Read Microsoft Word - RC 11-12 Program Packet.doc text version

Respiratory Therapy Program

Program Chair: Greg Carter, BS, RRT

Phone: 253-566-5231 Email: [email protected] The Respiratory Therapy program leads to an Associate of Applied Science degree. The program is full-time, sequential, consisting of seven (7) quarters of instruction offered during daytime hours. Students complete classroom and laboratory work on campus and gain clinical experience in affiliated clinical sites. Students acquire skills in reviewing and recording clinical patient data, performing respiratory therapeutic procedures, and providing for the comforts and needs of the patient during the procedures. Respiratory therapists work under the direction of a physician to assist in diagnosis and treatment for patients with cardiopulmonary diseases and disorders. Positions are available in acute/critical care hospitals, extended care facilities, outpatient clinics, private physicians' offices, home care companies, sleep studies, pulmonary function testing, and equipment sales. Thoroughness, accuracy, mechanical aptitude/ability to troubleshoot equipment, and empathy are traits needed by people interested in this program. Prospective respiratory therapists should also be versatile and able to follow precise and detailed directions. Upon successful completion of this program, graduates are eligible to take the Certified Respiratory Therapist examination administered by the National Board for Respiratory Care. Upon passing of this exam, the graduates become a Certified Respiratory Therapist (CRT). Following completion of the CRT credential, graduates are eligible to take the Registered Respiratory Therapist examination. Upon passing this exam (both a written and a clinical simulation examination), graduates become a Registered Respiratory Therapist (RRT). Washington State Requirements for Licensure: Respiratory therapists must be licensed by the state as Respiratory Care Practitioners. Requirements include: completion of an approved training program; a background investigation; and passing the entry level certification examination given by the National Board for Respiratory Care (NBRC). The Respiratory Therapy program is accredited by the Commission on Accreditation for Respiratory Care (www.coarc.com). Commission on Accreditation for Respiratory Care 1248 Harwood Road Bedford, Texas 76021-4244 (817) 283-2835

5/17/2011

1

College Admission and Assessment

There is a separate application process to the college, which will include a College Assessment Test. This test will evaluate skills in reading, writing, and math. It is scheduled through the Assessment Office in Building 18 at 253-566-5093 and takes approximately 2 hours ($18 test fee). After the test is evaluated, the prospective student will meet with an advisor to discuss the results, including which remedial classes may have to be taken before beginning the prerequisite courses. College application packets are available from the Admissions Office in Building 18, (Phone 253566-5001). The application is also available online: http://www.tacoma.ctc.edu/register/admissions.htm

Program Admission Requirements

Applicants must be at least 18 years of age at the beginning of the program in Fall quarter, be fluent in the English language, Demonstrate completion of the program prerequisites with an overall GPA of 2.5 and possess the physical and emotional ability to complete the program as described in the technical standards (see page 10 ­ 12 of the application). To be considered for the program, applicants must submit the following: 1. Completed Health, Justice & Human Services application form 2. Letters of recommendation-optional-from a source familiar with the applicant's professional behavior, dependability, and self-motivation (former employers, instructors, etc.) 3. Hospital Visitation-optional but highly recommended. (2-4 hour visit in a Respiratory Therapy unit/facility.) See job shadow form on the last few pages of this packet 4. Letter of Intent ­ optional but highly recommended. Applicants unable to perform a site visit may submit a letter of intent. This letter should explain why the applicant wants to become a respiratory therapist. 5. Official college transcripts submitted to the Registration Office (Bldg 7) showing completion of all prerequisites with a grade of "C" (2.0) or better. Each prerequisite course must have been successfully passed within two attempts of taking the course. Withdrawals (W) or (WI) do not count as an attempt Please send complete application packets to: Tacoma Community College Health, Justice and Human Services Division Respiratory Therapy, Bldg. 19-70 6501 S. 19th St. Tacoma, WA 98466

Admission policies are subject to change. Applications will be accepted under the terms in place at the time an application is received by the Allied Health Office. It is the responsibility of the applicant to keep up-todate on any changes that may affect his/her qualifications for acceptance.

