Fill - Free fillable Contact the San Juan College Admissions Office for (San Juan College) PDF form

Instructions for Applying to the RT Program

Apply to San Juan College and submit all official transcripts:

• Contact the San Juan College Admissions Office for a SJC Application for Admission ($10 for paper application) or

apply free online at www.sanjuancollege.edu. Declare your major as AA.LBAS.RESP on the SJC Application.

• Send ONE official transcript from EACH college, university, and high school that you attended to the San Juan

College Admissions Office (505-566-3300) at:

San Juan College

Admissions Office

4601 College Blvd.

Farmington, NM 87402

RT Program Prerequisites:

• Visit the San Juan College website @ www.sanjuancollege.edu/school-of-health-sciences/programs/respiratory-

therapy/ to review the program prerequisites and curriculum.

• Contact the Health Sciences Academic Advisor, Gayle Hill, to arrange an appointment to review unofficial

transcripts from EACH college and university that you have attended for prerequisite information. Mr. Hill is

located at San Juan College’s main campus in the Health Sciences building and can be reached at (505) 566-

3013, or hillw@sanjuancollege.edu

Send the following RT Program Application materials to the RT Program IN ONE SEALED ENVELOPE:

☐ Completed RT Program Application

☐ Two (2) Completed Letter of Recommendations in sealed envelopes with signature over seal

☐ Completed verification Job Shadow Form

☐ Results of your ATI/TEAS Exam (Copy of score only). The Exam must be taken within one year of your

application date. Go to https://www.sanjuancollege.edu/student-services/departments/testing-center/health-

science-entrance-exam/ for additional information regarding the process to take the ATI/TEAS (Health Science

Entrance Exam). OR--If you have a degree, please submit a copy of an unofficial transcript confirming the

degree.

☐ Copies of any additional certifications and/or licenses (must be current).

☐ Schedule interview with Program Director and Clinical Coordinator prior to application deadline.

☐ Signed Acknowledgement Page.

All the materials must be received at the RT Program before 5 pm on June 29, 2018. Send to:

San Juan College

Respiratory Therapy Program

4601 College Blvd.

Farmington, NM 87402

Confirm that the RT Program Application packet has been received by June 29, 2018.

• Email the RT Program at rt@sanjuancollege.edu to confirm that the RT Program has received the application

packet on time.

Revised 2/2018

1

Selection Criteria

San Juan College RT Program will accept a maximum of 18 students in 2018. Applicants will be ranked based on

selective admission scoring.

Total Points Possible: 100

Acceptance into the Respiratory Care Program is competitive and is based on the total number of points that are

accumulated in the following section areas: A--Cumulative GPA/General education courses and prerequisite GPA,

B--Additional courses completed, C--ATI TEAS V, D--Education/Training, E--Work experience, F--Info-session

attendance, G--Current licenses. Meeting with the program director is required, but does not carry points in the

admission scoring process. The following methods are used to award points in the process of evaluating your

application. Please note that these criteria are subject to modification and may be changed without prior notice. In the

event that it becomes necessary to modify the criteria, all applications will be subject to the modification regardless of

when the application was submitted. Changes in admission criteria will be published on the program website.

CRITERIA SCORING

Maximum

Points

SCORE

Section

A

Prerequisite Grades

Cumulative GPA 20%

Program General Education and Pre-Requisites GPA 40%

60

Section

B

Additional Courses Completed

Anatomy & Physiology I

Anatomy & Physiology II

Microbiology

Medical Terminology

1.25

5

Section

C

ATI TEAS V for Allied Health Exam/Degree Education

20% of TEAS score or

20 points awarded with Associates degree or higher

20

Section

D

Education and Training

Certificate Program

Associates Degree

Bachelor’s Degree

Non-Healthcare

2

3

4

Healthcare

3

4

5

Section

E

Work Experience

Less than 1 year

3+ years

Non-Healthcare

1

2

Healthcare

2

3

Section

F

Info-session Attendance

2

Section

G

Current Licenses

CNA, EMT, BLS, PTCB--1.0 point each, total of 5 points max

Non-healthcare certifications--0.5 point each, total of 5 points max

5

***Tie breaker will be the GPA from the Math and Sciences classes. 2% of GPA points will be

awarded based on 8 credits.

