Fillable Radiologic Technology Program Application Checklist (Clovis Community College)

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Radiologic Technology Program Application Checklist (Clovis Community College)

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Radiologic Technology Program Application Checklist
For the Radiologic Technology Program Application to be considered complete, the applicant must have
completed the following list of requirements. Applicants must initial next to each item to indicate their
understanding of the requirement.
INT
CCC Admission Application – If not currently enrolled in CCC, complete an
Application for Admissions to Clovis Community College by JULY 1st. Your Radiologic
Technology Program Application will not be processed if you do not have a current
application for admission to CCC on file.
Radiologic Technology Program Application – Complete all sections of the Radiologic
Technology Program Application and turn into Admissions prior to JULY 1st.
Transcripts – Official copies of all college transcripts must be sent directly to the Office
of Admissions and Records and arrive prior to JULY 1st.
Prerequisite Courses – Applicants must have completed ALL prerequisite courses as
detailed on the degree plan prior to enrollment in to the Radiologic Technology Program.
Applicants who are enrolled in the last of these prerequisites may still submit their
application for the following semester but will only be considered if they successfully
complete the prerequisite(s) enrolled in.
Applicants who are completing prerequisites at another college, must notify
Admissions when turning in their RADT application. Official transcripts must be
sent to CCC immediately upon completion of the class. Failure to do so will
results in the application being considered incomplete.
BIOL 2210C*, BIOL 2225C*, MATH 1130*, and NSG 105 (*previously BIO 211,
BIO 212 and MATH 113) must have been completed within five (5) years prior to
the semester applying for. See Degree Plan for more details.
Grade Point Average – Applicants must have a minimum prerequisite grade point
average (GPA) of 3.0, including all colleges and universities attended, to be considered
for the Radiologic Technology Program.
Academic Advising – Applicants are encouraged to meet with Academic Advising prior
to submitting their application to ensure that all requirements are satisfied.
All of the Health Science Programs at Clovis Community College require criminal
background checks and drug screenings prior to admittance into the clinical setting.
Failure to pass one or both could result in dismissal from the program. Applicants with
felony convictions and certain misdemeanors may not be allowed in the clinical sites or be
eligible to take the American Registry of Radiologic Technologist national certification
examination. Disqualifying convictions are determined by the Department of Health and
not CCC.
ACKNOWLEDGEMENT
I understand that admission into the Radiologic Technology Program is competitive
and strictly based on the prerequisite GPA of all applicants. A minimum GPA of 3.0 does
not guarantee acceptance.
I understand that determinations on acceptances for the Fall semester are not made until
after grades are posted by the CCC Registrar for the Summer semester.
I understand that all correspondence regarding my application and acceptance into the
Radiologic Technology Program will be conducted through CCC email. Failure to check
my CCC email may result in missed information or deadlines.
I understand that as a student in the Radiology Technology Program it will be my
responsibility to obtain and maintain all current immunization and compliance
requirements.
ACNOWLEDGEMENT OF TRAVEL REQUIREMENTS
I understand that travel will be required to attend clinical. Clinical sites are located
within Eastern New Mexico and West Texas, with the furthest site being 120 miles from
Clovis.
I understand that I will be responsible for all travel costs and arrangements, including
but not limited to transportation and lodging.
I understand that inability to travel for any reason will prohibit me from being in the
Radiologic Technology Program.
ADVISING
Applicants are responsible for meeting with an Academic Advisor to file a current Radiologic
Technology degree plan and to review the information contained in the Clovis Community College
Catalog. The policies and regulations contained in this catalog apply to all applicants, including those
who have filed and are following degree plan requirements of an earlier catalog. Some policies and
requirements may be subject to change based on program requirements. If you have any questions
regarding the degree plan, contact the Academic Advising Center, located in the Dr. H.A. Miller Student
Services Center, or call (575)-769-4020.
I, _______________________________________, have fully read and understand the application
requirements for consideration for the CCC Radiologic Technology Program. I understand that my
application will not be forwarded to the Radiologic Technology Program for consideration if I fail to
complete any of these requirements by the July 1
st
deadline.
Applicant’s Signature
Date
Applicant
Information
Radiologic Technology Program
Application
Note: If you change your address or telephone number, you must notify the Admissions
and Records Department and the Allied Health office in a timely manner.
Is this your rst application to the program: Yes_____ No_____
If no, list the year of previous application: ____________________
Have you attended another college since your last application: Yes____ No____
Where did you attend_______________________________________________________
________________________________________________________________________
If yes, you must request an ofcial copy of your transcript(s) to be mailed to the Ofce
of Admissions and Records, or you may walk in an ofcial, sealed copy.
First Middle Last (Maiden)
Date of Birth
Address
City/State/Zip
For importane application and transcript deadline information, please refer to page one of the
Radiology Technology Program application process
Please print legibly
Primary Phone
Secondary Phone
CCC Email (required)
Name
Phone
Name
Phone
Contact Information Emergency Contacts
Signature
Applicant's Signature Date
Revised
November 2017
C
Male Female
Home
Ce
ll
Home Cell
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signature
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Name
Student ID #
Provisional
Agreement
I understand that my application to the Radiologic Technology Program at Clovis Community
College is on a PROVISIONAL BASIS pending receipt of transcripts from the following
school(s)/college(s)
1.
2.
3.
4.
5.
6.
I agree to complete my Radiologic Technology Program application file no later than the
published deadline for the semester in which I am applying. I understand that if my file is not
complete by the published deadline it will not be forwarded to the Radiologic Technology
Program Director.
Applicant’s Signature: Date:
C
______ I understand that all corrospondance regarding my application and acceptance into the
Radiologic Technology Program will be conducted through CCC email. Failure to check my
CCC email may result in missed information or deadlines.
Initial:
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Radiologic Technology Program Application Checklist (Clovis Community College)

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Completed 26 July 2020

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