Fill - Free fillable COLLEGE OF DUPAGE Diagnostic Medical Imaging Sonography Associate (College of DuPage) PDF form

COLLEGE OF DUPAGE

Diagnostic Medical Imaging Sonography

Associate Degree Program

FALL 2022 ADMISSION

NOTE: The DMIS Program is undergoing revisions.

Please monitor this program admission packet for updates and/or modifications.

Application Deadline – May 17, 2022 by 5pm

www.cod.edu/sonography

Program Coordinator: Melissa McKirdie, BA, RDMS, RVT

mckirdiem@cod.edu

Note: Please see specific program registration or admission packets for detailed information on when to begin completing

health requirements, drug tests, CPR, criminal background checks and proof of insurance submission. Timing varies

depending upon either entrance to or participation in the clinical component of a given program. Funds paid to Edward

Corporate Health or to a personal health care provider/ source, CastleBranch.com, insurance companies, and funds used

towards CPR completion are not eligible for any sort of refund from College of DuPage if the required course(s) are not

successfully completed.

Students are not accepted into this program until they receive official acceptance letters from the College of DuPage

Nursing & Health Sciences Division.

ASSOCIATE IN SONOGRAPHY (AAS – DMIS)

Program Information Disclaimer

This program information is published for that purpose only; however, the information in this packet is not to be regarded

as an irrevocable contract between the student and the program. The program reserves the right to change, at any time,

without notice, graduation requirements, fees, and other charges, curriculum, course structure and content, and other such

matters as may be within its control, not with-standing any information set forth in this program information packet in

accordance with College of DuPage policies and procedures.

Students are not accepted into this program until they receive and respond to an official acceptance letter from the College

of DuPage Nursing & Health Sciences Division.

Program Admission Preference

Each program with out-of-district clinical sites (see list of participating programs below) may admit a maximum of 20%

of out-of-district applicants to the program, based on merit. The 20% maximum policy would only apply to out-of-district

applicants who do not have access to a particular program in the community college district in which they reside.

Students coming from districts with a particular program within their district would only be considered if there were open

seats after all qualified candidates from in-district and out-of-district without programs were accepted.

If there are insufficient numbers of qualified in-district applicants, the maximum percentage of out-of-district students

accepted can be exceeded until the program achieves full enrollment, with the approval of the Dean of Nursing & Health

Sciences.

 Computed Tomography

 Health Information Technology

 Magnetic Resonance Imaging Technology

(MRI)

 Mammography

 Nuclear Medicine (DMIN)

 Nursing (ADN)

 Physical Therapist Assistant (PTA)

 Proton Therapy

 Radiation Therapy

 Radiography (DMIR)

 Respiratory Care

 Sonography (Ultrasound) DMIS

 Speech Language Pathology Assistant (SLPA)

 Surgical Technology

Priority for Admission

a. In-District applicants

b. Out-of-District who are part of the CAREER Consortium Agreement (meaning your residing community

college does not offer the particular program in which you are applying)

c. Out-of-District applicants working full-time in-district (proof of in-district employment will be required

each semester)

d. Out-of-District applicants (who are not part of the CAREER Consortium Agreement) including those

students with a joint or chargeback agreement and International students

Program Description/Introduction

Diagnostic Medical Sonography (Ultrasound) is a clinical discipline involving the use of equipment that produces

sound waves that creates images of human anatomy for medical interpretation and diagnosis by a Radiologist. The

Sonography Degree Program is designed to prepare students for entry-level positions in Sonography. Admission

requirements are outlined in this packet. To be considered for Fall 2022 admission all application materials must be

received by the application deadline. NOTE: All prerequisite and general education courses must be completed

by the end of the Spring semester that is prior to program start in the Fall.

