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722.8.21.08 Student Selection Criteria - Regional West Medical Center

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

STUDENT SELECTION CRITERIA<br />

Members of the <strong>Selection</strong>s Committee determine the selection of students for the<br />

Radiography Program. The Committee assures the applicant meets application<br />

requirements. The Committee selects the best qualified students based on SAT or ACT<br />

scores, a personal interview, written submissions by the applicant, and references.<br />

Responsibility: Program Director; <strong>Selection</strong>s Committee; Applicant<br />

Standard: Human Resources<br />

The applicant to the Program must submit an application form by February 1st of the<br />

year the applicant wishes to enter the Program. Each applicant must also submit high<br />

school transcripts, college transcripts, SAT or ACT scores, a completed observation<br />

form, and references to complete the application process.<br />

The applicant must assure all submissions necessary for application postmarked no<br />

later than February 20th.<br />

The Admission Coordinator will review the application of each applicant prior to the<br />

interview date and advise the applicant in writing of areas of deficiency in meeting<br />

application requirements.<br />

The <strong>Selection</strong>s Committee will extend invitations to applicants who meet the admission<br />

criteria for an interview for positions in the Program. The Committee will provide<br />

interview dates to applicants in writing.<br />

The Program will offer an interview time to applicants pending resolution of any<br />

deficiencies by a specified cutoff date. Applicants must demonstrate completion of, or a<br />

plan to complete, courses identified as the prerequisites for the Program before being<br />

scheduled for an interview.<br />

The Program requires students in the Program to be academically proficient to graduate<br />

from the Program. Applicants with an overall college grade point average (GPA) of 2.5<br />

or greater and an SAT or ACT composite score of 18 or greater will be offered an<br />

interview, provided that the applicant has demonstrated that the pre-requisite courses<br />

will be completed before the beginning of the Program in August.<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

The Program will use the following three categories in the selection of students:<br />

Interviews -The interviewers will complete the interview summary form immediately<br />

after interviewing each applicant. The form used will identify a five point system, with<br />

five being the best.<br />

Written Communication Skills – The applicant will be required to complete a written<br />

interview question during the interview process. With this essay and the previously<br />

submitted observation form questions, members of the <strong>Selection</strong>s Committee (Writing<br />

Section) will evaluate the writing skills of each applicant. The form used will use a four<br />

point system, with four being the best. The Program will not reveal the applicant name<br />

to the person who evaluates the written submissions. The total score will be based on<br />

one-third grammar and spelling, one-third content, and one-third critical thinking.<br />

SAT or ACT scores – The student will submit a copy of his or her ACT or SAT Scores.<br />

References – The applicant is responsible for distributing the reference forms and<br />

providing the Program with the names and addresses corresponding to the references<br />

on the application form. As a part of the application process the applicant will print off<br />

reference forms. The person identified as a reference is instructed to complete the form,<br />

seal it in an envelope, and sign the back of the envelope over the sealed edge of the<br />

flap. The applicant or the reference mails the form back to the School of Radiologic<br />

Technology postmarked by February 20th. The Program will destroy confidential<br />

reference forms after the selection of students.<br />

The Admissions Coordinator will compile the numerical components for the references<br />

of each applicant. The form used will identify a five point system, with five being the<br />

best. If the reviewer of the reference identifies an area of concern during the review of<br />

the reference, the reviewer will communicate the concern to the interviewers for further<br />

investigation of the issue.<br />

The ACT Scores and the Written Assignments each have a 33% weight and the<br />

Interview will have a 34% weight in the selection of the applicants. After completion of<br />

interviews the data for each applicant from each of these three categories will be<br />

compiled and a member of the Committee will add, average, and rank the selection<br />

criteria for each applicant. Applicants will be selected from this ranking<br />

The Program will offer a position to the top applicants by rank order. In the event of a<br />

tie, the <strong>Selection</strong> committee will use the following criteria to break the tie: references,<br />

comments from references, or re-interviewing applicants with the same score.<br />

The Program will notify all applicants of their status in regards to acceptance into the<br />

Program. Applicants selected for the Program will need to pass background checks,<br />

and drug testing before final acceptance into the Program.<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

Applicants identified as alternates will be notified. The Program will contact an alternate<br />

regarding admission into the Program if a selected candidate does not enter the<br />

Program. Once the Program starts in August, the Program will no longer contact<br />

alternates for any openings.<br />

The Program can select a maximum of seven students each year. The Educational<br />

