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Respiratory Therapy (RT) Associate Degree Program (Durham Technical Community College)

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Return this form to:
Admissions Registration, and Records.
View submission instructions below.
For Admissions use only.
Received by: _________
Date: __________________
Respiratory Therapy (RT) Associate Degree Program
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: February 1
Submit completed application packets November 2 through February 1.
Email Donna Alston if you have questions.
Submit completed application packets electronically to the Admissions, Registration, and Records office. Follow
the instructions to submit electronic documents using our secure system. Acceptable digital formats include PDF,
JPEG, TIFF, GIF, and PNG. No faxed or emailed applications will be accepted.
CHECKLIST: All steps below are required. Please check 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 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.
☐ I have attended a Respiratory Therapy Program information session within the past 2 years.
Date: ___________________
☐ I have completed an interview with a member of the Respiratory Therapy Program faculty.
Date: ___________________
Meet Course Placement Requirements
Students must demonstrate they are college ready in one of the following ways check one):
☐ 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
Revised 10/2020 Page 1 of 3
Note:
☐ 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) and MAT-003 through Tier 2 (grade of P2)
Meet Natural Sciences Requirement
Students who transfer in BIO 168 are not required to meet one of these requirements
Students must demonstrate readiness for BIO 168 – Anatomy and Physiology I in one of the following
ways check one):
☐ Provide proof of completing high school biology and chemistry within the last 10 years with a grade of
C (70%) or above
☐ Complete CHM 094 Basic Biological Chemistry
☐ Complete college biology and chemistry (both including a lab). Must show a grade of C (70%) or above in the
lecture and lab (no time limit).
Additional Required Documents
Students must provide all of the documents listed below with the completed application.
☐ I have attached a copy of the ATI TEAS test score showing I have achieved the minimum score requirement of
60% on the adjusted individual score within the last 3 years. Important: If you took the TEAS test at another
institution, attach your scores from ATI to your application form.
☐ I have attached a signed Clinical Training Form (attached below)
☐ I have attached a signed English Language Requirement Form (attached below)
☐ I have attached a signed Essential Skills Form (attached below)
☐ I have attached a signed Technology Proficiency Form (attached below)
☐ I have attached the completed Admissions Essay (See Rubric and Instructions on page 3)
Statement of Student Responsibility
I verify that I have read all the information regarding admissions to the Respiratory Therapy program, and understand
the steps I must take to qualify for admissions. I understand that it is my responsibility to notify the Admissions, Records,
and Registration 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 Technology
admissions decisions.
I understand that my Respiratory Therapy application will not be accepted unless everything is completed.
I understand that students who register for Respiratory Therapy classes after acceptance into the program and then
withdraw before classes begin or during the first semester will be given the opportunity to apply ONLY ONCE MORE.
Note: Once an applicant has accepted a seat within the Respiratory Therapy program, this is considered their first
admittance. Students are only allowed to be accepted into the Respiratory Therapy program twice (this also applies to
returning students – only allowed to return once).
Name
_________________________________________ Student ID#________________________
Signature _______________________________________ Date______________________________
Revised 10/2020 Page 2 of 3
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Admissions Essay Instructions and Grading Rubric
Application to the Respiratory Therapy program includes completion of a brief essay. The essay should be 1-2 pages,
typed and double-spaced using a font size no greater than 12.
The essay should address all of the following points:
• What is a Respiratory Therapist?
• What do they do?
• Where do they work?
• Why are you choosing to go into the field of respiratory care?
• What characteristics or attributes do you possess that will enhance Respiratory Therapy as a profession? Each
should be described with an example of experiences or observations that have molded such
characteristics/attributes rather than general statements for the purpose of demonstrating the uniqueness of
each individual.
How it will be evaluated
INTRODUCTION
Well-developed
Introduction creates
Introduction
Background details are a
Background/History introduction engages the interest. Thesis adequately random collection of
Thesis Statement reader and creates clearly states the explains the information, unclear, or
CONCLUSION interest. Contains detailed
background information.
Thesis clearly states a
significant and compelling
position. Conclusion
effectively wraps up and
goes beyond restating the
thesis.
position. Conclusion
effectively
summarizes topics.
background, but
may lack detail.
Thesis states the
position.
Conclusion is
recognizable and
ties up almost all
loose ends.
not related to the topic.
Thesis is vague or unclear.
Conclusion does not
summarize main points.