100

TOTAL

Revised 2/2018

2

Program Start Date

August 20, 2018

ATI TEAS

Testing Dates for RT

May 16-June 16, 2018

Application Deadline

June 29, 2018

Decision Date

Third Monday in July

DEADLINES

Legal Limitations

Individuals who have been convicted of a felony or some misdemeanors may not be eligible for certification or licensure.

If convicted of a felony or some misdemeanors, you must contact the Respiratory Therapy Licensing Board in the state

where you plan to seek licensure to verify your eligibility for licensure. The State of New Mexico’s statute 61 article 12.B-

10 it states “The provisions of the Criminal Offender Employment Act [28-2-1 to 28-2-6 NMSA 1978] shall govern

consideration of criminal records required or permitted by the Respiratory Care Act.”

All students accepted into the SJC Respiratory Therapy Program will be required to complete a New Mexico Department

of Health criminal background check at their own expense and provide a copy to the RT Program before being allowed

to attend clinical practicum assignments.

Job Shadow

All applicants must complete the JOB SHADOW requirements. This is a volunteer observation for a minimum of four

hours at a hospital of your choice (e.g. San Juan Regional Medical Center, Mercy Regional, Southwest Memorial

Hospital, or Indian Health Services) under the supervision of a Respiratory Therapist. The purpose of this experience is to

give the applicant an opportunity to observe treatment, gain insight into the profession of respiratory care and to ensure

that this career meets your expectations and needs. It is the responsibility of the applicant to make arrangements with

an RT for this experience. The applicant is also responsible for having the supervising therapist complete the “Job

Shadow” form. All forms must be included with the application packet by the deadline.

Guidelines for observation experience:

1. Job Shadow must be completed, signed and dated within six months prior to the application deadline.

2. Contact facilities in your area. Explain that you are applying to a RT program and that you would like to Job Shadow

an RT at their site. It is up to the applicant and therapist to agree on the schedule. Remember this is a voluntary

service provided by the clinician and facility.

3. Dress appropriately. Follow the professional dress code of the facility, usually slacks, polo shirt, and tennis shoes are

acceptable. No shorts, jeans, t-shirts, hats, sandals, heavy make-up, excessive perfume/cologne, or body piercings.

Any visible markings (e.g. tattoos) should be covered.

4. Be punctual & prepared. Make sure that you know who, when, and where you will be meeting. Please call 24 hours in

advance to cancel or reschedule your appointment. Complete the information on the Job Shadow verification form

relating to the applicant, and take the form with you for a signature.

5. Maintain confidentiality. The facility may inform you about HIPAA (Health Insurance Portability and Accountability

Act) and ask you to sign a form that you will comply with this. The RT may choose to share relevant information with

you before or after the treatment session. NEVER mention a patient’s name, medical diagnosis, or treatment plan

outside of the facility.

Revised 2/2018

3

6. During the observation visit. Remain in the area(s) assigned to you by the staff member. Follow all instructions the

practitioner gives you, especially concerning how much you are to

interact with the clients. Do not ask personal

questions about the patient during the respiratory therapy treatment session.

7. Completion of job shadow. Provide the Respiratory Therapist with the Job Shadow verification form to sign. Be sure

to take the completed form with you because it must be submitted with your application.

8. Thank the respiratory therapist. Thank the hospital for allowing you to observe at their facility. Remember that this is

an observation only and that you are not allowed to assist with any treatment due to liability issues. Professional

protocol encourages you to send a formal thank you note to the RT practitioner after you finish the hours of

observation.