Advisory Committee will be responsible for determining the actual number of students<br />

accepted into the Program each year. The number of students accepted into the<br />

Program each year shall be dependent on the available number of staff technologists in<br />

clinical educational settings during daytime hours excluding radiation oncology, nuclear<br />

medicine, ultrasound, MRI or at a management/supervisory level.<br />

Not all available positions may be filled.<br />

The conditional student must complete all prerequisite classes before the first day of<br />

classes in the Program and demonstrate completion by submission of an official<br />

transcript.<br />

_______________________<br />

Daniel Gilbert, MSEd, RT(R)(CV)(MR)(CT)(QM)<br />

Program Director<br />

_________________________<br />

Sharon McKinney, MPA<br />

Director, Imaging Services<br />

__________________________<br />

Stephen C. Johnson MD, PhD<br />

<strong>Medical</strong> Advisor<br />

_______________________________ ___________________________<br />

Jan Taylor<br />

Todd S. Sorensen, M.D.<br />

Vice President, Ancillary Services<br />

President / CEO<br />

Reviewed: 12/30/99, 3/28/00, 12/01/11, 3/22/12<br />

Revised: 01/15/86; 09/14/86; 06/07/87; 09/22/88; 12/28/89;4/8/91; 10/09/91; 12/12/94, 5/10/95, 2/3/98,<br />

2/23/99, 8/18/00, 5/6/02, 9/29/04; 3/29/06, 2/26/07, 5/28/09, 3/22/12, 3/21/13<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

STANDARDS IN INFORMATION<br />

The applicant should be aware that the Program and the American Registry of<br />

Radiologic Technologists (ARRT) have certain standards that students must follow to be<br />

accepted into the Program or be eligible to take the ARRT national certifying<br />

examination.<br />

1. All aspects of patient information are confidential. Disciplinary action will be taken<br />

against a student disclosing any patient information to inappropriate persons or<br />

inappropriate situations. Disciplinary action may result in dismissal from the Program.<br />

2. The Program is a twenty-four month Program. Classes continue year round.<br />

3. <strong>Student</strong>s will have shifts of 8-5, 7-4, or 7:30-3:30, depending on clinical site. <strong>Student</strong>s<br />

will have clinical rotations that include daytime and weekends hours.<br />

4 The Program schedules students for 40 hours of didactic and clinical education per<br />

week. A student will need to spend time, in addition to these hours doing homework<br />

and studying.<br />

5. A student accepted into the Program will complete a pre-enrollment drug test.<br />

6. A student accepted into the Program will need to provide permission for background<br />

checks to be performed on the student by the sponsoring organization and/or clinical<br />

educational settings.<br />

7. A student in the Program must maintain a minimum of 3.0 GPA in all courses<br />

throughout the length of the Program.<br />

8. Disciplinary action or dismissal will occur for cheating, plagiarism, or purposely<br />

preventing others from achieving their educational goals. These types of events<br />

require disclosure to the American Registry of Radiologic Technologists (ARRT) and<br />

may compromise the student’s eligibility to sit for the national examination.<br />

9. The student must complete at minimum an associated degree before sitting for the<br />

ARRT exam.<br />

The American Registry of Radiologic Technologists (ARRT), in its code of ethics,<br />

requires an applicant making application for an ARRT exam to report “Convictions,<br />

criminal proceedings, or military court-martials as described below:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

Conviction of a crime, including felony, a gross misdemeanor, or a<br />

misdemeanor, with the sole exception of speeding and parking violations.<br />

All alcohol and/or drug related violations must be reported. Offenses that<br />

occurred while a juvenile and that are processed through the juvenile court<br />

system are not required to be reported to the ARRT.<br />

Criminal proceedings where a finding or verdict of guilt is made or<br />

returned but the adjudication of the guilt is either withheld, deferred, or not<br />

entered or the sentence is suspended or stayed; or a criminal proceeding<br />

where the individual enter a pleas of guilty or nolo contendere (no<br />

contest); [Interim] or where the individual enters into a pre-trial diversion<br />

activity.<br />

Military court-martials that involve substance abuse, any sex-related<br />

infractions, or patient-related infractions.”<br />

In addition the student must allow the ARRT to:<br />

Communicate freely and a openly with the Program Director, and to allow<br />

the ARRT to obtain specific parts of the student’s educational records in<br />

order to verify when the student has ever been subjected to a sanction as<br />

a result of a violation of an academic honor code, or suspended or<br />

dismissed by an educational Program that the student attended in order to<br />

meet ARRT certification requirements.<br />

In addition, the student will be required to waive in part the confidentiality<br />

of the student’s educational records under the Family Educational Rights<br />

and Privacy Act, 20 U.S.C. section 1232g (“FERPA”), and give consent to<br />

the release of any or all educational records relating to the student’s<br />

discipline, suspension, and/or dismissal to the ARRT for purposes of its<br />

review of the student’s application for certification by the ARRT.<br />

Whether an individual, who must report these events to the ARRT, will be eligible<br />

to sit for the ARRT examination is the determination of the ARRT not the Program.<br />