MAIN POINTS
Well-developed main
Three or more main
Three or more
Less than three main
Body Paragraphs points directly related to
the thesis. Supporting
examples are concrete and
detailed. The narrative is
developed with a
consistent and effective
point-of-view, showing the
story in detail.
points are related
to the thesis, but
one may lack
details. The
narrative shows
events from the
author’s point of
view using some
details.
main points are
present. The
narrative shows the
events, but may
lack details.
points, and/or poor
development of ideas. The
narrative is undeveloped,
and tells rather than
shows, the story.
ORGANIZATION
Logical progression of
Logical progression
Organization is
No discernable
Structure Transitions ideas with a clear structure
that enhances the thesis.
Transitions are mature and
graceful.
of ideas. Transitions
are present equally
throughout essay.
clear. Transitions
are present.
organization. Transitions
are not present.
STYLE
Sentence flow, variety
Diction
Writing is smooth, skillful,
and coherent. Sentences
are strong and expressive
with varied structure.
Diction is consistent and
words well chosen.
Writing is clear and
sentences have
varied structure.
Diction is
consistent.
Writing is clear, but
sentences may lack
variety. Diction is
appropriate.
Writing is confusing, hard
to follow. Contains
fragments and/or run-on
sentences. Inappropriate
diction.
MECHANICS
Punctuation, spelling, and
Punctuation,
A few errors in
Distracting errors in
Spelling, punctuation, capitalization are correct. spelling, and punctuation, punctuation, spelling, and
capitalization No errors. capitalization are
generally correct,
with few errors.
(1-2)
spelling,
capitalization. (3-4)
capitalization.
Revised 10/2020 Page 3 of 3
Statement of Policy Regarding Acceptance for Clinical Training in the Following
Programs at Durham Technical Community College
Associate Degree Nursing Medical Assisting Practical Nursing
Anesthesia Technology Occupational Therapy Assistant Respiratory Therapy
Clinical Trials Research Associate Pharmacy Technology
Surgical Technology
Health Information Technology Medical Product Safety and Pharmacovigilence
Students accepted into the above programs must meet the standards of both the College and the
affiliated clinical sites in order to participate in the appropriate clinical training for the program. Each
clinical site where a student receives training reserves the right to refuse clinical training to any student
found to be unacceptable according to that site’s policies and regulations. Clinical sites require a
Criminal Background Check (CBC) prior to the student’s placement for training at that site.
Reasons for refusal could include, among other considerations, a documented criminal background check
indicating convictions for drug or alcohol related charges, child abuse or molestation, burglary, larceny, or
other convictions deemed inappropriate to the particular clinical setting. In addition, students may be
required to submit to a 12-panel drug screening per the clinical site’s requirement.
The student must conform to and be subject to all policies and regulations of the assigned clinical site. The
site reserves the right to end clinical training of any student whose performance violates rules, policies,
procedures or professional standards expected by the agency. Written justification from the clinical site will
be provided to the college for such suspension. The clinical site and college personnel reserve the right to
take appropriate immediate action, when necessary, to maintain the proper and safe operation of its
facilities and the safety of clients in the clinical setting.
Criminal Background Check and Drug Screening: When students are admitted into the program of study, the
student receives the CBC and drug screening information and directions: The criminal background check will
include reports from all states where the student has lived, worked, or gone to school from the date that they
turned eighteen (18) years of age. The CBC will include both felonies and misdemeanors. The National Sex
Offender Registry is included in the CBC. Flagged reports are sent directly from the designated CBC vendor to
the clinical sites. Durham Tech does not retain copies of the results. Note: Please do not get this report from
your local police department. The drug screening is a 12-panel test.
Students will pay a fee directly to a designated vendor for the CBC and drug screening.
Additional information on the Criminal Background Check requirement may be obtained from the Durham
Tech website.
I verify that I have read and fully understand the Statement of Policy Regarding Acceptance for Clinical
Training at Durham Technical Community College. I also understand that a criminal background check
and/or drug testing will be required for placement in clinical training sites for Durham Technical Community
College.
NAME (Print) __________________________________________ STUDENT ID# ______________________
Program of Study _________________________________________________________________________
SIGNATURE ___________________________________________ DATE ____________________________
Health Technologies Clinical Training Form 6/2018
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Durham Technical Community College
English Language Requirement Form
All health care workers (native and non-native U.S. English speakers alike) are expected to use clear
communication skills in the workplace. Students whose native language is not U.S. English are expected
to demonstrate "near native" U.S. English language abilities. To confirm this ability, all students entering
a Health Technologies program are required to meet the English language requirement.
Students meeting the following criteria must comply with this revised requirement:
1. Students who applied to a Health and Wellness program on or after January 1, 2016, OR
2. Students who applied to a Health and Wellness program before January 1, 2016, but have not
yet met the previous English language requirement.
Please check the ONE that applies:
☐ I have only attended a U.S. high school, and my first language is U.S. English.