The program is full-time on campus and at hospitals (no online courses).

semester = (2) 12-hour days/evenings on campus

Last Updated 5/18/2021 3

-5

semesters = (2) 8-12-hour days/evenings on campus AND (3) 8.5 hour shifts per week at a hospital (shifts can

be days, nights or weekends – hospital decides)

semester = (3) 8.5 hour shifts a week at a hospital

Mission Statement

The primary goal of the Diagnostic Medical Imaging in Sonography (DMIS) Associate Degree Program is to

provide students with didactic, laboratory, and clinical education/experiences in preparation for a health career as a

Diagnostic Medical Imaging Sonographer. The graduate will demonstrate competency to meet certification

requirements, deliver compassionate patient care, and function as an integral member of the health care team with

competence and confidence. Program policies and procedures have been designed to meet or exceed those

established by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) upon

recommendation by the Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS).

Program Goals

1. “To prepare competent entry-level general sonographers in the cognitive (knowledge), psychomotor (skills),

and affective (behavior) learning domains.”

2. “To prepare competent entry-level vascular technologists in the cognitive (knowledge), psychomotor (skills),

and affective (behavior) learning domains.”

3. Educate competent and compassionate sonographers capable of functioning as an entry level Sonographer

within 24 months

4. Provide a comprehensive competency-based curriculum

5. Prepare the student to think and act independently

6. Prepare the student for entry into the ever-changing sonography work environment

7. Prepare the student to achieve a satisfactory result on the American Registry of Diagnostic Medical

Sonographers (ARDMS) board exams for Obstetrics/Gynecology, Abdomen/Superficial Structures, Physics

Instrumentation (SPI) & Vascular Technology (RVT)

8. Provide comprehensive student education to aid in student retention, course, and program completion

Estimate of Program Cost

Please visit the Program Costs webpage for estimated cost.

Academic Success in the AAS Sonography Degree Program

All students enrolled in the Sonography program must maintain a minimum of “C” or better in all DMIS courses in

order to continue in the program. Receiving a “D” or “F” in any DMIS course will terminate the student’s

continuation in the program. Students requesting readmission will need to re-apply and are evaluated based upon

the then current application requirements and ranked with all other applicants.

Upon successful completion of the program, the student is awarded an Associate in Applied Science degree from

College of DuPage. Sixty days prior to graduation, students become eligible to take the American Registry of

Diagnostic Medical Sonographers (ARDMS) examinations in Physics (SPI), Obstetrics/Gynecology,

Abdomen/Superficial Structures, and Vascular Technology. Students who successfully pass the Physics (SPI)

examination as well as a corresponding specialty examination (Obstetrics/Gynecology, or Abdomen/Superficial

Structures) will receive the national credential of Registered Diagnostic Medical Sonographer (RDMS). Students

who successfully complete the SPI examination and the Vascular Technology examination will earn the national

credential Registered Vascular Technologist (RVT).

Last Updated 5/18/2021 4

Statement of Health

Prior to starting clinicals, all students in the AAS Sonography Degree Program will need to complete health

requirements, a drug screen, background check, and complete the medical document manager requirement. You

will be informed by the Program Coordinator when you will need to complete your health requirements. Please

do not complete these requirements until you are instructed to do so. The Health Requirements packet is available

at Health Requirement Packet and the Diagnostic Medical Imaging Sonography webpages. Some clinical affiliates

require further testing, which is the responsibility of the student.

Students with chronic medical conditions and physical limitations are required to submit documentation of current

health status relating to their specific condition. The statement should include the physician’s assessment as to the

student’s ability to meet the program objectives and standard skills in sonography, and the current medications the

student is required to take for health maintenance.

Statement on Medical Care and Health Insurance

Students are responsible for their own medical care and health insurance while in the program. Students must

possess health care insurance in order to train at the clinical affiliate. The student is responsible for any costs that

may be incurred related to personal injuries he/she may acquire while performing activities at the clinical affiliate.

The affiliating clinical facility and/or College of DuPage cannot be held liable for such injuries. Please visit the

Student Health Insurance website for additional details.

Students are required to provide evidence of current health insurance coverage. Please follow specific guidelines as

instructed for submitting proof of insurance.

