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DELGADO COMMUNITY COLLEGE ALLIED HEALTH DIVISION (Delgado Community College)

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12/2015
DELGADO COMMUNITY COLLEGE
ALLIED HEALTH DIVISION
Office of Admissions
615 City Park Avenue
Building 4, Room 313
New Orleans, LA 70119
Phone: 504-671-6201 Fax: 504-483-4609
Thank you for your interest in the Diagnostic Medical Sonography Program.
Please review all instructions before beginning the application.
YOUR ADMISSIONS PACKET FOR THE SONOGRAPHY PROGRAM SHOULD
CONTAIN:
*Application
*Recommendations in Sealed Envelopes
*Documentation of Observation form(s) in Sealed/Signed Envelope(s)
*Official Transcripts of all Colleges attended
*Personal Statement (Narrative)
APPLICATION PACKET "POSTMARK" DEADLINE
If the deadline falls on a weekend, the deadline will be the following weekday.
You may hand deliver to City Park Allied Health Admission Office
MAY 1
st
(Class Beginning – August each year)
APPLICATION INSTRUCTIONS
Your application form will be processed only if the packet is complete. We request that you
carefully complete the forms and include all supplemental documents required.
FAILURE TO PROPERLY COMPLETE THE FORM WILL SIGNIFICANTLY DELAY
OR PREVENT THE PROCESSING OF YOUR APPLICATION.
Application and Personal Statement must be “Typed”
Be sure to date and sign your application.
An incomplete or illegible application will not be processed.
Keep a copy of the application for your records.
EACH PAGE OF EACH DOCUMENT MUST INCLUDE APPLICANT’S NAME AND DATE.
12/2015
TRANSCRIPTS
An official transcript is required for EACH college or university attended other than
Delgado. These MUST BE INCLUDED IN ALL FILES FOR PROGRAM
APPLICANTS. If the transcript is for a college outside Louisiana, you must also
submit course descriptions to aide in determining course equivalencies.
The transcripts should be returned (in sealed envelopes) enclosed with your application
packet that will be submitted to the Allied Health Admissions Office.
PLEASE DO NOT OPEN THE SEALED ENVELOPE(S).
If academic renewal has been granted by another college you must submit the transcript as
documentation.
Note: If you send your application packet DURING ANY semester,
while you are enrolled in a college/university, it will be necessary
for you to submit updated transcripts after completion of that
particular semester.
APPLICATION ACHNOWLEDGEMENT
Acknowledgement and Notification of Missing Credentials:
An Acknowledgment verifying receipt of your application by the Allied Health Admissions Office will be sent via
email provided on Application. Notification of Missing Credentials email may be sent at a later date if your
application packet is missing any information.
DOCUMENTATION OF OBSERVATION FORMS
Distribute the Documentation of Observation Forms to the appropriate individuals accompanied by a self-addressed,
stamped verification return envelope. When the verifications are returned to you, DO NOT OPEN – envelopes
with broken seals will NOT be reviewed. (The individual who prepares your evaluation may deliver it to you in
person only if sealed and signed, then include in your packet for submission)
RETURN TO THE OFFICE OF ALLIED HEALTH ADMISSIONS
Completed APPLICATION (Be sure it is dated and signed.)
Sealed, Signed envelope(s) containing official TRANSCRIPTS from every
college or university attended other than Delgado
2 Letters of Recommendation in sealed, signed envelopes (professional references
required.)
Documentation of Observation Form, from each Observation Site attended, in sealed
and signed envelope(s).
Typewritten Personal Statement (Narrative)
RETURN ALL OF THE ABOVE DOCUMENTS TO:
DELGADO COMMUNITY COLLEGE, ALLIED HEALTH DIVISION, OFFICE OF
ADMISSIONS, 615 City Park Avenue, Building 4, Room 313, New Orleans, LA 70119.
NOTE 1: If you have any questions after reviewing the application,
Please contact the Allied Health Admissions Office – (504)-671-6201.
NOTE 2: Questions regarding program interviews, curriculum, academic
schedules or special circumstances should be directed to the Clinical
Director, Michael Toups – (504)-571-1435 or mtoups@dcc.edu.
Technical Standards: See Diagnostic Medical Sonography Program Webpage on the College
Website. dcc.edu
Diagnostic Medical Sonography Program - Post-Associate Certificate
ADMISSION APPLICATION FORM
Delgado Community College is an equal opportunity facility. The College does not discriminate on the basis of race, color,
national origin, gender, age or qualified disability. Successful entry as a student in the program of Diagnostic Medical
Sonography will be based upon the merits of past education, medical experience, references, responses to the questions on the
application form and possible interview.
This Application must be Typed. Illegible or incomplete applications will not be processed.
It is recommended that you make a copy of this application for your records. Be sure to sign and date this application.
PERSONAL DATA:
1. Social Security Number: _______________________________ CW ID(Lola) #__________________________________
2. Full Legal Name: ____________________________________________________________________________________
Last First MI
3. Permanent Home Address:
______________________________________________ __________________________ ______________________
Number & Street Home Phone (Area Code and Number) Cell Phone
__________________________________________________________ ________________________________________________________________
City State Zip E-Mail Address
4. Current mailing address if different from permanent address:
_________________________________________________________
Number & Street
_________________________________________________________ __________________________________________
City State Zip Area Code and Phone Number
