Fillable SONOGRAPHY PROGRAM APPLICATION (Midlands Technical College)

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SONOGRAPHY PROGRAM APPLICATION (Midlands Technical College)

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  • 3 check-boxes
  • 68 other fields

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U.S.A. forms for Midlands Technical College

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MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.732.5221
CORPORATE AND CONTINUING EDUCATION
SONOGRAPHY PROGRAM APPLICATION
Please print or type:
– –
Last Name First Name Maiden/Middle Social Security #
Address (include apt. #) City State Zip Code
Phone Number(s) Email Address
Emergency Contact Name Emergency Contact Telephone Number
SECONDARY COLLEGE INFORMATION
Please list all colleges attended beginning with the most recent.
Institution Name State
Last Date Attended: / /
Degree Earned GPA
Institution Name State
Last Date Attended: / /
Degree Earned GPA
Institution Name State
Last Date Attended: / /
Degree Earned GPA
Use an additional sheet if necessary.
PREREQUISITE COURSES – must be taken within 5 years of start date of sonography program.
Please check if you have taken the following:
o Anatomy and Physiology I
o Anatomy and Physiology II
o Medical Terminology
Check the program for which you are applying to: o General Sonography o Cardiovascular Sonography
MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.732.5221
REFERENCES
Please list 3 references that can attest to your work ethic and people skills, include their relationship to you and their
contact information.
Last Name First Name Maiden/Middle
Address (include apt. #) City State Zip Code
Phone Number(s) Relationship to You
Last Name First Name Maiden/Middle
Address (include apt. #) City State Zip Code
Phone Number(s) Relationship to You
Last Name First Name Maiden/Middle
Address (include apt. #) City State Zip Code
Phone Number(s) Relationship to You
WORK EXPERIENCE
Please begin with most recent employer.
Name of Employer Position
Dates of Employment : / / to / /
Contact Name Phone Number
Name of Employer Position
Dates of Employment : / / to / /
Contact Name Phone Number
Name of Employer Position
Dates of Employment : / / to / /
Contact Name Phone Number
TRANSCRIPTS
Please have official transcripts sent as soon as possible. Your application will not be considered complete without
these. Use attached form.
APPLICATION FEE
Please send $25 application fee along with your application. Any application not accompanied by the fee will not be
processed.
MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.732.5221
QUESTIONS
Please answer the following questions in two to three sentences.
1. Why do you want to begin a career in sonography?
2. What have you done to verify that sonography is the career that you would like to pursue?
3. Why do you believe you would be a competent sonographer?
4. Explain how you will be able to devote 15 months full-time to this program.
MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.732.5221
CORPORATE AND CONTINUING EDUCATION
SONOGRAPHY PROGRAM
TRANSCRIPT REQUEST FORM
Midlands Technical College
Continuing Education – Sonography Program
PO Box 2408
Columbia, South Carolina 29202
803.732.5221
Name of student (printed) Social Security # or Student ID
Signature Date
Please forward an official copy of my transcripts, including date of graduation, SAT/ACT scores, if applicable, to:
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MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.732.5221
CORPORATE AND CONTINUING EDUCATION
SONOGRAPHY PROGRAM ACADEMIC
AND PROFESSIONAL STANDARDS
A student entering the profession of Medical Sonography must understand that they are entering a field of medicine
that requires certain academic and professional standards that other career choices may not.
Professional dress, appearance, and modes of communication must be of certain standards in order to maintain the
confidence and care of the patient. Patients under the care of sonographers present themselves in all ages, cultures
and of various ethnic origins; therefore trendy modes of dress and appearance are not allowed. The program has an
established dress code and a code of conduct you must follow throughout the academic year.
Your signing of this form indicates that you understand the requirements of the program and that if accepted into the
program you meet the academic standards and that you agree to abide by the professional standards.
Printed Name of Applicant Date
Applicant Signature
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SONOGRAPHY PROGRAM APPLICATION (Midlands Technical College)

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Completed 4 October 2020

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