Statement on Medical Malpractice Insurance

Malpractice insurance is required and is included in the clinical education tuition costs on an annual basis. That is, the

cost of the insurance is included with the tuition costs for DMIS 1112 and DMIS 2212. Students must be officially

registered and listed on the instructor's class roster to be covered by the malpractice insurance.

Statement on Drug Testing/Criminal Background Check

A drug test and Criminal Background Check are required prior to starting a clinical rotation in the Sonography

program. Several clinical affiliates also require finger printing. The costs of these requirements are the

responsibility of the student. You will be informed by the Program Coordinator when you will need to complete

these requirements. Please do not complete them until instructed to do so.

Criminal Background Check Information

All health care workers and student health care workers are required to undergo a criminal background check in

order to work in a clinical setting. A student with a positive background check containing disqualifying conditions

as defined by Illinois State Law (225ILCS46/25) and 77 Ill Adm. Code 955 Section 955.160 will not be allowed to

enter the clinical portion of this program, thus preventing the student from obtaining mandated certification and/or

licensure.

NOTE: You may have been convicted and not sent to jail. People are often fined or given probation or

conditional discharge rather than jail time, but these are still considered convictions. If you are unsure as to

whether an arrest resulted in a conviction, contact the county in which you were arrested and speak to a

representative in the Circuit Clerk’s office, State’s Attorney’s office or your attorney.

Last Updated 5/18/2021 5

Transportation

Students are required to provide their own reliable transportation to the college and clinical sites. Public

transportation is often not an option due to clinical site hours and/or locations. Clinical placements are assigned by

the Clinical Coordinator to meet the needs of all students and the program. Students cannot select clinical sites. Any

parking fees and/or tolls are the responsibility of the student. *In extremely rare cases clinical sites can be up to

100 miles from College of DuPage.

Standard Skills in Sonography

To participate in the clinical education portion of the Sonography program, the applicant must possess additional

non-academic skills. These technical standards are consistent with the duties of an entry-level sonographer in a

professional position. The applicant must have the ability to:

 Lift and carry 30 pounds of weight

 Lift and transfer patients to and from wheelchairs, stretchers, beds, and imaging tables

 Move, adjust, and manipulate equipment to perform imaging studies

 Position patients for exams

 Respond appropriately to sounds such as the patient’s voice and movements in a normal conversational

volume

 Review and evaluate recorded real-time images to determine the quality of the image, as well as demonstrate

visual accuracy in differentiating among subtle shades of grays used in Diagnostic Medical Sonography

 Respond appropriately to equipment signals such as sound and light

 Manipulate the necessary hospital equipment for patient care and patient imaging, such as dials, switches,

push buttons, and keyboards

 Stand and perform exams for a prolonged period without breaks in a typical shift of eight to twelve hours

 Fluent communication in the English language to function effectively in the program and at clinical sites

 Position a transducer device in a back and forth manner while maintaining balance

 Communicate orally and in writing with patients, physicians, and other personnel; clearly and effectively

 Be able to follow verbal and written directions

Statement on Clinical Education

The purpose of clinical education is to provide the student with necessary patient experiences where refinement of

the use of theoretical principles learned in the didactic portion of the program can take place. Students may be

required to rotate through multiple clinical education centers. Students will not replace members of the affiliated

clinical staff; they will have the status of students. Typically, students are not paid for clinical hours.

Please be advised that the AAS Sonography Degree Program follows a rigorous curriculum requiring serious

student memorization, practical application of theory, coursework, and transportation to/from class and

clinicals. It is a full-time program. Taking personal time off (i.e. vacations) outside scheduled breaks is not

permitted and will affect program continuation.

Last Updated 5/18/2021 6

Non-Discrimination Statement

The College prohibits discrimination in its admissions, employment, and educational programs or activities on

the basis of race, color, sex, religion, creed, national origin, age, ancestry, marital status, sexual orientation,

gender identity and expression, arrest record, military status or unfavorable military discharge, citizenship

status, and physical or mental disability. The College will protect an individual’s right to express their

viewpoint or opinion, so long as it does not violate State or Federal law and is not detrimental to the College.

