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Nuclear Medicine Technology

Program

Faculty

TonyaPigulski,AAS,CNMTProgramDirector

NuclearMedicineTechnology

TobyMontez,BS,CNMTInstructor,ClinicalCoordinatorNuclearMedicineTechnology

PollieMartinezAdministrativeAssistantI

Dental&ImagingTechnologyDepartment(361)698‐2858

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NuclearMedicineTechnologyProgram

IntroductionThankyouforyourrecentinquiryintotheNuclearMedicineTechnologyProgramhere at Del Mar College. The program combines classroom curriculum withclinicalexperienceatmajormedicalfacilities,whichhavestate‐of‐the‐artnuclearmedicinedepartments.Ourstudentshavetheopportunitytospendtimeateachaffiliate so that clinical skills are learned. Clinical rotations are assignedthroughouttheprogram,andthehoursassignedvary innumber,usually8–24clockhoursperweek.NuclearMedicineoffersexcitingpossibilities for thosewhotrulydesireacareerassociatedwithmedicalscienceandauniquepositiononthemedicalteam.Jobopportunities can be described as excellent in almost all areas of the country.Annual base salaries are ranging from$39,000 to $70,000 and does not reflectshift differentials, callback pay, or benefits such as vacations, sick leave,insurance,retirement,etc.Manymedicalfacilitiesoffersign‐onbonuses,aswell.NewclassesbeginonceeachyearwiththestartoftheFallsemester,andthereislimited enrollment by the JRCNMT. Students are accepted according to thecriteriaspecifiedinthispacket.AsDirector of theNuclearMedicine Technology Program, I ameager to acceptyourapplication.Shouldyouhaveanyquestions,feelfreetocallmeat(361)698‐2830,myofficeislocatedontheWestCampusinHS#3,Room146.TonyaPigulski

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Studentsareexpectedtoadheretothehigheststandardsofmedicalethicsinallperiodsofattendanceintheclinicalcenters.Allclinicalcenters,whileseparatelylocated,areconsideredtobeanintegralpartoftheDelMarCollegecampus.AnyinfractionofmedicalethicsintheclinicaleducationsiteswillbedealtwithunderappropriatedisciplinarypolicyofDelMarCollege.Itisthestudents’responsibilitytoknowwhattheappropriatepoliciesandproceduresareateachoftheclinicaleducationsites.

PhilosophyThe philosophy of the Nuclear Medicine Technology Program is based on theconceptthatacurriculumshouldincludecourseworkthatpreparesourstudentstoacquireknowledge,skills,andattitudes thatwillmovethemthrough fullandproductive lives asmedical imaging specialists. The foundation set forth atDelMar College should prepare students to copewith changing environments andtechnology and help them meet occupational and personal challenges. Thepreparation offered by the Nuclear Medicine Technology Program shouldencourage thedesireand theability to continue learning, growing, and reapingtherewardsofafull,productive,andfruitfullife.

MissionTo provide the DelMar College NuclearMedical Technology Program studentswith a fully accredited program of education of the highest quality in order toprepare them with the knowledge as competent entry level nuclear medicinetechnologists or to continue their education beyond the Nuclear MedicineTechnology Program. Students will accumulate technical, ethical, andprofessionalskillsrequiredthroughdidacticcourses,laboratoryparticipationandclinicalexperiences.

GoalsGoal#1 The Nuclear Medicine Technology Program will provide a fully

accredited course of study for earning a two year Associate inAppliedScienceDegreeinNuclearMedicineTechnology.

Goal#2 Thecourseofstudywillpreparestudentsforentrylevelpositionsin

NuclearMedicineTechnology.

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Goal#3 Students are encouraged to continue their education beyond the

NuclearMedicineTechnologyProgram.Programgraduatesareeligibletositeforacertificationexaminationadministeredbythefollowinggroups:

• TheNuclearMedicineTechnologyCertificationBoard(NMTCB)• TheAmericanRegistryofRadiologicTechnologist(ARRT)

*Applicationfortheexamshouldbemadeduringthestudent’sfinalsemester.