9. Complete Application by attaching the completed job shadow form to the application.

Letters of Recommendation

INSTRUCTIONS FOR LETTERS OF RECOMMENDATION:

Choose ONLY TWO people who will be submitting letters of recommendation on your behalf. The recommenders are

being asked to evaluate the applicant’s personal and professional behaviors. One recommendation must be from

someone who has supervised you in a work or volunteer experience. The other recommendation may be from an

instructor/professor, counselor/advisor, health care professional, previous/current employer, or community

leader/representative. Recommendations from family or personal friends are UNACCEPTABLE. Provide your

recommender with a self-addressed stamped envelope with your address to return the letter to you for you to include in

your application packet. Please have the recommender sign the back of the envelope across the seal and enclose the

sealed envelope with your application.

Non-Discrimination Policy

San Juan College will comply with existing federal and state laws and regulations, including the Title VII Civil Rights Act of

1964 and 1990, Executive Order 11246 Section 504 of the 1973 Rehabilitation Act, the Age Discrimination Act of 1967,

the Americans with Disability Act of 1990, as amended, and the Vietnam Era Veteran’s Readjustment Act of 1974. It is

the policy of the College to provide for equal opportunity in recruitment, employment, compensation, benefits,

transfers, layoffs, returns, institutionally sponsored education, training, tuition assistance, social and recreational

programs, staff development opportunities and advancement, and all other personnel practices without regard to race,

color, religion, national origin, ancestry, sex, disability, age, or veterans’ status. Questions should be directed to the EEO

officer at 566-3253.

Revised 2/2018

4

Program Cost

Fall Semester 1

Spring Semester 2

Resident

Non-Resident

Tuition/Fees*

$933

$2,653

Books

1

$677

Lab Fee

$225

$1,835

$3,555

Summer Semester 3

Fall Semester 4

Resident

Non-Resident

Tuition/Fees*

$919

$2,044

Books

1

$476

Lab Fee

$350

$1,745

$2,870

Estimated Totals for Entire Program

Resident

Non-Resident

Tuition/Fees*

$746

$2,066

Books

1

$403

Lab Fee

$350

$1,499

$2,819

Resident

Non-Resident

Tuition/Fees*

$886

$2,506

Books

1

$227

Lab Fee

$490

$1,603

$3,223

Resident

Non-Resident

Semester 1

$1,835

$3,555

Semester 2

$1,499

$2,819

Semester 3

$1,745

$2,870

Semester 4

$1,603

$3,223

TOTAL

$6,682

$12,467

*All Tuition and Fees are subject to change. Please refer to the semester schedule in reference for current rates. Fees

may include but are not limited to: Technology Fee, Student Fee, and Lab Fee.

Books

1

These expenses are estimated and may be paid to outside vendors. Book costs are estimated based on new

textbook costs at the time of printing.

** Additional costs: 12-panel Drug test, Criminal Background Check, Immunizations, BLS, ACLS, PALS, and NRP

Certification, Uniforms, Shoes, Licensure Exam, Equipment and Graduate Cap & Gown. Students are responsible

for travel and/or housing costs for all clinical assignments. Some rotations will be outside of the Four Corners

Region.

Transfer Students

It is highly recommended that any students transferring from another accredited institution speak with an academic

advisor. Gayle Hill is the Health Sciences academic advisor. He is located at San Juan College’s main campus in the

Health Sciences Building and can be reached at (505) 566-3013, or hillw@sanjuancollege.edu

Program Acceptance

Students will be notified of acceptance into the respiratory therapy program by postal mail following the third Monday

in July for a fall semester program entry. Applicants who have not met the basic program eligibility requirements will

also be contacted by mail regarding their status.

Selected students will receive a detailed information packet with specific instructions and guidelines regarding further

program requirements which are to be completed prior to starting the Fall Semester courses. Selected students are

required to attend a program orientation the week prior to the start of the fall semester.

Revised 2/2018

5

Other Requirements/Information

ESSENTIAL TECHNICAL AND ACADEMIC ABILITIES REQUIRED OF THE RESPIRATORY THERAPIST:

The following are technical standards and essential job functions for every Respiratory therapist, as compiled from

observations of a wide variety of job experiences for the performance of common safe therapeutic functions. Students

accepted into the Respiratory Therapy Program at San Juan College should exhibit or demonstrate the following

essential skills for completion of the program and success in the profession of Respiratory Care. These technical and

academic standards must be met and maintained throughout the length of the Program.