☐ I have attended school outside the United States.
☐ My first language is not U.S. English.
If you checked the first checkbox, please sign here. There is nothing further that you need to do.
I understand that this is an official Durham Technical Community College document and that any
falsification on this document may result in disciplinary action according to the Student Code of
Conduct.
My signature below indicates that I am responding truthfully.
Student Name (print): ____________________________________ Student ID: __________________
Student Signature: _______________________________________ Date: ______________________
If you checked the second or third checkboxes, you must meet the English Language Requirement by
successfully completing one of the following options listed on the following page.
1. Take the Duolingo English Test and score 100 points or higher or
2. Take the Test of English as a Foreign Language (TOEFL), iBT version (obtain a score of 22 in
listening and above 26 in speaking or
3. Complete EFL 055 OR EFL 064 and other EFL courses as recommended or required by placement
testing (obtain a score of 80% or above).
Note: Scores for the above tests and classes are valid for up to 5 years.
I understand that this is an official Durham Technical Community College document and that any
falsification on this document may result in disciplinary action according to the Student Code of
Conduct.
English Language Requirement Form, revised Nov. 2020 1
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I checked the second or third checkboxes; however, I have met the English Language Proficiency
Requirement as follows:
☐ I have taken the Duolingo English Test and scored 100 points or higher.
☐ I took the Test of English as a Foreign Language (TOEFL), iBT version and scored above 22 in
listening and above 26 in speaking.
☐ I have completed one or more EFL curriculum courses in the areas listening/speaking and have
scored an 80% or higher.
My signature below indicates that I am responding truthfully.
How to complete this section: Fill in your name but no other information in the admissions application
and email it to wilderp@durhamtech.edu. She will sign it and return it to you. You can then complete
the application and submit it electronically (see instructions at the top of the application).
Student Name (Print): ___________________________________ Student ID: __________________
Student Signature: ______________________________________ Date: ______________________
EAP Representative Name/Title ________________________________________________________
EAP Representative Signature: ___________________________________ Date__________________
English Language Requirement Form, revised Nov. 2020 2
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Associate Degree Respiratory Therapy
Essential Skills for Admission and Progression
Physical and Psychological Requirements
A prospective respiratory therapy candidate must demonstrate the physical and psychological ability to provide
safe respiratory care. Every prospective student must assess his or her ability to provide safe and competent
respiratory care prior to choosing respiratory as a career. To understand the physical and psychological
qualifications needed for success, the essential abilities have been listed below.
Qualifications Standard Examples of Necessary Activities
Critical
Thinking
The respiratory student must possess
critical thinking ability sufficient for
problem solving and clinical
judgment.
• Identify cause-effect relationships in
clinical situations
• Develop appropriate interventions
• Assess risks and provide for patient safely
• Consider multiple priorities and make
effective decisions quickly
• Develop and evaluate Respiratory care
plans
Interpersonal
Skills
The respiratory student must possess
interpersonal abilities sufficient to
interact with individuals, families and
groups from a variety of social,
emotional, cultural, and intellectual
backgrounds.
• Establish helping relationships with
patients, families, significant others and
the interdisciplinary healthcare team
• Cope effectively and calmly during
emotions and stress in the workplace
• Demonstrate caring behaviors
Communication
The respiratory student must possess
communication abilities sufficient for
interaction with others in verbal and
written form.
• Communicate relevant, accurate, and
complete information in a concise and
clear manner both verbally and in writing
to patients and healthcare team
members
• Utilize information technology to support
and communicate the planning and
provision of care
• Ability to conduct interviews and
inservices
Mobility
The respiratory student must possess
physical abilities sufficient to move
from room to room and maneuver in
small spaces.
•
Move around in patient rooms,
bathrooms, workspaces, and treatment
areas
• Administer cardiopulmonary resuscitation
• Stand, squat, reach above head, lift, push,
pull
• Walk the equivalent of 5 miles daily at
work
Motor Skills
The respiratory student must possess
gross and fine motor abilities
sufficient to provide safe and
effective respiratory care.
• Operate and calibrate respiratory care
equipment proficiently, e.g. assemble
equipment, insert needles and catheters,
manipulate ventilators, and position
patients
Hearing
The respiratory student must possess
auditory ability sufficient to monitor
• Hear monitor and ventilator alarms,
emergency signals and cries for help
Revised 12/2018
Qualifications Standard Examples of Necessary Activities
and assess patient’s needs and
maintain facility safety.
• Auscultate blood pressure, breath, and
heart sounds
Visual
The respiratory student must possess
visual ability sufficient for
observation and assessment
necessary in respiratory care.