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NuclearMedicineTechnology

CRITERIAFORADMISSION

1. Theapplicantmustbe18yearsofage.

2. TheapplicantmusthaveearnedaHighSchooldiplomaoraGEDcertificate.

3. ThefollowingformsordocumentationmustallbefiledwiththeProgramDirector:

DocumentationofCPRcertification CompletedapplicationfortheNuclearMedicineProgram Officialcollegetranscripts Completionofhospitalvisit Documentation showing you have received this criteria for admission into the

NuclearMedicineProgram DocumentationtosubstantiateanyclaimsofCollegeHonorsi.e.DeansList

4. Applicantmustattendamandatoryorientationsessioncoveringadmissionprocedures

andaquestion/answersession.

SessionsareheldthefirstThursdayeveningofeverymonthstartingat5:30p.m.inHS#3,Room107,WestCampus

5. Once accepted into the Nuclear Medicine Program students must comply with the

followingimmunizationrequirements:ThelawrequiresthatcollegesinTexaswhohavehealthcareerprogramsrequire thestudentsenrolled in thoseprogramstoobtain thefollowing immunizations on the next page entitled “Dental & Imaging TechnologyStudent‐TexasImmunizationRequirements”.

6. Theapplicantmust visit a local hospital and stayno less than four clockhours in the

NuclearMedicinedepartment.

• AlamedaImaging 888‐6684• ChristusSpohnHospitalShoreline 881‐3005• ChristiusSpohnHospitalMemorial 902‐6690• RadiologyAssociates 866‐1825

7. The applicantmust earn sufficient admission points to be placed on the class roster.

The procedures for receiving admission points will be described in the “admissionprocess”document.

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8. Theapplicantmustbeabletofullyparticipateinallclinicalactivitiesinsuchawayastonot pose a risk to the safety of the patient or clinical personnel. Amedical physicalexamwillberequired.

9. Official acceptance into the Nuclear Medicine Technology Program requires a drugscreeningandacriminalbackgroundcheckatthestudentsexpense.

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DelMarCollegeNuclearMedicineTechnologyProgram

AdmissionProcess

1. Theapplicantwillcompleteandsubmitanapplicationportfolio,whichwill

includedeachofthefollowingitems:

NuclearMedicineapplicationform “HospitalSiteVisit”documentationformproperlysignedanddated(see

page CopiesofallOfficialCollegetranscripts DocumentationtosubstantiateanyclaimsofCollegeHonors;i.e.Deans

List Documentation showing you have received this criteria for admission

intotheNuclearMedicineTechnologyProgram(seepage Documentationshowinginformationsessionwasattended DocumentationofcurrentCPR

This completed application portfolio must be submitted to the NuclearMedicine Program Director no later thanMarch 1st for consideration foradmissionintotheFallsemesterofthesameyear.AnyportfoliosubmittedafterthisdeadlinewillautomaticallybeconsideredforadmissionintotheFallsemesterofthenextcalendaryear.

2. During the month of June of each year, the Nuclear Medicine Program

DirectorwillreviewallapplicantsthathavesubmittedcompleteportfoliossinceMarch1stofthepreviouscalendaryear.Duringthisreviewprocess,pointsearnedbyeachapplicantwillbetotaled.Theapplicantwiththehighesttotalpointswillfilltheallottedopeningsforstudents to be admitted into the Nuclear Medicine class that will begintrainingwiththestartofthenextFallsemester.(Thenumberofstudentsadmitted into the program varies from year to year depending uponavailableclinicaltrainingsites.)

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NOTE:TheapplicantmayupdatehisorherportfolioaslateasMarch1stofthecalendaryearinwhichtheportfoliowillbereviewedforpoints.

3. The Nuclear Medicine Admissions Committee will meet during June to

select the new class for the Fall semester. A letter will be sent to theapplicantwiththeCommittee’sdecisionbyJuly.

Iftheapplicantisnotacceptedintotheprogramheorshewillbeadvisedto reapply for the next year. Such a re‐application must be made inwriting through a letter to the Nuclear Medicine Program DirectorpostmarkednolaterthanthelastofOctoberofthesamecalendaryear.Following this date, all portfolios of applicant’s not requesting re‐applicationwillbediscarded.