What are the technical requirements in the program?

• Physical Endurance, Mobility and Skill:

o Stand (e.g., at client side during surgical or therapeutic procedure)

o Sustain repetitive movements (e.g., CPR)

o Maintain physical tolerance (e.g., work entire shift)

o Reach below waist (e.g., plug electrical appliance into wall outlet)

o Pinch/pick otherwise work with fingers (e.g., manipulate a syringe)

o Walk fast or run (e.g., code blues/resuscitation)

• Physical Strength:

o Push and pull 50 pounds of weight (e.g., ambulate client)

o Support 50 pounds of weight (e.g., ambulate client)

o Lift 50 pounds of weight (e.g., ambulate client)

o Defend self against combative client

o Carry equipment/supplies

o Use upper body strength (e.g., perform CPR, physically restrain a client)

• Hearing:

o Hear normal speaking-level sounds (e.g., person-to-person report)

o Hear faint body sounds (e.g., blood pressure sounds, assess placement of tubes)

o Hear in situations when not able to see lips (e.g., when masks are used)

o Hear auditory alarms (e.g., monitors, fire alarms, call bells)

• Visual:

o See object up to 20 inches away (e.g., information on a computer screen, skin conditions)

o See objects up to 20 feet away (e.g., client in room)

o Use depth perception and peripheral vision

o Distinguish color and color intensity (e.g., color codes on supplies, flushed skin/paleness)

• Tactile:

o Feel vibrations (e.g., palpate pulses)

o Detect temperature (e.g., skin, solutions)

o Feel differences in surface characteristics (e.g., skin turgor, rashes)

o Feel differences in sizes, shapes (e.g. palpate vein, identify body landmarks)

o Detect environmental temperature

• Emotional Stability

o Establish therapeutic boundaries Provide client with emotional support

o Adapt to changing environment/stress

o Deal with the unexpected (e.g., client condition, crisis)

o Focus attention on task

Revised 2/2018

6

o Cope with own emotions

o Perform multiple responsibilities concurrently

o Cope with strong emotions in others (e.g., grief)

What academic skills are needed to participate in the program?

• Math

o Comprehend graphic trends and read measurements

o Calibrate equipment

o Convert numbers to and from metric System (e.g., dosages)

o Count rates (e.g., drips/minute, pulse, count duration of contractions, CPR, etc)

o Read measurement marks (e.g., measurement tapes, scales)

o Add, subtract, multiply, and/or divide whole numbers

o Compute fractions and decimals (e.g., medication dosages)

o Document numbers in records

• Analytical Thinking

o Process information from multiple sources

o Evaluate outcomes; Solve problems; Prioritize tasks

o Use long-term and short-term memory

• Critical Thinking

o Identify cause-effect relationship

o Make decisions independently

o Adapt decisions based on new information

• Communication and Interpersonal Skills

o Establish rapport with patients and interact with families and groups

o Respect/value cultural differences in others

o Establish rapport with team members

o Negotiate interpersonal conflict

o Listen/Comprehend written/spoken word

o Collaborate with others (e.g., health care workers, peers)

o Manage clinical information

COMPUTER SKILLS REQUIRED FOR THE RT PROGRAM

Students in the RT Program must be able to use a computer. Computer skills required include: email, accessing and using the SJC

Canvas course delivery system, creating documents and presentations, uploading and downloading information to and from the

internet. All students must have access to a computer on a regular basis. Students are NOT required to have a personally owned

computer or home-based high speed internet access as these materials and services are made readily available at all SJC campuses.

