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Research Medical Center School of Radiologic Technology Application for Program Admission

Applicant

Emergency Contact

Are you at least 18 years old? *
Have you applied to this program in the last 3 years? *
Are you a citizen of the United States? *

Non US Citizens:

List All Educational Institutions Attended (in chronological order from the most recent)

College, University, Technical, High School City State Attendance Dates Credits Earned GPA Degree or Certificate Date Received or Expected

Academic Courses Currently in Progress (must be completed prior to the start of the Program)

Educational Institute Name of Course Credits Expected Completion Date

Employment History (chronological record of part-time or full-time employment)

Employer Position Dates of Employment

Criminal Procedures and Ethics Requirements for ARRT Certification

According to https://www.arrt.org/Certification, every candidate for ARRT certification must "be a person of good moralcharacter and must not have engaged in conduct that is inconsistent with the ARRT Rules of Ethics," and they must"agree to comply with the ARRT Rules and Regulations and the ARRT Standards of Ethics." ARRT investigates allpotential violations in order to determine eligibility. Issues addressed by the Rules of Ethics include convictions, criminalprocedures, or military court martials, felonies, misdemeanors, and/or criminal procedures resulting in a plea of guilty ornolo contendere (no contest), a verdict of guilty, withheld or deferred adjudication, suspended or stay of sentence, or pretrial diversion. Juvenile convictions processed in juvenile court and minor traffic citations not involving drugs or alcohol donot need to be reported. Additionally, candidates for certification are required to disclose whether they have ever had anylicense, registration, or certification subjected to discipline by a regulatory authority or certification board (other thanARRT). Applicants may complete a pre-application (https://www.arrt.org/pdfs/Ethics/Ethics-Review-Pre-Application.pdf ) todetermine their ethics eligibility prior to enrolling in or during their educational program.

The final selection of applicants is contingent upon passing a physical examination administered by Research Medical Center and testing negative for illegal drugs in a urinalysis test.

Before your application can be processed, the School of Radiologic Technology must receive:

  • Completed and signed application form before December 1st.
  • Copies of all official transcripts submitted directly from high school and colleges.
  • Two (2) completed and signed reference forms.
  • Verification of a job shadow observation.
  • Two-page essay on how you became interested in radiology, why you want to be a radiographer, and the role of a radiologic technologist in the imaging profession.
  • Application fee of $40.00 (check, money order, or cashier’s check) made payable to Research Medical Center. o Fee will be refunded if the applicant cancels the application within 3 working days of receipt of the fee by the school.

It is the applicant’s responsibility to confirm all required information has been received by the program by December 1st.

Mail the Completed Application to:
Research Medical Center
School of Radiologic Technology
2316 E. Meyer Blvd.
Kansas City, Missouri 64132
816.276.3390

RMC School of Radiologic Technology Equal Opportunity Record

Equal Opportunity Programs are required by the Federal Government to provide statistical information about applicantsto demonstrate that the program meets equal opportunity requirements.

Your completion of this form is voluntary and would be greatly appreciated.

This information will be kept separate and confidential from the applicant’s file and will not be considered in any way todetermine eligibility/acceptance to the program.

Gender
Race
Are you a Vietnam Era Veteran?

A person who served on active duty in Vietnam between 02-28-61 and 05-07-75 for a period of 180 days or who was on active duty between 08-05-64 and 05-07-75 but not in Vietnam, and was discharged or released with other than a dishonorable discharge or for a service connected disability.

Are you a Disabled Veteran?

A person entitled to disability compensation under laws administered by the Veterans Administration for disability rated at 30% or more, or a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty.

RMC School of Radiologic Technology Equal Opportunity Record

A person considering a career in the radiologic sciences can make a better-informed career decision if it is based onpersonal experiences or observations. The School requires that all applicants to the Research Medical Center’s Programmust perform a job shadow of the Imaging Department at Research Medical Center. Please call 816.276.3296 toschedule a job shadow.

Professional dress is required when observing at the department. Jeans, t-shirts, sweatshirts, and open-toed shoes arenot allowed. No pierced jewelry should be worn with the exception of one or two earrings per earlobe. Overallappearance should be professional.

Please bring this form with you when you observe in the department.

Research Medical Center School of Radiologic Technology Reference Form

Following is a list of characteristics that we feel are required for a student to successfully complete the educational completing this form and returning it to the applicant in a sealed envelope to the school.

Charachteristics Description 4 - Outstanding 3 - Satisfactory
2 - Needs improvement 1 - Unsatisfactory
N - Not observed or no basis for judgment
Responsibility Dependable and accountable for one’s actions
Leadership Demonstrates the ability to direct the activity of others
Initiative Motivated to pursue actions independently; self-starter
Flexibility Capable of responding or conforming to changes or new situations
Organizational Skills Systematically plans for optimal efficiency
Self-Confidence Assured in one’s ability and skills
Independent Worker Completes tasks with minimal supervision
Communication Verbal Contributes knowledge and opinions in an articulate, understanding and non-threatening manner
Communication Written Expresses self clearly in writing
Response to Stress Maintains composure and ability to listen
Positive Attitude Maintains optimistic approach to people and the task at hand
Manual Dexterity Ability to perform psychomotor skills
Interpersonal Skills Ability to work and get along with others
Judgment Demonstrates a constructive approach to problem solving and decision making
Maturity and Professionalism Demonstrates common sense, tact and appropriate behavior
Knowledge Base Demonstrates common sense, tact and appropriate behavior
Dependability Follows through on assignments; meets deadlines
Punctuality Prompt, arrives at the proper time
Attendance Has a record of good attendance
Multi-tasking Ability to manage numerous tasks effectively and efficiently
Criticism and Conflict Resolution Accepts criticism readily and is able to work through conflicts to a positive end

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