This Policy against discrimination applies throughout all College environments, whether on campus, at work assignments

off campus, at College-sponsored social functions, or otherwise.

Procedures to facilitate the College’s prohibition of discrimination will be promulgated consistent with the Policy. (Board

Policy 20-5).

Student Email Policy

College of DuPage will send all official communications to you through your official COD email (dupage.edu).

You will no longer be able to use a preferred email account. You do have the option to forward these

communications to a personal email account if you wish.

Check your COD email weekly for possible important information including but not limited to:

 Official COD communications

 Possible DMIS Application Material Inquiries

 Possible DMIS Applicant Interview Appointment Invitation

 Accept/Decline/Alternate letters of decision and/or related information

 Financial aid communications

 Petition to graduate

 Transfer credit evaluation

 Prerequisite proof Sensitive

 FERPA-related communications

 Transcript order

 Important messages from instructors

For more information on the student email policy go to:

https://cod.edu/student_life/resources/information_technology/email/email-policy.aspx

Citizenship/Visa Status

If you are not a U.S. citizen or a permanent resident of the U.S., and/or if you have any questions or concerns

regarding your eligibility to participate in health sciences programs, please contact the International Student

Office, SSC 2225, (630) 942-3328, e-mail: intlstdt@cod.edu.

Qualified applicants will be considered out-of-district in the admissions ranking process if they are not a:

 U.S. citizen

 Permanent resident

Last Updated 5/18/2021 7

Application Materials Checklist

NOTE: Admission Committees for Health Science programs have the right to deny admission to any applicant that

they feel is unable to fulfill the essential functions as described in this packet.

*It is the applicant’s responsibility to ensure that all application requirements have been completed and

received by the designated office, by the application deadline.

To be considered for admission into the Sonography Program, an applicant must follow the below steps in

sequence:

______ 1. Attend a highly recommended Diagnostic Medical Imaging Sonography Advising Session. Please

click on the PDF link below as it contains upcoming dates/times that we will be doing via ZOOM.

You do not register to attend or you can view our Advising Session PowerPoint.

______ 2. If you have not been admitted to College of DuPage, please complete the non-refundable $20

College of DuPage General Admissions Application online. This application is for general

admissions to College of DuPage only; it is not an application to the Health Career Selective

Enrollment AAS Sonography program.

______ 3. To ensure that all of your eligible credits are evaluated towards the admission requirements, turn in

ALL official Transcripts from institutions that you have attended. Immediately:

a. Submit your official transcript(s) to College of DuPage, Office of Student Records. If College

of DuPage is the only institution you have attended, you do not need to request official

transcripts.

b. Verify receipt of your transcript(s). Log into myACCESS account, click on ‘myACCESS for

Students’, select ‘My Profile’. The receipt status of your transcript will be listed under

‘Transcript Institutions’.

NOTE: If you have an international transcript from high school or college, it must first be evaluated.

Please visit the following website https://www.cod.edu/registration/records/trans_eval_listing.aspx

for details.

______ 4. Schedule an appointment with a Health Program Advisor by calling 630-942-2259. The Health

Program Advisor will develop an Academic Plan to ensure you complete all prerequisites in the

correct order. Please be sure to discuss other application requirements during this appointment

* Please see page 11 for listing of required minimum core courses.

o NOTE: All prerequisite and general education courses must be completed by the end of

Spring 2022 semester, preceding Fall 2022 admission.

______ 5. Complete the non-refundable $50 Health Career Selective Enrollment Program Application online

by logging into the student portal at https://inside.cod.edu

 Click on myACCESS for Students

Last Updated 4/8/2022 8

 Click on the Health Careers Applications link

 Select Health Careers Application

 Select Diagnostic Medical Imaging Sonography Degree when asked “What selective

enrollment program are you applying to?”