Revised 2/2018

7

Respiratory Therapy Application YEAR ___________ for FALL SEMESTER

Personal Information

1. Name of Applicant

________________________________________________________________________________________________________

LAST M.I. FIRST MAIDEN

________________________________________________________________________________________________________

Preferred Name:

2. San Juan College ID#

LAST FOUR digits

of your SSN#

3. Physical Address

________________________________________________________________________________________________________

STREET NAME & NUMBER APT.# CITY STATE ZIP CODE

4. Mailing Address

________________________________________________________________________________________________________

STREET NAME & NUMBER APT.# CITY STATE ZIP CODE

5. E-Mail Addresses

_________________________________________________________________________________________________________

A. Personal/Work

_________________________________________________________________________________________________________

B. Personal/Work

6. Home Phone Number

( )

7. Work Phone Number

( )

8. Cell Phone Number

( )

9. Preferred Method of

Contact

_______________________________ ________________________________ ________________________________

10. Emergency Contact

NAME

RELATIONSHIP

STATE

_______________________________ ________________________________ ________________________________

DAYTIME PHONE

EVENING PHONE

CELL PHONE

Revised 2/2018

8

Personal Information, continued

Have you ever been convicted of a felony?

☐

Yes

☐

No

Have you ever been convicted of a misdemeanor?

☐

Yes

☐

No

If yes, have you contacted the Respiratory Therapy Licensing Board in your State?

☐

Yes

☐

No

TELL US WHY YOU WANT TO GET INTO THE SJC RT PROGRAM:

(Please use another sheet of paper if needed)

Section A: Prerequisites

PREREQUISITE

COURSES

COURSE ID

(E.G. BIOL 121)

COURSE TITLE FINAL

GRADE

YEAR &

SEMESTER

COMPLETED

INSTITUTION

WHERE

COURSE WAS

TAKEN

Course

Equivalent

(for office

use only)

Freshman Composition

Public Speaking/

Interpersonal

Communication

Math for Health Careers

Introduction to

Psychology

Business

Microcomputer

Introductory Biology

Introductory Chemistry

Human Body Structure

& Function

Have you completed any of the following courses within the last 5 years?

A & P I

A & P II

Medical Terminology

Microbiology

Revised 2/2018

9

NAME OF INSTITUTION:

City: STATE:

Health Related

Dates Attended:

☐Yes ☐No

Program:

Degree and/or Certificate

NAME OF INSTITUTION:

City: STATE:

Health Related

Dates Attended:

☐Yes ☐No

Program:

Degree and/or Certificate

Date of Exam: Copy of First Page of Results

☐Yes ☐No

Attached to Application:

OR/Completion of Associates

Date Completed

☐Associate’s ☐Bachelor’s

Degree or higher

Section C: Educational Institutions

NAME OF HIGH SCHOOL:

City: STATE:

Health Related

Graduation Date:

☐Yes ☐No

Program:

NAME OF INSTITUTION:

City: STATE:

Health Related

Dates Attended:

☐Yes ☐No

Program:

Degree and/or Certificate

Section B: ATI TEAS V for Health Science Entrance Exam Results

Please document the date of your ATI TEAS V for Health Science Entrance Exam in the table below and include a copy of

the FIRST PAGE of the ATI TEAS V results with your application packet.

Revised 2/2018

10

Job Title Organization’s Name Dates Is this Healthcare related?

Name of Organization Month/Year to Month Year

Indicate Type of Experience:

☐Yes ☐No

Work/Volunteer

List Work or Volunteer Responsibilities/Skills

Job Title Organization’s Name Dates Is this Healthcare related?

Name of Organization Month/Year to Month Year

Indicate Type of Experience:

☐Yes ☐No

Work/Volunteer

List Work or Volunteer Responsibilities/Skills

Job Title Organization’s Name Dates Is this Healthcare related?

Name of Organization Month/Year to Month Year

Indicate Type of Experience:

☐Yes ☐No

Work/Volunteer

Job Title Organization’s Name Dates Is this Healthcare related?

