Rev. 3/28/2018
My external transcripts have been evaluated by KCC. Submit your transfer course report from
STAR accessible via the UH Portal (myuh.hawaii.edu).
My external transcripts have not been evaluated by KCC. Submit unofficial copies with this
application, send official copies to the KCC Kekaulike Information & Service Center, complete
Online request for Transcript Evaluation. To complete this form, you must log in with your UH
Email account. Complete this form at:
http://go.hawaii.edu/oxG
6. □ The State of Hawaii requires individuals to be 18 years of age or older to shoot x-rays in Hawaii. Will you be
18 years old by the start of the program? YES NO
7. □ “My Plan Initiative.” Complete self assessments.
8. □ If accepted into the program, you must attend both Mandatory Orientation Sessions during the summer.
Mandatory Orientation #1 is on the third Tuesday in June, Mandatory Orientation #2 is on the third
Tuesday in July.
QUALIFICATION FOR ADMISSION TO THE RADIOLOGIC TECHNOLOGY PROGRAM:
Applicants must complete all prerequisites for the Radiologic Technology Program with a “C” grade or higher. In addition, qualifying
scores on the Admissions Assessment (A
2
) are required: Math (75%), English (Reading Comprehension 75%, Vocabulary and General
Knowledge 75%, and Grammar 75%), and Anatomy & Physiology (75%).
SELECTION PROCESS FOR ADMISSION TO THE RADIOLOGIC TECHNOLOGY PROGRAM:
Selection is based on rank. Applicants receive points for grades for completed prerequisite and support courses and the cumulative
score on the A
2
. Applicants are ranked in the following order: Qualified, State of Hawaii residency, and total points. In the event of a
tie, prerequisite course GPA will be calculated and examined. If this does not provide a clear tie-break, cumulative GPA from all
institutions where prerequisite courses were taken will be examined.
APPLICANT CERTIFICATIONS:
I certify that the answers and responses provided for all of the items on this Admissions Application/Check List are true to the best of
my knowledge and belief. I understand that providing incorrect or false information will subject me to the requirements and/or
discipline measures as provided under the University’s Student Conduct Code. I understand that if I am not accepted into the program
of application, I must submit a new application and all required documents for any subsequent semester. I also allow KISC to change
my major and home institution if I am accepted into the RAD TECH program. I understand that if I am not accepted into the RAD
TECH program, my home institution and major will not change.
“Health care students are required to complete University prescribed academic requirements that involve practice
in a University affiliated health care facility setting with no substitution allowable for the completion required
clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not
satisfying academic program requirements. It is the responsibility of the student to satisfactorily complete any
background checks and drug testing that may be required by the affiliated health care facility to which he/she is
assigned for clinical practice in accordance with procedures and timelines as prescribed by that affiliated health
care facility.”
I have read and understand the notification that a background check and drug test may be required for entry into clinical practice. I
also understand that clinical practice is required for completion of this program. ________ (please initial)
If accepted into the program, I understand that I must submit a UH System Application (if not already an “active” student) for the Fall
semester by the first Orientation. __________ (please initial)
I understand that priority selection is given to Hawai‘i State residents for tuition purposes and that non-residents will be considered
after all qualified residents have been accommodated per Board of Regents Policy. ________ (please initial)
Print Name ____________________________ Signature ________________________ Date_____________
Health Sciences Department