5. Emergency Information:
_____________________________________________________________________________________________________________________________
Person to Contact Relationship Area Code and Phone Number
EDUCATIONAL DATA:
6.
List all high schools, trade or vocational schools (use separate sheet if necessary)
Name of School Location Grade Entered Grade Completed Graduated
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
7. List all colleges and universities you have attended (use separate sheet if necessary)
Name Location Major Dates Attended Degree
__________________________________________________________________________FROM_______TO_______ ________________________
Mo/Yr Mo/Yr
__________________________________________________________________________FROM_______TO_______ ________________________
Mo/Yr Mo/Yr
__________________________________________________________________________FROM_______TO_______ ________________________
Mo/Yr Mo/Yr
8. Are you presently enrolled in college? Yes_______ No_______ Semester_________ Institution_______________________________________________
List courses you are taking this semester.___________________________________________________________________________________________
____________________________________________________________________________________________________________________________
EMPLOYMENT DATA:
9. List your employment experiences over the past 10 years, including military service. Add additional sheet if necessary.
1. ________________________________________________________________________FROM_______TO_______ ________________________
Mo/Yr Mo/Yr
2. ________________________________________________________________________FROM_______TO_______ ________________________
Mo/Yr Mo/Yr
3. ________________________________________________________________________FROM_______TO_______ ________________________
Mo/Yr Mo/Yr
10. Are you reapplying for this program? Yes_____ No _____. If yes, when did you last apply?__________________________________________________
11. Are you a veteran of the US Military Service? Yes _____ No _____. If YES, are you eligible for and certified by the Veterans Administration for education
benefits? Yes _____ No _____ If YES, attach page to this application and give branch of service, dates entered and separated from service, rank at time of
separation and type of discharge.
12. Are you a member of the National Guard or Reserve? Yes_____ No _____. If YES, attach page to application and give branch, days and number of meetings
attended each month.
13. Have you ever been suspended or dismissed from any college or university for scholastic or disciplinary reasons? Yes_____ No_____. If YES, give name of
institution, date and reason for this action. ___________________________________________________________________________________________
14. Have you applied for admission to other Allied Health Programs at Delgado? Yes_____ No_____. If YES, give the program name and dates.
_____________________________________________________________________________________________________________________________
15. Are you a U.S. Citizen? Yes_____ No _____.
16. Optional Response: If you have a disability, describe on a separate page any special equipment, architectural modifications, or other factors which would have to
be considered by you and by the School/department in planning your educational experience at Delgado Community College if you are accepted for admission.
ALL APPLICANTS PLEASE READ CAREFULLY AND SIGN THE FOLLOWING
Other than a minor traffic violation, have you ever been convicted of a felony? Yes_______ No _______ If yes, please explain on additional page.
NOTE: The National Certification Boards may refuse to grant Certification to persons who have been convicted of a felony.
I understand that the information submitted on this application for admission to Delgado Community College’s Allied Health
program in my name will be relied upon by Delgado Community College officials to determine my status for admission
eligibility. I authorize Delgado Community College officials to verify any information I have provided. I further authorize
any and all educational institutions, governmental agencies, and private employers that I have attended, worked for, or who
maintain records related to me to release such information to Delgado Community College.
I agree to notify Delgado Community College’s Allied Health Admissions Office of any changes to the information provided.
I certify that the information in this application is complete and correct and understand that submission of false, incomplete,
or incorrect information is grounds for rejection of my application, withdrawal of any acceptance offer, cancellation of
enrollment, or appropriate disciplinary action. I understand it is also necessary to conform to the program’s technical
standards and requirements concerning a physical examination. If accepted, I agree to abide by and observe all program and
affiliate hospital policies, rules and regulations, as amended from time to time.
I also understand that this application is for the Diagnostic Medical Sonography Program only. If accepted to Program, I
must apply for admission to Delgado Community College. Completion of this form does not indicate that you are accepted
into the program.
___________________________________________________________________ ______________________________________
Signature of Applicant Date
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DELGADO COMMUNITY COLLEGE ALLIED HEALTH DIVISION (Delgado Community College)

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Completed 17 September 2020

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