Provide proof of completion of an associate’s or bachelor’s degree
______ Provide proof of satisfactory scores on ACT, SAT, GED, HiSET, NCDAP, COMPASS, ASSET, or ACCUPLACER
scores within the last ten years
______ Demonstrate mastery on RISE English placement test 2 and RISE Math placement test 2; OR successfully
complete ENG-002 through Tier 2 (grade of P2) & MAT-003 through Tier 2 (grade of P2)
Certificate Qualifications:
Students must demonstrate they have met the Data Management qualifications in one of the following ways
(initial each item that fulfills this requirement):
______ Provide evidence of minimum of a bachelor’s degree in biological science, chemistry, computer
science, mathematics or statistics, or allied health care with clinical practice OR
______ Provide evidence of at least ONE YEAR experience in a clinical research field documented by a letter of
support from an employer AND curriculum vitae/resume demonstrating scope of experience and job
responsibilities OR
______ Provide evidence of completion of a Core Competencies or Advanced Topics certificate(s)
Additional Required Documents:
Students must provide all of the documents listed below with the completed application:
______ I have attached a signed Clinical Training Form (download from Health Technologies admission steps
)
______ I have attached a signed English Language Requirement Form (download from Health Technologies
admission steps
STATEMENT OF STUDENT RESPONSIBILITY
I verify that I have read all the information regarding admissions to the Clinical Trials Program, and understand the steps
I must take to qualify for admissions. I understand that it is my responsibility to notify the Admissions, Registration and
Records office regarding changes in name, address, or phone number through eForms.
I understand that all official communication from the college is delivered via ConnectMail, including Health and Wellness
admissions decisions.
I understand that my Clinical Trials Admissions Application will not be accepted if incomplete.
I understand that accepting a seat within the Clinical Trials program counts as the first admission. A maximum of two
admissions are allowed.
Name
________________________________________ Student ID#______________________
Signature
________________________________________ Date____________________________
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