•
Observe patient responses to treatment,
such as changes in skin color, work of
breathing, or facial expression
• Read patient medical records
• Read and interpret ventilator graphics
Tactile:
The respiratory student must possess
tactile ability sufficient for physical
assessment
• Perform palpation, functions of physical
examination and/or those related to
therapeutic intervention
• Perform therapeutic and diagnostic
modalities required on the job
Weight Bearing
The respiratory student must possess
the ability to maneuver/move 30-50
pounds, weekly and sometimes daily.
• Position patients to perform therapies
• Moving and relocating heavy equipment
Emotional
The respiratory student must possess
emotional stability sufficient to
maintain composure in stressful
situations.
• Cope effectively with stress in the
workplace
• Cope with client and colleague emotions
calmly
• Receive corrective feedback calmly
Environmental
The respiratory student must possess
the ability to tolerate environmental
stressors
• Adapt to variations in work schedules
• Work safely with chemicals used in
healthcare settings
• Work in areas that are close, crowded or
noisy
•
Observe infection control procedures
1. A prospective student with a disability that is concerned that the disability may impact his or her
ability to perform one or more of these skills, provide patient care, or participate in other job
activities, is encouraged to contact a disabilities services counselor for assistance by calling 919-536-
7208 or by emailing disabilityservices@durhamtech.edu.
2. To verify a student’s ability to provide essential respiratory care during clinical training, a physical
examination is required of all students. This examination will be documented by a physician/nurse-
practitioner/physician’s assistant on the form provided by the Admissions and Enrollment Services
office.
3. Subsequent yearly TB screening is required. Participation in clinical is contingent upon negative
documentation and/or appropriate medical treatment and clearance.
4. Although it is not required, students are highly encouraged to be vaccinated for Hepatitis B prior to
clinical rotation in respiratory courses.
5. Occasionally, a student may experience a change in the status of these requirements while
progressing through the curriculum. Should this occur, the student is required to notify the
program’s clinical coordinator.
Revised 12/2018
Student Name: ____________________
Durham Tech Student ID #: _______________
Associate Degree Respiratory Therapy
Essential Skills for Admission and Progression
Physical and Psychological Requirements
I certify that I have read the Essential Skills for Admission and Progression form. I certify that I
understand the physical and psychological requirements needed for providing safe respiratory care. I
have assessed my ability to perform these skills and am able to demonstrate these essential skills.
Student signature _______________________________ Date ___________________
*Please submit only this signature page with your application and retain the list of requirements for
future reference.
Revised 12/2018
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Technology Proficiency for the Respiratory Therapy Program
The skills listed below are examples of skills or abilities Respiratory Therapy Program students are
expected to have on entering the program. The program does not teach these skills; students are
responsible for having or developing them outside of the program. If you do not have proficiency in any
of the tasks listed below, it is your responsibility to become proficient through taking an Introduction to
Computers course, using online tutorials such as those found at GCFGlobal or
Durham Tech Library
LibGuides, or other measures you choose. Proficiency in the skills listed below is essential to student
success in the Respiratory Therapy Program program as well as in the field of Respiratory Therapy.
At the time you apply to the Respiratory Therapy program you must be able to:
• Use your connect mail email account to receive and send communication to Durham Tech,
including attaching documents, opening attachments and saving them
• Use a web browser to navigate a variety of websites, refresh a web page, and find resources
• Use web-based document sharing platforms such as Google docs
Use Microsoft Office programs:
1. Use Microsoft Word to:
• Create, open, and save documents
• Compose documents using text functions including editing
• Use page layout, font and paragraph functions to format text (margins, orientation,
columns, headers, page numbering, font style & size, bold, italics, color, highlighting,
spacing)
• Use spelling and grammar check to find and correct errors in your writing
• Insert tables to organize content
• Use track changes to work on shared documents
2. Use Microsoft PowerPoint to:
• Create, open, edit and save presentations
Use Sakai, a learning management system, to:
• Find a course syllabus
• Open weekly lessons
• Take online tests
• Submit assignments
• Monitor performance in the grade book
• Communicate with others in the class
• Participate in discussion forums
I verify that I understand the technology proficiency expectations of the Respiratory Therapy program
and agree that I am able to do the tasks I have checked off above. I understand that these skills are
necessary to succeed in the program and that they are not taught in the program. I understand that it is
my responsibility to learn how to do any skills I have not checked off prior to starting the Respiratory
Therapy program.
Student signature __________________________________ Date _______________________
Revised 8/14/2019
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Respiratory Therapy (RT) Associate Degree Program (Durham Technical Community College)

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Completed 3 February 2021

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