5/17/2011

2

Application Procedures

The application deadline is May 1st of each year; the program starts once a year in fall quarter. All complete application packets must be received by the Health, Justice and Human Services office by no later than 5 p.m. on the application deadline and will be carefully screened by program faculty and considered for acceptance. Grades from courses completed during the winter quarters will be accepted through May 1st. Official transcripts must be submitted for transfer of credits by no later than the application deadline. It is the student's responsibility to ensure that his/her application is complete in all respects. Applicants must be officially accepted into the program by the program chair before enrolling in Respiratory Therapy courses. Notifications regarding status will be mailed to each applicant by the end of May. Application Factoring System Admission into the Respiratory program is a competitive process. There is no waitlist and there are more applicants to the program than there are available positions. Therefore if a student takes all of the prerequisite classes and meets the other requirements for a completed application, it does not guarantee admission into the program. Each applicant will receive a score based on: · Grades received in the 5 prerequisite courses. · Additional college level science and math courses passed with a B or better (2 pts. each) · Additional healthcare related experience. Admission into the program will be offered to the top scores. Calculating an Application Score All completed prerequisites are based on a 4.0 scale. Points Awarded for Grades Earned in the 5 Prerequisite Courses

A = 4.0 B- = 2.7 A- = 3.7 C+ = 2.3 B+ = 3.3 C = 2.0 B = 3.0 < C not accepted

All applicants may attempt to earn additional points towards their overall application score by providing proof of patient related healthcare experience (paid or volunteer). A completed form must be include with the application packet. A direct supervisor must verify and sign this form. All experience will be verified upon submission of the application. Falsification or inability to verify this form will result in disqualification of the application. Additional Points Based on Optional Direct Patient Care Experience

100 ­ 199 hours 200 ­ 299 hours 300 ­ 399 hours 2 points 4 points 6 points

5/17/2011

3

The following are examples of direct patient care related healthcare that are accepted and do not require prior approval. These include, but may not be limited to:

1. CNA experience (Clinical time from CNA courses) 2. EMT/Paramedic ­ please provide an estimate of time spent working with patients 3. Certified, Registered or licensed LPN, RN, Radiology Technologist, Sonography technologist, Medical Assistant, Dental Assistant/Hygienist

For direct patient related experience obtained but not listed above, written approval is required from the Program Director or Clinical Coordinator PRIOR to application submission. Applicants will be notified of their admission into the Respiratory Therapy program in writing and will be asked to confirm their acceptance of admission. In the event class openings occur, others will be considered for admission. If an applicant is not admitted into the class for which s/he is applying, the applicant will have the option to either have the application returned in order to re-apply at a future time, or to have the application held for consideration for the next program start. In both instances it is the prospective student's responsibility to keep up to date regarding admissions policy changes and to update their admission application.

Prerequisites

1. Math 95 or TMATH 100 ­ Intermediate Algebra or higher (5 credits) 2. BIOL& 241 and 242 ­ Anatomy and Physiology I & II(12 credits) 3. PSYC& 100 or 200 ­ General Psychology or Lifespan Psychology (5 credits) 4. HIM 130 ­ Medical Terminology (3 credits)

All of the above prerequisites courses must be completed with a grade "C" or better and within two attempts before application can be taken. There is a ten-year time limit for all math and science courses.

Co-requisites

1. ENGL& 101 ­ College Freshman Composition (5 credits) 2. Communications ­ Choose one of the following: CMST& 101 ­ Introduction to Communication, CMST& 220 ­ Public Speaking, CMST 110 ­ Multicultural Communication (5 credits) 3. Basic Computer Course- Choose one of the following: CU 102, 103, 104, or CU 105 ­ Word I, Excel I, Power Point (IT 235 substitute is acceptable.)(1-5 credit requirement)

All of the above co-requisites courses must be completed with a grade "C" or better and within two attempts. These courses may be taken while in the respiratory program, and MUST be completed to receive your degree and eligibility to take national board examination. It is recommended that the additional non-respiratory support courses be taken prior to entry in the program.