Once the application is submitted, you may not change the term or program. If you do not have

a credit card, you can purchase a prepaid credit card from your local retailer

______ 6. Provide documentation of experience working with patients in a healthcare setting (if you have relevant

experience) or provide proof of experience working directly with others. Letter provided must be on

company letterhead, created by a supervisor at the facility, stating that a minimum of 20 hours were

completed, within the last 3 years. (The Service Learning Placement project in DMIS 1110 does not

count for this requirement). Please e-mail to hsadmissions@cod.edu.

______ 7. Complete the College of DuPage Residency Verification form and provide proof of residency to the

Office of Student Registration Services by e-mailing to registration@cod.edu by the program application

deadline date. Note: If this residency requirement has not been submitted to Registration by the

program application deadline date, you will not be considered for admission.

The proof must demonstrate that the student lived in an in-district address for at least 30 days prior to

the Health Career program application deadline date.

Please note: Separate Residency Verification Forms must be submitted for each program

application.

______ 8. (*NOTE - Only those applying to this cycle - for Fall 2022 admission should take the HESI exam.

We are transitioning to a different test starting with the next cycle - for Fall 2023 admission. Details

TBA.

Take the HESI Admission Assessment exam at the Glen Ellyn Testing Center prior to the application

deadline. Visit the Testing Center webpage register for upcoming test dates. The test will take

approximately 4 hours to complete. Please plan accordingly.

Last Updated 4/8/2022 9

Your first step towards taking the HP-HESI exam is to email the Testing Center at

academictesting@cod.edu for payment information. The Testing Office will then send you

information on how to pay for the test. You will actually pay for the Evolve test. Within 2 business

days, you will receive an email from the Testing Office on how to register for the test.

For more information about the exam and how to prepare visit Admission Assessment Exam Review

book

You will be tested in the following areas: Reading Comprehension, Vocabulary & General

Knowledge, Math, and Anatomy & Physiology. You will also complete the Learning Style section,

but this section will not be awarded any merit points. A score of 50% or higher must be obtained

on the Vocabulary & General Knowledge portion of the exam to be considered eligible for

admission. For more information about how merit points are awarded, please refer to the merit score

evaluation sheet on page 12.

When applying to the Sonography programs at College of DuPage, the HESI A2 exam can be taken

up to a total of 2 times with at least a 30-day interval between the two exams. Any additional repeat

exams are not accepted for a period of at least 3 calendar years. Students should register early due

to limited seats per session. HESI A2 testing must be completed within two years of applying to the

program in order for it to be valid for application purposes. The most current exam scores will be

used on the merit evaluation. Applicants are able to sign into their HESI account to review their

results at any time.

______ 9. Submit three (3) Recommendation Forms (pages 13-14), from individuals who can attest to the

applicant’s work and/or academic ability. Forms completed by friends or relatives of the applicant are

unacceptable. The enclosed form must be used according to the instructions on the form. All

recommendation forms need to be submitted after you have completed & submit the $50 health

Career application. Recommendation Forms must be submitted e-mailed to hsadmissions@cod.edu.

NOTE: When e-mailing forms to hsadmissions@cod.edu, the form MUST be submitted by the

recommender. Submissions by the applicant will not be accepted.

1. One copy of the form must be completed and mailed in by one of the applicant’s college-level

instructors

2. One copy of the form must be completed and mailed in by an employer or Clinical Instructor

3. A third copy of the form needs to be completed and turned in by an additional college-level

instructor or an employer/manager/supervisor of the applicant.

______ 10. You will be contacted via COD email by the Sonography Admissions Committee for an interview

after most of your application materials have been submitted. Interviews are not handled by the

Nursing & Health Sciences Division. Interviews start in April/May. It is the applicant’s responsibility

to monitor their COD email for communications from the college during the application period.

“All application documents delivered to the College of DuPage pertaining to a health sciences admissions file

become the property of the College of DuPage and will not be returned to the applicant. This includes but is not

limited to transcripts, letters of recommendation, clinical evaluation forms or outside test reports.”