4. Ifoneoftheapplicantsselectedfortheprogramcannotbegintheprogram

withthestartoftheFallsemester,heorshewillforfeittheirpositionintheclass andwill be required to follow the process for re‐application if theywishtobeconsideredforthenextFallsemester.Insuchacase, thepersonwith thenexthighestnumberofpointswillbemoved into the class. Each person in the applicant pool will be movedforwardaccordingly.Thisprocesswillberepeateduntilallpositionsintheclasshavebeenfilled.

5. Allapplicantswhomeet thecriteriawill receiveaconditionalacceptance.

This conditional status is pending criminal background and drug testing.Seeattachedpolicy.(Seepage

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DelMarCollegeNuclearMedicineTechnologyAssociatesinAppliedScience

This programprovides thebasic skills requiredof abeginning staff technologistpracticing innuclearmedicine. Uponsatisfactorycompletionof thecurriculum,the graduate will be eligible to write the national certification examinationadministered by the American Registry of Radiologic Technologists and thecertification examination administered by the Nuclear Medicine TechnologyCertificationBoard.Allofthemajorrequirementcourses(NMTT)aretobetakeninasequentialorderorattheadvisementofthedepartmentmajoradvisor.Agradeof“C”orhigherisrequiredforsatisfactorycompletionofallcourses.Tocontinueintheprogram,astudentmayrepeataNMTTcourseonlyonetimeandmayrepeatnomorethantwoNMTTcourseswhileenrolledintheprogram.The term “repeat” shall be interpreted to mean re‐enrollment followingwithdrawal,drop,orunsatisfactorygrade. Astudentwillhavenomorethan36monthstocompleteallmajorrequirements.A student seeking entry into Nuclear Medicine must file a specific programapplication form and complete additional admission procedures as required.Studentsmay not take any of themajor NMTT courses until accepted into theprogramCurriculumPrerequisite:HPRS 1204 BasicHealthProfessionSkillsHPRS1106 MedicalTerminologyENGL1301 CompositionIMATH1314 CollegeAlgebraBIOL2401 HumanAnatomy&PhysiologyISPCH1318 InterpersonalCommunicationSCIT1418 AppliedPhysicsORPHYS1305PhysicsISocialBehavioralScienceElectiveHumanities/VisualorPerformingArtsElective

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RelatedRequiredCourses:BIOL2402 HumanAnatomy&PhysiologyIICHEM1406 BasicChemistryMajorRequirements:NMTT1301 IntroductorytoNuclearMedicineNMTT1313 NuclearMedicinePhysicsNMTT1266 PracticumINMTT1267 PracticumIINMTT1309 NuclearMedicineInstrumentationNMTT2266 PracticumIIINMTT2309 NuclearMedicineMethodologyIINMTT2301 Radiochemistry&RadiopharmacyNMTT2313 NuclearMedicineMethodologyIIINMTT2333 AdvancedPETandFusionTechnologyNMTT2366 PracticumIVNMTT2367 PracticumVNMTT2235 NuclearMedicineTechnologySeminarRADR2333 AdvancedMedicalImaging

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DelMarCollegeNuclearMedicineTechnology

EducationalExpenseList

IfyouarearecognizedresidentoftheDelMarCollegeDistrict,thefollowinglistreflects theapproximateeducation costs associatedwith theNuclearMedicineprogram. The figures assume that you are taking all courses each semester aslistedintheofficialdegreeplanfoundelsewhereinthisdocument.FirstSemester(12SemesterCreditHrs.)

TuitionandFeesLaboratoryFees&SuppliesTextbooks

$861.00$500.00

SecondSemester(12SemesterCreditHrs.)

TuitionandFeesLaboratoryFees&SuppliesTextbooks

$861.00$48.00$100.00

ThirdSemester(5SemesterCreditHrs.)

TuitionandFeesLaboratoryFees&SuppliesTextbooks

$459.00$24.00

FourthSemester(9SemesterCreditHrs.)

TuitionandFeesLaboratoryFees&SuppliesTextbooks

$660.00$48.00

FifthSemester(5SemesterCreditHrs.)