5/17/2011

4

Tuition and Miscellaneous Costs

There are 7 quarters of Respiratory Therapy courses. Below we have provided a breakdown of the cost based on the current Resident rates for Fall 2011. Please refer to TCC's tuition grid at www.tacomacc.edu/costsandaid/tuition for more details. First Quarter ­ 17 credits Second Quarter ­ 14 credits Third Quarter ­ 15 credits Fourth Quarter ­ 16 credits Fifth Quarter ­ 17 credits Sixth Quarter ­ 10-14 credits Seventh Quarter ­ 11 credits Estimated Total (before additional fees and expenses)

Additional fees added at time of registration include: Facility Fee - $ .50 per credit to 15 credits, maximum rate $7.50 Technology Fee - $1.75 per credit to 10 credits, maximum rate $17.50 Safety Fee - $15.00 per student Course Fees - as displayed in class schedule for individual classes

Please note: · Tuition rates subject to change by Washington State Legislature. · Tuition and fees are due at the time of registration and payment must be completed within 2 business days of registration. Continuing students and new students who register early may defer fee payment until the published deferment date (see Quarterly Class Schedule calendar). · Some courses have additional fees assessed. Washington Online (WAOL) students are assessed a $40.00 course fee once each quarter. This fee is non-refundable once the course begins. · U.S. citizens and permanent residents who have not yet established Washington residency may now attend TCC at state resident rates. This optional waiver has been approved by the TCC Board of Trustees, but may not be available at all state colleges. A student who plans to transfer to a college that does not participate in this waiver is advised to establish Washington residency before transfer. Residency information is available at the Admissions Counter.

$1312.56 $1182.42 $1225.80 $1269.18 $1312.56 $1008.90 ­ $1182.42 $1052.28 $8363.70 - $8537.22

Approximate Miscellaneous Costs:

Course Lab and Clinical Fees..............................................................$250.00 Books..........................................................................................$1500.00 Uniform (Scrubs)............................................................................$70.00 Shoes..........................................................................................$100.00 Name Tag.....................................................................................$6.00 Stethoscope...................................................................................$80.00 Watch with second hand....................................................................Variable Immunizations ..............................................................................$250.00 Health Insurance.............................................................................Variable Conference fees (vary by location)........................................................$120.00 DataArc.......................................................................................$60.00 Certified Background Check and Health Clearance Tracking ........................$100.00 Graduation and National Board Examination Fees National Certification Exam (CRT) $190.00 National Registry Exam (RRT) $390.00 (written $190.00, clinical simulation $200.00) State License fee $150.00 ($50 for a optional temporary license) Graduation Certificate $15.00 Graduation Regalia (optional) $25.00

5/17/2011

5

Clinical Requirements for In-Program Students

To complete the required clinical rotations, in-program students will need to provide the following additional documentation prior to starting respiratory care classes. APPLICANTS WILL NOT BE ASKED TO COMPLETE THESE REQUIREMENTS. This information will be covered in further detail at the mandatory orientation for those students who are formally accepted. Health Clearance- Documentation of current immunizations for: 1. TB 2-Step Test 2. Annual TB Skin Test 3. Hepatitis B series 4. MMR (Measles, Mumps, Rubella) 5. Varicella (Chicken Pox) 6. Tetanus, Diptheria, Pertussis 7. Annual Flu Vaccine Current CPR- Card for Health Care Providers. (Provided as part of RC 175) AIDS Education Certificate ­ 7 hour course (Provided as part of RC 175) Proof of Health Insurance ­ Required by clinical sites. Certified Background Check ­ The vendor for criminal background checks is CertifiedBackground.com©. Transportation - It is the student's responsibility to arrange for dependable transportation to and from the clinical site. Some clinical rotations begin as early as 6:00 am, some may be evening or night shift, and may be 6, 8, or 12 hour shifts. Dependable child/dependent care is necessary.

PLEASE NOTE: Individual health care organizations where a student may be placed for clinical learning may have additional participation requirements, such as drug screening. The student will be directly responsible to that health care organization for meeting their requirements.

5/17/2011

6

Respiratory Therapy Program Curriculum Associate of Applied Sciences Degree

Pre-requisites Credits BIOL& 241 & 242 Anatomy and Physiology I & II ......................................................................... 12 College Algebra (Math 99 or higher) ............................................................................................... 5 PSYC& 100 or 200General Psychology or Lifespan Psychology ................................................... 5 HIM 1301 Medical Terminology ........................................................................................ 3 Total Credits............................................................................................. 25