*Applicants interested in re-applying will need to start over and resubmit all application items

during the new application cycle. COD does not save application materials.

Last Updated 5/18/2021 10

Admissions Process

The AAS Sonography Degree Program can admit only a limited number of students. The number of students

selected is determined by the current availability of clinical sites and may vary from year to year. An Admissions

Committee, consisting of DMIS faculty will oversee the selection process using a Merit Evaluation based upon

admission requirements. Students are admitted to the program according to Merit Evaluation scores and

residency. Admission to the program is not a guarantee of completion of the program nor does it guarantee

employment upon graduation.

Letters of decision (accept, decline, alternate) are mailed to each applicant approximately 4 weeks after the

application deadline. Accepted applicants must confirm their desire to accept in writing (on a provided form) within

a two-week period. If no response is received, the next qualified student on the alternate list, according to Merit

Evaluation rank order, will be offered acceptance into the program. Students re-applying are advised to contact a

Sonography faculty member to review their file early to see if they can improve their score in any way.

Requests for admission do not carry over to the following cycle. Applicants who were not accepted for the cycle in

which they originally applied will need to pay the $50 non-refundable Health Career application fee and submit

any/all supporting documents again as listed on the Admissions Checklist of the Application Packet requirements

(if applicable).

Last Updated 2/24/2022 11

GENERAL EDUCATION CORE

PREREQUISITES:

The required minimum core courses are as follows:

COURSE # COURSE TITLE GRADE

REQUIRED

ENGLISH 1101 English Composition I “C” or higher

SPEECH 1100 or 1120 Fund. Speech Communication “C” or higher

(or equivalent) Small-Group Communication

A&P 1552 or 1572* Human Anatomy & Physiology II ‘B’ or higher

or Human A&P with Cadaver II

*Prerequisite: A&P 1551 or 1571 with a grade of ‘B’ or higher

HUMANITIES Any Humanities Course ‘C’ or higher

PSYCH 1100 (or equivalent) General Psychology ‘C’ or higher

HLTHS 1110 Biomedical Terminology ‘B’ or higher

MATH 1120 Mathematical Foundations for DMIS ‘B’ or higher

*Algebra/Statistics/or higher AND Gen. Physics or Radiographic Physics ‘B’ or higher

DMIS 1110 Basic Patient Care Skills for Sonographers ‘B’ or higher

DMIS 1105 Intro to Pathophysiology for Sonographers ‘B’ or higher

For those utilizing Financial Aid -

*Please note that financial aid will not cover Algebra/Statistics/or higher AND Gen. Physics or Radiographic

Physics when taken instead of MATH 1120.

If you wish to take ANAT 1552 or 1572 AND DMIS 1105 Pathophysiology for Sonographers concurrently (at the

same time), a permit is required to register so please follow below registration directions:

1. Request a permit in MyAccess

2. Go to myaccess.cod.edu - log in and select 'request a permit'

3. Identify which semester (fall or spring) and which section of DMIS 1105 Pathophysiology for

Sonographers you wish to register. See the COD Class Schedule in MyAccess for specific course

information.

NOTE: The DMIS Program is undergoing revisions. Please monitor this program admission

packet for updates and/or modifications.

CATALOG INFORMATION FOR AAS:

https://www.cod.edu/academics/programs/pdf/career/dmis-degree.pdf

Last Updated 5/18/2021 12

Diagnostic Medical Imaging Sonography Associate Degree

Merit Evaluation

(Subject to Change)

For your reference only; admissions committee completes this form. Do not fill out and submit

NAME: ____________________ Student ID: _______________ DATE: _____________________

Anatomy and Physiology 1552 or 1572 (Scale A)

DMIS 1105 Pathophysiology (Scale A)

DMIS 1110 Basic Patient Care (Scale A)

HLTHS 1110 (Scale A)

Recommendation Form 1 (academic) (Scale B)

Recommendation Form 2 (employer) (Scale B)