TuitionandFeesLaboratoryFees&SuppliesTextbooks

$459.00$24.00

Total $4,044.00IfyouarearecognizedresidentofTexas,butnotarecognizedresidentoftheDelMarCollegedistrict,yourtotalexpenseswillbeapproximately$8,406.00If you are not a recognized resident of Texas, your total expense will beapproximately$10,161.00outofstate.Residency requirements are contained in the college catalog. Also you maycontacttheDelMarCollegeBusinessOfficeforinformationrelativetoresidencyrequirements.Call(361)698‐1263.

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DelMarCollegeNuclearMedicineTechnologyProgram

StatementofNon‐Discrimination

Pursuant to Section 504 of the RehabilitationAct of 1973,DelMar Collegewillprovide services and training, without discrimination, to any qualifiedhandicappedpersonwhomeettheacademicandtechnicalstandardsrequisitetoadmissionand/orparticipationintheNuclearMedicineTechnologyProgram.

TechnicalStandardfortheNuclearMedicineTechnologistEmploymentQualifiers:

1. Studentsmustbefreefromcontagiousdiseasesandchemicaldependence2. Studentsmustbeabletoperformallfunctionsandtasksrequiredofanuclearmedicine

technologist.3. Studentmustnothavebeenconvictedofafelony.

VisualObservation:Visualobservationmustbesufficientandadequatetoallowthestudentto:

1. Produceimagestodeterminequality,andidentifyanatomy.2. Observepatient’scondition.3. Readcontrolpanel’stechniquecharts,patients’chartsandotherpertinentmaterialsfor

patientcareandprofessionalpractice.MotorFunction:Motorfunctionsmustbesufficienttopermitthestudentto:

4. Standunassistedforlongperiodsoftime.5. Assistpatientsinandoutofwheelchairsandonandoffofstretchersortables.6. Liftandhandleequipmentrelatedtonuclearmedicine7. Operatenuclearmedicineequipment8. Assistpatientsinemergencysituations

CommunicationSkills:

9. Thestudentshallpossessverbalandnon‐verbalskillsadequatefortransmittinginformationtopatientsandothers.

10. Adequatehearingfromcommunicationskillswithboththehospitalpersonnelandpatients.

BehavioralandSocialSkills:Students’behavioralandsocialskillsmustbeacceptabletoacollegeandhospitalsetting.

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DELMARCOLLEGEDENTAL&IMAGINGTECHNOLOGYDEPARTMENT

POLICYFORCRIMINALBACKGROUNDSCREENING

DelMar College adheres to the policies of all clinical facilities with which the programs areaffiliated for student clinical learningexperiences. Manyclinical facilitiesand schooldistrictsrequirecriminalbackgroundscreeningofallstudents.PurposeSome clinical agencies usedbyDelMarCollege stipulate in the clinical affiliated agreementswith Del Mar College that students’ criminal background be prescreened before they arepermittedintotheclinicalfacility.Thisprescreeningrequirementsisthesameasthatrequiredof employees of public and private clinical agencies. The rationale for this requirement forclinical students isbasedontheconceptofduediligenceandcompetencyassessmentsofallindividuals whose assignments bring them in contact with patients and employees.Competencyassessmentextendsbeyondtechnicalskillstoincludeanindividual’spastbehavioras indicated by their criminal history. This approach ensures uniform compliancewith JointCommission standards pertaining to human resourcemanagement. Moreover, the public isdemandinggreaterdiligence in lightof thenational reportsofdeaths resulting frommedicalerrors. Successful completion of a background check does not guarantee licensure oremploymentaftergraduation.Fullacceptanceintotheprogramiscontingentuponsatisfactoryresults.TimingAll background checks will be conducted as a condition of full acceptance into the DelMarCollegeprograms.Verificationmustbereceivedfromthedesignatedcompanypriortobeingfullyadmittedtotheprogram. Theresultswillbeacceptedfor thedurationof thestudent’senrollmentintheprogramiftheparticipatingstudenthasnothadabreakintheprogramandifthe student has had no convictions while enrolled. A break in enrollment is defined asnonattendance of one full semester or more. Attendance must be verifiable through theCollege.TheDental& ImagingTechnologyDepartmentwilldesignatethecompanyselectedtodothecriminal background screening. The Programwill not accept criminal background screeningresults from any company other than the designated by the Dental & Imaging TechnologyDepartment.Thestudentwillpayforthecostofthecriminalbackgroundscreeningatthetimeofthescreening.Thecostisnon‐refundable.