10. Financial aid is available for eligible students for through the University of Nebraska<br />

at Kearney, Chadron State College, or <strong>West</strong>ern Nebraska Community College.<br />

<strong>Regional</strong> <strong>West</strong> <strong>Medical</strong> <strong>Center</strong> does not provide financial aid.<br />

11. <strong>Student</strong>s will rotate through various clinical sites including <strong>Regional</strong> <strong>West</strong> <strong>Medical</strong><br />

<strong>Center</strong>; <strong>Regional</strong> <strong>West</strong> Physicians Clinic –Orthopedics; <strong>Regional</strong> <strong>West</strong> Physicians<br />

Clinic – Family Medicine/Internal Medicine; Box Butte General Hospital in Alliance;<br />

Community Hospital in Torrington, Wyoming; Morrill County Community Hospital in<br />

Bridgeport; or other clinical sites as designated by the Program.<br />

12. The student will be responsible for obtaining appropriate editions of required<br />

textbooks before the beginning of a course. The Program will provide the start date<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

of courses and textbooks needed. <strong>Student</strong>s will not be able to purchase textbooks<br />

through the Program.<br />

This is not an inclusive list of the Standards expected of <strong>Regional</strong> <strong>West</strong> <strong>Medical</strong> <strong>Center</strong><br />

School of Radiologic Technology students. Refer to the student handbook for other<br />

Standards.<br />

I have read and understand that if accepted in to the Program that I must follow these<br />

Standards and other policies of <strong>Regional</strong> <strong>West</strong> <strong>Medical</strong> <strong>Center</strong> and <strong>Regional</strong> <strong>West</strong><br />

<strong>Medical</strong> <strong>Center</strong> School of Radiologic Technology.<br />

_______________________________<br />

Signature<br />

_______________________________ ______________________<br />

Printed name of applicant<br />

Date<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

Interviewer: __________________<br />

INTERVIEW QUESTIONS<br />

Applicant: ____________________ Date: _______________________<br />

A. Positive self-concept – demonstration by high levels of determination,<br />

confidence and independence.<br />

<strong>Student</strong>s with these skills will tend to be more successful even when<br />

encountering difficult and unmet situations.<br />

Provide a number (1, 2, 3, 4 or 5) Indicating your rating of the applicant for this section.<br />

1. Does not meet expectations.<br />

2. Observes that some expectations are met.<br />

3. Meets expectations<br />

4. On occasion exceeds expectations<br />

5. Consistently exceeds expectations.<br />

________<br />

*1. What do you feel are your proudest accomplishments up to this time?<br />

2. Why should the Program select you as a student? What qualities make you a good<br />

candidate?<br />

Comments:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

B. Realistic self-appraisal is demonstrated by the ability to assess one’s own<br />

strengths and weaknesses and the recognition of one’s inadequacies.<br />

Recognizing situations where the student needs additional assistance will assure<br />

the student does not fail because he or she will not ask for help. <strong>Student</strong>s with<br />

good self appraisal skills will know the amount of study time needed to succeed.<br />

1. Does not meet expectations.<br />

2. Observes that some expectations are met.<br />

3. Meets expectations<br />

4. On occasion exceeds expectations<br />

5. Consistently exceeds expectations.<br />

________<br />

*1. Tell us about a challenging event that happened to you. Wait for answer. How did<br />

you deal with this from personal, educational, and financial standpoints. Wait for<br />

answer. Tell us how you would change how you handled this situation if a similar<br />

event were to occur.<br />

2. Tell us about two memorable projects, one success and one failure. To what do you<br />

attribute the success and failure?<br />

Comments:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

C. Understanding - ability to deal with the differences in cultures, race and gender<br />

demands of the system and respond accordingly without blaming others for<br />

problems. This aspect of the student identifies how well the student is able to<br />

adjust to a different environment and social setting.<br />

Provide a number (1, 2, 3, 4 or 5) Indicating your rating of the applicant for this section.<br />