Recommendation Form 3 (Scale B)

HESI A2 Score – 8 Total Points (4 Sections Considered)

Scores will be taken from the most current exam only

Anatomy & Physiology, Math, Reading Comprehension and Vocabulary

Score >75% = 2 point

Score 50-74% = 1 point

Score <50% = 0 points

Interview – (up to 12 points possible) ____________

Total Points

Scale A

A: = 4 points

B: = 3 points

C: = 0 points

D: = 0 points

Scale B

Outstanding = 5 points

Very Highly = 4 points

Recommend = 0 points

With Reservations = 0 points

Do not recommend = 0 points

Last Updated 5/19/2020 13

College of DuPage Sonography AAS Degree Program

Student Recommendation Form

(Must be e-mailed

to hsadmissions@cod.edu by May 17, 2022 at 5pm)

Section A: Must Be Completed By Applicant

Applicant’s Name: ____________________________________________________________________

Street Address: _______________________________________________________________________

City: _________________________________ State: _____________ Zip Code: ____________

Applicant’s E-mail Address: ____________________________________________

The Family Educational Rights and Privacy Act (PL 93-380) allows a candidate to waive his/her rights of access to

recommendations written on his/her behalf if the recommendation is used solely for the purpose of admission. You are not

required to waive access. Under the legislation, you have the option of signing a waiver.

Check one and sign: _____ I waive my right of access to this recommendation

_____ I do not waive my right of access to this recommendation

Applicant’s Signature: ________________________________________________

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Section B: Must be completed by applicant’s instructor or employer. Please proceed only if Section

A has been completed and signed by the applicant.

The above individual is applying for admission to the Diagnostic Medical Imaging Sonography AAS Degree Program. The

DMIS program requires the completion of three (3) recommendation forms. One (1) must be completed by a college-level

instructor of the applicant, one (1) must be completed by an employer/manager/supervisor, and the remaining form (1) needs

to be completed by either an additional college-level instructor OR an employer/manager/supervisor of the applicant.

Recommendation forms completed by friends or relatives of the applicant are unacceptable. Please rate the applicant on

the following characteristics by checking the appropriate boxes.

Outstanding

Excellent

Good

Fair

Poor

Unable to Assess

Academic Ability

Clinical Ability

Written Language Skills

Oral Language Skills

Maturity

Respect for Others

Motivation

Dependability

Punctuality

Critical Thinking

Kinesthetic Awareness

Leadership

(Page 1 of 2)

Last Updated 5/19/2020 14

How long have you known the applicant? _________________________________________________________

What is your relationship to the applicant? (i.e. instructor, clinical supervisor) ___________________________

How well do you know the applicant? (Please check one) _____ very well

_____ fairly well

_____ not very well

What do you feel are the applicant’s strengths?

What do you feel are the applicant’s weaknesses?

Summary of Recommendation (please check one)

_____ Recommend as outstanding

_____ Recommend very highly

_____ Recommend

_____ Recommend with reservation

_____ Do not recommend

Name of person completing this form: _______________________________________ Date: ______________

Signature: ________________________________________________

Title: ____________________________________________________

Institution or Facility: _________________________________________________________________________

Address: ____________________________________________________________________________________

Phone: _________________________________

Please e-mail the form to hsadmissions@cod.edu. The e-mail MUST come from the evaluator filling out the

form on behalf of the student.

(Page 2 of 2)

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

COLLEGE OF DUPAGE Diagnostic Medical Imaging Sonography Associate (College of DuPage)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank COLLEGE OF DUPAGE Diagnostic Medical Imaging Sonography Associate (College of DuPage) Form

Related forms

Fillable COLLEGE OF DUPAGE Diagnostic Medical Imaging Sonography Associate (College of DuPage)

Fill Online, Printable, Fillable, Blank COLLEGE OF DUPAGE Diagnostic Medical Imaging Sonography Associate (College of DuPage) Form

Related forms

First 20 documents completely FREE!