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ProcessCriminal background checks will be performed by an external vendor and will review thestudent’s criminal history. The check should include the cities and counties of all knownresidences. Criminal background checks must include a person’s criminal history for sevenyearspriortothedateofapplication.Thefollowinghistorieswilldisqualifyanindividualfromconsiderationforadmissionintheprogram.

Misdemeanor convictions/deferred adjudication or felony convictions/deferredadjudicationinvolvingcrimesagainstpersons;

Misdemeanorconvictions/deferredadjudicationrelatedtomoralturpitude; Misdemeanor/felony convictions/deferred adjudications for the sale, possession,

distribution,ortransferofnarcoticsorcontrolledsubstances; Registeredsexoffenders

Individualswithanyoftheabovehistorieswillnotbeeligibletoenrollintheprogramandifthehistory isdiscoveredora convictionoccursafterenrollment, the student,willbe required towithdrawfromtheprogram.Astudentwhoisconvictedofacriminaloffencewhileenrolledinthe program must report the conviction to the Program Director within three days of theconviction.Thetermconvictionforthesepurposesincludesprobatedsentencesanddeferredadjudications.Notes:

1. The student should be aware that the disqualifications listed above are used foremploymenteligibilitybymosthospitalsinTexas.

2. Completionofaspecificprogramwillbedeterminedbystudent’sabilitytosuccessfullycompletetherequiredclinicalrotations.

3. Clinical rotations are completed as sites specified by and contracted with Del MarCollege.DelMarCollegewillnotlocateorprovidealternativesitesforclinicalrotationsforstudentineligibletoattendclinicalrotationsatspecificsites.

ComplianceandRecordKeeping

The vendor will notify DelMar College Program Director of all individuals who fail acriminalbackgroundcheck.

VerificationsentbythevendortoDelMarCollegewillincludeonlythestudent’snameandsocialsecuritynumber.

TheDelMarCollegeProgramDirectorwillsendverificationonadherencetothepolicyto the clinical affiliate prior to the clinical rotation start date. Verification isaccomplishedbysendingaletterfromtheProgramDirectorstatingthatthesestandardshavebeenmetbythestudent,listingthestudent’sfullnameandclinicalrotationstartdate.Ifmorethanonestudentisattendingaclinicalrotation,acomprehensivelistwithallofthestudent’snamesmaybesubmitted.

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Notes:Verification informationwillbefiled inasecuredareatoensureconfidentiality. Intheeventthat thestudent feels thatanerrorhasbeenmade in the resultsof thecriminalbackgroundcheck, it is the responsibility of the student to contact the external vendor for a verificationcheckandthestudentisresponsibleforanycostassociatedwiththischeck.Otherthanerrorrelativetoidentify,therewillbenoappealofthispolicy.

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DELMARCOLLEGENULCEARMEDICINETECHNOLOGY

DENTAL&IMAGINGTECHNOLOGYDEPARTMENT

STUDENT–TEXASIMMUNIZATIONREQUIREMENTSThefollowingrequirementsapplytoallstudentsenrolled inhealth‐relatedprograms inTexasschools,whichwill involve direct patient contact in program‐affiliatedmedical care facilities.ThisincludesNuclearMedicinemajors.

A. StudentswhowerebornonorafterJanuary1,1957,mustshow,priortofirstpatientcontact, acceptable written evidence of vaccination of two doses of measles –containing vaccine administered since January 1, 1968. Serologic confirmation ofimmunitytomeaslesisacceptable.Evidenceofimmunitymustconsistoralaboratoryreportthatindicateseitherconfirmationofimmunityorinfection.