First Quarter - Fall Credits RC 1752 Respiratory Care Orientation ..................................................................... 2 RC 150 Fundamentals of RC .....................................................................3 RC 160 Cardiopulmonary A & P ............................................................................. 4 RC 170 Respiratory Equipment I ............................................................................ 3 RC 180 Respiratory Clinical I .................................................................................. 4 RC 193 Respiratory Pharmacology I ...................................................................... 1 Total Credits ............................................................................................ 17 Second Quarter - Winter Credits RC 151 Fundamentals of RC II ............................................................................... 3 RC 161 Arterial Blood Gases .................................................................................. 3 RC 171 Respiratory Equipment II ........................................................................... 3 RC 181 Respiratory Clinical II ................................................................................. 4 RC 194 Respiratory Pharmacology II .................................................................... 1 Total Credits ............................................................................................ 14 Third Quarter - Spring Credits RC 152 Mechanical Ventilation ............................................................................... 3 RC 162 Advanced Pathophysiology ...................................................................... 3 RC 172 Respiratory Equipment III .......................................................................... 4 RC 182 Respiratory Clinical III ....................................................................4 RC 195 Respiratory Pharmacology III .................................................................... 1 Total Credits ............................................................................................ 15 Fourth Quarter - Summer Credits RC 183 Respiratory Clinical IV ............................................................................... 7 RC 192 Advanced Mechanical Ventilation (Hybrid) ................................................ 4 CMST& 101 Introduction to Communication .................................................................. 5 Total Credits ............................................................................................. 16 Fifth Quarter ­ Second Fall Credits ENGL& 101 English Composition I .............................................................................. 5 RC 240 Advanced Assessment & Diagnosis .......................................................... 3 RC 263 Pulmonary Functions ................................................................................ 3 RC 280 Specialty Clinical Rotation ......................................................................... 4 RC 290 Ethics & Professionalism in Respiratory Care (Online) ............................ 2 Total Credits ............................................................................................ 17

If students have already completed co-requisite classes but still need course credits for financial aid purposes, RC 299 (Independent Study) can be substituted for 1-5 credits as needed at any point during the program. 2 The orientation is a week-long class. The class is completed between Summer and Fall Quarters.

1

5/17/2011

7

Sixth Quarter ­ Second Winter Credits Computers Word I, Excel I, and/or Power Point .......................................... 1-5 variable RC 251 Respiratory Pathophysiology Cases .......................................................... 2 RC 261 Pediatric and Neonatal Respiratory Care .................................................. 4 RC 281 Advance Critical Care Clinical Rotation ..................................................... 3 Total Credits ....................................................................................... 10-14 Seventh Quarter ­ Second Spring Credits RC 262 Review of Application of Respiratory Care (Hybrid)................................... 4 RC 272 Pulmonary Rehabilitation and Home Care ................................................ 3 RC 282 Neonatal/Specialty Clinical Rotation ......................................................... 2 RC 283 Specialty Clinical Rotation II ...................................................................... 2 Total Credits ............................................................................................ 11 Additional Program Course for students requiring fulltime schedule for Financial Aid Individual Study (RC 299) ................................................................................ 1-5 variable

Total Program Credits .................................................................... 132-136

Transfer Information

The Associate in Applied Sciences degree is not a transferable degree to a four-year institution, although some courses within the degree may be accepted for transfer. Graduates may need to complete requirements for the Associate of Arts and Sciences degree for that purpose. Students wishing to transfer to a 4-year institution after graduation from the respiratory program are encouraged to take support courses for the general Associate of Arts and Sciences. Recommended courses that could be considered transferable include: English 102 Sociology Humanities History Foreign Language Please refer to the college catalog of the school you wish to transfer to for complete degree requirements.

Technical Standards for Respiratory Therapy Students

The profession of respiratory therapy is a highly respected one. The reasons for this are many, but a great deal of it has to do with the fact that patients put their lives in our hands. Patients place their trust in healthcare providers and we, in turn, must be worthy of that trust. In order to become a member of a trustworthy allied health profession, there are several requirements that are essential. These have to do with responsibility, accountability, knowledge, skill and safety. The Respiratory Program has the responsibility to the public to assure that it's students and graduates are competent in all of these areas and at the appropriate level. The program 5/17/2011 8

