Fill - Free fillable Clinical Trials Research AAS Degree Admissions Application (Durham Technical Community College) PDF form

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 AAS Degree 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

Spring Start: Due December 4

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.

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)

Revised 1/30/20 Page 1 of 2

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 the criminal background check and drug screening are not required to be completed prior to applying

to the Clinical Trials Program (this will be started after attending mandatory orientation).

I understand upon my acceptance to the Clinical Trials (CTR) 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 CTR program but am denied clinical

placement by any of the hospitals/healthcare facilities, I will be unable to successfully complete the CTR 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 CTR program. Students are only allowed two entries (admissions) into the CTR

program.

I understand that upon acceptance to the CTR 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 Clinical Trials 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

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Clinical Trials Research AAS Degree Admissions Application (Durham Technical Community College)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Clinical Trials Research AAS Degree Admissions Application (Durham Technical Community College) Form

Related forms

Fillable Clinical Trials Research AAS Degree Admissions Application (Durham Technical Community College)

Fill Online, Printable, Fillable, Blank Clinical Trials Research AAS Degree Admissions Application (Durham Technical Community College) Form

Related forms

First 20 documents completely FREE!