B. Studentsmustshow,priortoprogramadmission,writtenevidenceofvaccinationofone

dose or rubella (German Measles) vaccine. Serologic confirmation of immunity torubella is acceptable. Evidence of immunitymust consist of a laboratory report thatindicateseitherconfirmationofimmunityorinfection.

C. Students born on or after January 1, 1957,must show, prior to first patient contact,writtenevidenceofvaccinationofonedoseofmumpsvaccine.Serologicconfirmationofimmunitytomumpsisacceptable.Evidenceofimmunitymustconsistofalaboratoryreportthatindicateseitherconfirmationofimmunityorinfection.

D. Studentsshallreceiveacompleteseries(threeinjections)ofHepatitisBvaccinepriortofirstpatient contact. Serologic confirmationof immunity toHepatitisB is acceptable.Evidenceofimmunitymustconsistofalaboratoryreportthatindicatesconfirmationofimmunity.

E. Studentsshallreceivetwodosesofvaricella(ChickenPox)vaccine,priortofirstpatientcontact, unless the first dose was received prior to thirteen years of age. A writtenhistorybyaphysicianorparentmaybeusedtovalidatevaricelladiseaseorimmunityinlieu of the vaccine. Vaccination, of necessary,must take place before the student isacceptedintotheprogramofstudy.

F. Onedoseoftetanus‐diphtheriatoxoidisrequiredwithinthelasttenyears.

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DelMarCollegeNuclearMedicineTechnologyProgram

PregnancyPolicyTheintentofthispolicyisnotmeanttobediscriminatoryinanymanner.Thispolicywillbeimplementedatthetimeawrittendeclarationisreceived.A woman who has voluntarily informed her employer (Program Director), inwriting of her pregnancy and the estimated date of conception is considered adeclaredpregnantstudent.Thestudent,aftercounselingwithafacultyandmedicaladvisormayelecttooneofthefollowing:

1. Withdraw from clinical educationwith an “incomplete” but remain in alldidacticactivitiesforsemestersinwhichpregnancyexists.

2. Remainintheprogramunderthefollowingconditions:

a. Thestudentwillbeissuedafetalfilmbadgeinadditiontoherown.She

will wear both film badges at all times in the clinical or laboratorysettings.Theexposuretotheembryo/fetuswillnotexceed0.5rem.Ifawoman chooses not to declare pregnancy, the occupational doseapplies.

b. ThestudentwillsupplytheProgramDirectorastatementofhealthfrom

an attending physician attesting to the student’s health and ability tocontinuestudies.

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DelMarCollegeNuclearMedicineTechnologyProgram

IMPORTANT – PLEASE READ THE FOLLOWING

STATEMENTS CAREFULLY! Your application is not complete until you have fulfilled each of the followingrequirements:

1. Completedapplicationonfile intheNuclearMedicineOffice(HS#3,Room146)

2. CopyofallOfficialCollegetranscriptsonfileintheNuclearMedicineOffice

(HS#3,Room146)

3. Completionofhospitalvisitationwithsigneddocumentationonfile intheNuclearMedicineOffice(HS#3,Room146)

4. CopiesofanyCollegeHonorsdocumentationfiledintheNuclearMedicineOffice(HS#3,Room146)

5. CopyofadmissioncriterianotificationfiledintheNuclearMedicineOffice(HS#3,Room146)

6. ProofofHealthCareProviderCPR(current)certification

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DelMarCollegeNuclearMedicineTechnology

ClinicalSiteVisitEachapplicantseekingadmission intotheNuclearMedicineTechnologyProgramwillberequiredtovisita localhospitalnucleardepartmenttoobserveitsoperationforaminimumoffour(4)clockhours.

Tomakeaclinicalsitevisitappointment,theapplicantshouldfollowthesesteps:

1. Selectthehospitalyouwishtovisit.Youmaychoosefrom:

AlamedaImaging 888‐6684 ChristusSpohnHospitalShoreline 881‐3005 ChristusSpohnHospitalMemorial 902‐6690 RadiologyAssociates 866‐1825

2. CallthehospitalNuclearMedicinedepartmentofyourchoiceandasktotalktotheNuclearTechnology

studentsupervisor.