adheres to the definition, requirements, and procedures for licensing as defined in the state statutes (WAC 246-928-410 and WAC 246-928-510). The faculty models professionalism and requires that students be accountable and assumes a measure of responsibility to adhere to the standards of practice. The profession of respiratory therapy requires the acquisition of respiratory science knowledge and technical skills. Respiratory faculty, students, as well as graduates are held to these laws. The educational process to achieve the Associate of Applied Science Degree in Respiratory Therapy requires assimilation of this knowledge, as well as the development of critical thinking, judgment and appropriate decision-making. State licensure requires for reporting of unprofessional conduct (WAC 246-928-710). With the acquisition of this knowledge, students and graduates must be able to function as safe practitioners. Patient safety is a major concern for establishing requirements for capabilities of students. In order to safely function in the roll of a student and/or respiratory therapist, one must exhibit physical, cognitive and behavioral abilities that are required for satisfactory completion of all aspects of the respiratory therapy program. Collection, evaluation and synthesis of data are vital to this discipline. In addition, there are professional attributes that are required by the profession. All of these are every bit as important as the knowledge and skill The therapeutic modalities provided by respiratory care practitioners require technical skills involving manual dexterity and a mechanical aptitude to perform in a safe and acceptable manner. Respiratory Therapists must be mobile and have the ability to operate in relatively small spaces. These requirements are necessary because of the critical and accurate care that is often provided in crisis situations. To make sure these requirements can be met. The Respiratory Care program at Tacoma Community College has come up with the following technical standards. Physical Demands: Respiratory therapy students must be able to display the medium strength rating, as described by the Dictionary for Occupational Titles, which reflects the ability to exert 20 to 50 pounds of force occasionally (occasionally: activity of condition exists up to 1/3 of the time), and/or 10 to 25 pounds of force frequently (frequently: activity or condition exists from 1/3 to 2/3 of the time), and/or greater than negligible up to 10 pounds of force constantly (constantly: activity or condition exists 2/3 or more of the time) to move objects. Motor Skills: Respiratory therapy students must be able to execute motor movements including the physical/dexterity strength to stand and ambulate and possess the physical/dexterity strength to lift and transfer patients. Candidates/current respiratory therapy students must also have the physical strength to perform cardiopulmonary resuscitation. Respiratory therapy procedures require coordination of both gross and fine muscular movements, equilibrium, and functional use of the senses of touch and vision. For this reason, candidates for admission to the Program of Respiratory Therapy must have manual dexterity and the ability to engage in procedures involving grasping, pushing, pulling, holding, manipulating, extending and rotating. Examples of such procedures would include, but not limited to:

· · · · · · ·

Draw venous and arterial blood Perform endotracheal suctioning Provide percussion and postural drainage for bronchial hygiene Perform manual resuscitation (CPR) in the event of a cardiac emergency Maintain and modify equipment in routine emergency situations Be able to move life support equipment in a rapid manner during a crisis situation Be sensitive to changes in pressure when performing emergency breathing with a manual resuscitator in the newborn and small infant as compared to the adult victim 9

5/17/2011

·

Tactile sensitivity required to perform arterial puncture on the newborn and small infant.

Sensory/Observational Skills: Respiratory therapy students must be able to observe demonstrations and participate in laboratory experiments as required in the curriculum. Respiratory therapy students must be able to observe patients and be able to obtain an appropriate medical history directly from the patient or guardian. Such observation requires the functional use of vision, hearing, and other sensory modalities. Respiratory therapy students must have visual perception which includes depth and acuity. Communication Skills: Respiratory therapy students must be able to communicate in English effectively and sensitively with patients. In addition, candidates/current respiratory therapy students must be able to communicate in English in oral and handwritten form with faculty, allied personnel, and peers in the classroom, laboratory, and clinical settings. Respiratory therapy students must also be sensitive to multicultural and multilingual needs. Such communication skills include not only speech, but reading and writing in English. Respiratory therapy students must have the ability to complete written assignments and search and evaluate the literature. Respiratory therapy students must have the ability to complete written assignments and maintain written records. Respiratory therapy students must have the ability to complete assessment exercises. Respiratory therapy students must also have the ability to use therapeutic communication, such as attending, clarifying, coaching, facilitating, and touching. These skills must be performed in clinical settings, as well as the didactic and laboratory environments. Intellectual/Conceptual, Integrative, and Qualitative Skills: Respiratory therapy students must have the ability to measure, calculate reason, analyze, and synthesize data. Problem solving and diagnosis, including obtaining, interpreting, and documenting data, are critical skills demanded of respiratory therapists which require all of these intellectual abilities. These skills allow students to make proper assessments, sound judgments, appropriately prioritize therapeutic interventions, and measure and record patient care outcomes. Respiratory therapy students must have the ability to learn to use computers for searching, recording, storing, and retrieving information. Behavioral/Social Skills and Professionalism: Respiratory therapy students must demonstrate attributes of empathy, integrity, concern for others, interpersonal skills, interest and motivation. Respiratory therapy students must possess the emotional well-being required for use of their intellectual abilities, the exercise of sound judgment, the prompt completion of all responsibilities attendant to the evaluation and care of patients, and the development of mature, sensitive, and effective relationships with patients. Respiratory therapy students must be able to adapt to everchanging environments, display flexibility, and learn to function in the face of uncertainties and stresses which are inherent in the educational process, as well as the clinical problems of many patients. Respiratory therapy students must be able to maintain professional conduct and appearance, maintain client confidentiality and operate within the scope of practice. Candidates/current respiratory therapy students must also have the ability to be assertive, delegate responsibilities appropriately, and function as a part of a medical team. Such abilities require organizational skills necessary to meet deadlines and manage time. The Respiratory Care program at Tacoma Community College will makes every effort to provide the physically compromised student the opportunities to learn and develop into a safe, rational respiratory care practitioner. It is incumbent upon the student to realize that certain manual, technical, and professional tasks must be mastered in order to achieve passing grades and to successfully complete the respiratory therapy curriculum.