Name of Organization Month/Year to Month Year

Indicate Type of Experience:

☐Yes ☐No

Work/Volunteer

List Work or Volunteer Responsibilities/Skills

Section D: Work Experience

Revised 2/2018

11

______________________________________________

Section E: Certifications

Do you have any State or National certifications? Examples: Basic life support, Certified Nursing Assistant, Pharmacy

Technician, Emergency Medical Technician.

Certification:

Date Completed Current

☐Yes ☐No

Expiration Date

on License

Certification

Copy of Certification

Attached to Application

☐Yes ☐No

Certification:

Date Completed Current

☐Yes ☐No

Expiration Date

on License

Certification

Copy of Certification

Attached to Application

☐

Yes

☐

No

Certification:

D Current

☐Yes ☐No

Expiration Date

on License

Certification

Copy of Certification

Attached to Application

☐

Yes

☐

No

ate Completed

Applicants Signature

Date

Revised 2/2018

12

________________________________________ ________________________________________

________________________________________

Application Acknowledgment

I, _______________________________________________, acknowledge that the following information required with

my application for the Respiratory Therapy Program must be completed and submitted by June 29, 2018 at 5:00 pm.

Please initial in front of the following to confirm that the requested information was submitted and/or acknowledged by

the applicant.

_____ Two (2) Completed Letters of Recommendations; in sealed envelopes with signature over seal.

_____ Completed Verification of Job Shadow Form

_____ Results of TEAS Exam (Copy of score only). The exam MUST be taken within one year of your application

date. If you have a degree, please submit a copy of an unofficial transcript confirming the degree.

_____ Copies of any additional certifications and/or licenses (must be current).

_____ Copy of unofficial transcripts (for GPA validation).

_____ I acknowledge that there will be additional expenses required to participate in the program: 12-panel

Drug test (May be required more than once), Criminal Background Check (May be required more than

once), Required Immunizations, BLS, ACLS, PALS, and NRP Certification, Uniforms, Shoes, Licensure

Exam, Equipment and Graduate Cap & Gown. Students are responsible for travel and/or housing costs

for all clinical assignments. Some clinical rotations will be outside of the Four Corners Region.

_____ I acknowledge that ALL students in the RT program ARE REQUIRED to attend ALL assigned clinical sites.

_____ I acknowledge that ALL students ARE REQUIRED to attend the RT PROGRAM ORIENTATION the week

before classes start.

_____ I acknowledge I have been informed of the essential technical and academic abilities required of the

Respiratory Program, and acknowledge I will be able to meet and maintain these standards throughout

the length of the program.

_____ I acknowledge a requirement to pass a New Mexico Department of Health Criminal Background Check,

and I understand that this is a requirement to attend clinical practicum assignments.

_____ I acknowledge that I must schedule an interview with the Program Director and Clinical Coordinator

PRIOR to the application deadline. Date and Time Scheduled ________________________________

_____ I understand that if required information is not included with my application for the SJC

Respiratory Therapy Program my application will not be considered.

_____ Submitted signed acknowledgement page.

Student Name (Please Print) Student Signature

Date

Revised 2/2018

13

THIS PAGE INTENTIONALLY LEFT BLANK

Revised 2/2018

14

__________________________________________________________________________________________

__________________________________________

Job Shadow Verification Form

Name: ________________________________________________________

(Please Print)

Email: _________________________________________________________

San Juan College Student ID#:______________________________________

Please read the statement below and then sign and date this form.

As a San Juan College Student in the Respiratory Therapy Program, I understand

I am required to job shadow prior to the start of the academic year.

Student Signature: ______________________________________________

Date: _________________________________________________________

Name of Hospital: ______________________________________________________________

Date Job Shadow Completed: _____________________ Hours of Observation: _____________

Name of Respiratory Therapist (printed): ____________________________________________

Signature of Respiratory Therapist: _________________________________________________

Comments:

If you have any questions concerning this form, you may call (505) 566-3854 or email rt@sanjuancollege.edu

Student must return this form with his/her completed Respiratory Therapy Application to the Respiratory

Program Administrative Assistant prior to application deadline.

Revised 2/2018

15

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