______ 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)
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 Medical Product Safety & Pharmacovigilance
(MSP) 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 MSP Admissions Application will not be accepted if incomplete.
I understand that the criminal background check and drug screening are not required to be completed prior to applying
to the Medical Product Safety & Pharmacovigilance (MSP) Program (this will be started after attending mandatory
orientation).
I understand upon my acceptance to the Medical Product Safety & Pharmacovigilance (MSP) program, clinical sites
require a criminal background check and drug screening prior to my placement for training at that site. I understand I
will pay a fee directly to a designated vendor for this background check. I understand that if I am admitted to the MSP
program but am denied clinical placement by any of the hospitals/healthcare facilities, I will be unable to successfully
complete the MSP program as the program’s clinical objectives cannot be met. Program admission on two occasions
with two clinical denials will be considered a second entry into the MSP program. Students are only allowed two entries
(admissions) into the CTR program.
I understand that upon acceptance to the MSP program, I will be given a Student Medical form and required to
complete a physical examination and assessment (including proof of immunizations or titers). I must maintain up to-date
health care insurance throughout the program.
I understand failure to upload the completed clinical requirements and documentation by August 10 (no exception or
extensions) may result in the inability to progress in the program or dismissal from the program.
I understand that accepting a seat within the MSP program counts as the first admission. A maximum of two admissions
are allowed.
Name
________________________________________ Student ID#______________________
Signature ________________________________________ Date____________________________
Revised 1/30/20 Page 2 of 2