5/17/2011

10

RESPIRATORY THERAPIST (Pierce County Employment & Training Consortium- Information Sheet

Job Description · · · · · · · Treat people who have difficulty breathing due to heart or lung problems. Determine most suitable method of administering inhalants, precautions to be observed, and potential modifications needed, compatible with physicians' orders. Perform the tests that aid in the diagnosis and evaluation of respiratory problems using special apparatus and administering therapies. Determine requirements for treatment, such as type and duration of therapy, and medication and dosages. Monitor patient progress. Teach patients how to use prescribed respiratory treatment methods and equipment. Provide emergency respiratory care.

Employment Outlook · Faster-than-average employment growth is projected for respiratory therapists. · Employment of respiratory therapists is expected to grow 19 percent from 2006 to 2016, faster than the average for all occupations. · Job opportunities will be best for therapists with cardiopulmonary skills or experience working with newborns and infants.

Average Annual Earnings in Pierce County* Entry Level: Median: Experienced: $35,200 $47,420 up to $50,000+

*Based on a survey of earnings from May 2006.

On-line Sources for Additional Information

The National Board of Respiratory Care, Inc. (NBRC): www.nbrc.org American Association for Respiratory Care (AARC): www.aarc.org Respiratory Care Society of Washington (RCSW): www.rcsw.org Commission for Accreditation of Respiratory Care (CoARC): www.coarc.com

Healthcare occupations that could transition into Respiratory Therapy, with training: Lab Assistant/Phlebotomist, Health Unit Clerk, Service Workers (including housekeeping and food services), Nursing Assistant or Medical Assistant.

Career Advancement

Respiratory therapists advance in clinical practice by moving from care of general to critical patients who have significant problems in other organ systems, such as the heart or kidneys. Respiratory therapists, especially those with 4-year degrees, may also advance to supervisory or managerial positions in a respiratory therapy department. Respiratory therapists in home care and equipment rental firms may become branch managers. Some respiratory therapists advance by moving into teaching positions.

5/17/2011

11

This page left blank intentionally

5/17/2011

12

Hospital Visitation Form ­ Respiratory Therapy Program

Applicant's Name: Hospital: Date/Time: Number of Hours:

Exams Observed:

Applicant's comments regarding visitation session:

Respiratory Therapist's Signature:

Applicant's Name: Hospital: Date/Time: Number of Hours:

Exams Observed:

Applicant's comments regarding visitation session:

Respiratory Therapist's Signature:

5/17/2011

13

This page left blank intentionally

5/17/2011

14

Healthcare/Patient care Verification Form ­ Respiratory Therapy Program

For additional points, please provide proof of patient-related volunteer or paid patient related healthcare experience. Please fill out this form and have your direct supervisor verify and sign. Points will be given based on overall hours. Please refer to page 4 for examples of accepted direct patient-related healthcare experience.

Print Name: _____________________________________________________________ Signature: ______________________________________________________________

Hospital/Clinic/Facility: _____________________________________________________

Number of Hours: ____________________ Start Date: _____________________ End Date: _____________________

Please list specific type of healthcare/patient care experience.