3. Introduceyourselftothestudentsupervisorandexplainthenatureofyourcall.Heorshewillscheduleavisitationappointment.

4. Theminimumvisitationtimeisfourhours.Youmaystaylongerifyouwish.Remember,thepurposeofthevisitistopermityoutosee“behindthescenes”andspeakwiththosealreadyworkingintheNuclearTechnologyprofession tohear theprosandconsof the job. Sostayas longasyouneeduntil youare

fairlysurethatthisisthecareerchoicesuitedtoyou.

5. Whenyougoforthevisit,dressinamannerappropriateforaprofessionalenvironment.Pleasedonotwearbluejeansortennisshoes.Applicantsshouldnotwearstrongperfumesorcolognes.

6. Duringthevisitation,pleaseremaininthedesignatedareaasassignedbythestudentsupervisor.Ifyou

havequestions,donothesitatetoask.Becareful,however,ofaskingquestionswhileinthepresenceofthepatient.Waituntilthepatienthasleftthearea.Duetopatientprivacylaws,donotdiscusspatientmedicalinformationwithothersatanytime.Youarerequiredtosignanddatea“PatientConfidentiality

Statement”tobereturnedinwithyourpacket.

7. Takethisformwithyouwhenyoumakeyourvisitandhavethestudentsupervisorsignintheprovided

spacebelow.ReturntheformtotheNuclearMedicineProgramDirectorwhenyouarereadytoturninyourapplication.

NameofApplicant

NameofHospital

DateofVisitation: AppointmentTime:from to

StudentSupervisorSignature:

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DelMarColleNuclearMedicineTechnology

PROGRAMAPPLICATION

ApplicationDeadline:March1stINSTRUCTIONS: Please PRINT or TYPE all information on this form. Complete all items.Information must be current and as accurate as possible. If the applicant’s name, mailingaddress,orphonenumberschangeafterthisapplicationhasbeenfiled,ittheresponsibilityoftheapplicanttoupdateandappropriateinformationwiththeProgramDirectorIMMEDIATELY.Failuretomaintainacurrentapplicationformcouldjeopardizetheapplication.

NameinFull First Middle LastSocialSecurity#: orStudentI.D.#: MailingAddress: Number&Street City,State,ZipCodeHomePhone#: CellPhone#: E‐MailAddress: PersontoNotifyinCaseofEmergency: Phone#: Degree(s)Held: CircleallthatapplyG.E.D. HighSchool Certificate Associate Bachelor’s Masters

Indicatewhich of the following college courses you have already completed and final gradeearnedineachcourse.AttachofficialtranscriptsHPRS1106 HPRS1204 ENGL1301 MATH1314 BIOL2401 BIOL2402 BIOL2420 CHEM1406 SPCH1315 PHYS1305 AnyBehavioralScienceCourseElective Humanities/VisualorPerformingArtsElective Admissionintotheclinical(on‐the‐job)portionrequiresthatyoubeabletofullyparticipateinall clinicalactivities insuchawayasnot toposea risk to thesafetyof thepatientorclinicalpersonnel.Canyousatisfysucharequirement? Yes No The following forms must be submitted in order to have a complete file folder for theAdmissionsCommitteetoreview.CurrentCPRCard ExpirationDate OfficialCollegeTranscripts HospitalSiteVisitForm Honorsdocumentation(ifapplicable) OrientationSessionForm

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DelMarCollegeNuclearMedicineTechnologyProgram

NameofApplicant: Last First MiddleBy my signature on this document, I acknowledge that I have beenprovided written documentation for admission into the NuclearMedicineTechnologyProgramatDelMarCollege.Inparticular,Ihavereceivedeachofthefollowing:

1. List of SPECIFIC criteria for admission into theNuclearMedicineTechnologyProgram.

2. Step‐by‐step description of the process used to make applicant

selectionfortheNuclearMedicineTechnologyProgramtoincludenotificationprocedures.

I understand that certain procedures (e.g. deadlines) within theselection process may be subject to change, however, the specificcriteria for admission that I have been provided is NOT subject tochangerelativetomyapplication. SignatureofApplicantRevised11/2009