Supervisor: Print Name: ____________________________________ Signature: _____________________________________ Phone: ________________________________________

*By signing above you verify that this applicant has had direct patient related healthcare experience.

5/17/2011

15

This page left blank intentionally

5/17/2011

16

THIS FORM IS FOR STUDENTS WHO NEED TO TRANSFER CREDITS FROM ANOTHER COLLEGE

If you took all of your classes at Tacoma Community College please disregard. DATE OF REQUEST__________________ REQUEST FOR EVALUATION OF TRANSFER CREDITS

Send Official Transcripts to: Tacoma Community College 6501 South 19th St. Bldg. 7, Records and Registration Tacoma, WA 98466-6100

NAME_________________________________________________________________________ PREVIOUS NAME(S)____________________________________________________________ ADDRESS______________________________________________________________________ CITY__________________________STATE______________ZIP_________________________ TCC STUDENT IDENTIFICATION NUMBER _____________-_____________-___________ PHONE NUMBER (______) ____________-___________ LIST ALL SCHOOLS TO BE EVALUATED________________________________________ _____________________________________________________________________________ PLEASE SEND COPIES TO THE FOLLOWING DEPARTMENTS: (Choose which program you wish to receive a copy) Assessment________________ Veterans_________________ Allied-Health______________ Diagnostic Medical Sonography Nursing Radiologic Technology Respiratory Therapy Pharmacy Technician Other _______________ Athletics_________________

PLEASE NOTE: * Students must submit an application to the Admissions Office before an evaluation can be completed. Evaluations generally take 2 ­ 6 weeks to be completed. Please be sure to allow enough time before program deadlines. (See individual program packets for dates.) A copy of the evaluation will also be mailed to the student. A maximum of 60 credits will be accepted towards a degree or certificate that the student is pursuing. Tacoma Community College does not release or certify copies of transcripts from other institutions. Transcripts submitted to Tacoma Community College are part of the official file and will not be returned to the student. * There after a student identification number shall be assigned. 5/17/2011 17

This page left blank intentionally

5/17/2011

18

_________________________ Date Received (Office use only)

Respiratory Therapy Program Application

Application Year: FALL________

Contact Information

Please type or print clearly:

Last Name

First Name

Initial

Previous Name

970Student Identification Number (Required)

@tacomacc.edu

TCC E-mail Address*

/

Birth Date / Place of Birth

Male ( ) (

Female )

(

)

Home Phone #

Work/Message Phone #

Cell Phone #

__________________________________________________________________________________________

Mailing Address City State ZIP Code

___________________________________________________________________________________

Alternate Address (if above is temporary) City State ZIP Code __________________________________________________________________________________________________ Person to Contact in Case of Emergency Phone #

Name of High School

Location

Graduation Date

Highest grade completed if not a graduate

GED Completion Date

PLEASE NOTE: All communications regarding application and acceptance will be through TCC email only. Please be sure to monitor your TCC email account so that you do not miss important information.

5/17/2011

19

All Colleges/Universities Attended (also list if attended TCC)

Name of Institution Location Credits

Graduation Date/Degree

Please select one of the following options:

I took all of my classes at Tacoma Community College and will attach an unofficial transcript to my application. My official transcripts from colleges other than Tacoma Community College were sent to the Records and Registration Office on: ___________________

(Date Submitted)

Official, sealed transcripts must be received in the Records and Registration Office (Bldg 7) BEFORE the May 1st deadline.

I consider myself to be a member of the following ethnic group:

White Hawaiian Vietnamese Eskimo African American Samoan Japanese Aleut Native American Guamanian Chinese Multi-Ethnic Hispanic Latino Korean Other:

Your answer to the above question will permit the Health, Justice and Human Services Office to accurately complete State and Federal census forms.

I understand that failure to submit transcripts or meet program requirements will delay and possibly void the application process. My signature confirms the accuracy and truthfulness of information contained in this application.

Signature Please Forward Application Packet to: Tacoma Community College Health, Justice and Human Services Division Respiratory Therapy, Bldg. 19 6501 South 19th Street Tacoma, WA 98466-6100 5/17/2011 20 Date

Information

Microsoft Word - RC 11-12 Program Packet.doc

20 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

673603