1. Does not meet expectations.<br />

2. Observes that some expectations are met.<br />

3. Meets expectations<br />

4. On occasion exceeds expectations<br />

5. Consistently exceeds expectations.<br />

________<br />

*1. How have you dealt with difficult people in the past? For example, a person<br />

becomes angry with you for something you don't think is your fault. How did you react?<br />

2. What is the most difficult adjustment you have ever had to make in your life?<br />

Comments:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

D. Preference for long term goals particularly long term academic goals, infer<br />

one’s ability to adapt to the atmosphere of delayed gratification that naturally<br />

exists in higher education. <strong>Student</strong>s who have identifiable long term goals should<br />

be able to make effective short term goals.<br />

Provide a number (1, 2, 3, 4 or 5) Indicating your rating of the applicant for this section.<br />

1. Does not meet expectations.<br />

2. Observes that some expectations are met.<br />

3. Meets expectations<br />

4. On occasion exceeds expectations<br />

5. Consistently exceeds expectations.<br />

________<br />

*1. Tell us of a major goal that you set for yourself and the steps that you took or are<br />

taking to achieve that goal.<br />

2. What alternative plans have you made if you were not to be accepted into the<br />

Program at <strong>Regional</strong> <strong>West</strong> <strong>Medical</strong> <strong>Center</strong>?<br />

Comments:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

E. The availability of a strong support person refers to the ability to identify and<br />

receive help, support, and encouragement as the student adapts and socially<br />

adjusts to college life.<br />

Provide a number (1, 2, 3, 4 or 5) Indicating your rating of the applicant for this section.<br />

1. Does not meet expectations.<br />

2. Observes that some expectations are met.<br />

3. Meets expectations<br />

4. On occasion exceeds expectations<br />

5. Consistently exceeds expectations.<br />

________<br />

*1. Who or what do you turn to assist you when life problems occur?<br />

2. How do you handle a situation where the work load is beginning to be too much and<br />

your emotions start to be involved in the situation?<br />

Comments:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

F. Leadership is demonstrated by involvement in extracurricular activities (sports<br />

teams, clubs, professional student organizations, fraternity/sorority, etc.)<br />

Community involvement indicates the ability to navigate academic and<br />

nonacademic time demands and also provides social networks for the student.<br />

Provide a number (1, 2, 3, 4 or 5) Indicating your rating of the applicant for this section.<br />

1. Does not meet expectations.<br />

2. Observes that some expectations are met.<br />

3. Meets expectations<br />

4. On occasion exceeds expectations<br />

5. Consistently exceeds expectations.<br />

________<br />

*1. What is most satisfying for you in your work, education or in volunteering?<br />

2. Describe one activity you have enjoyed in the past four years? What drew you to this<br />

activity?<br />

Comments:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

G. Knowledge acquired in a field refers to one’s ability to learn and acquire<br />

knowledge in less conventional ways and the ability to obtain knowledge outside<br />

the classroom (possibly nontraditional, cultural, racially or gender-based). The<br />

student should have investigated the field prior to applying to the Program.<br />

<strong>Student</strong>s who have investigated the field will be less like to find that radiology is<br />

not what was expected.<br />

Provide a number (1, 2, 3, 4 or 5) Indicating your rating of the applicant for this section.<br />

1. Does not meet expectations.<br />

2. Observes that some expectations are met.<br />

3. Meets expectations<br />

4. On occasion exceeds expectations<br />

5. Consistently exceeds expectations.<br />

________<br />

*1. What have you done to prepare yourself for entry into this Program beyond taking<br />

college classes?<br />

2. Tell us of a time during your observation period in preparing for the Program where<br />

the technologist demonstrated excellent patient care skills.<br />

Comments:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

H. This Program is significantly different from a traditional educational Program.<br />

While the applicant is determined to enter a radiography Program, it is also<br />

important that the applicant is aware of the expectations that we have of students<br />

in this Program.<br />

Does the applicant accurately relate the following information? Either reinforce<br />

correct answers or correct any erroneous statements.<br />

1. What is the length of the Program in months?<br />

(24 months - the Program extends through the summer of both years)<br />

2. How many hours per day is the student required to be in attendance for<br />

clinical or for didactic?<br />

(Nine hours with an hour for a meal break. This may be a continuous day<br />

with no breaks other than meal break)<br />

3. What towns other than Scottsbluff do students travel to as part of their<br />

clinical rotation?<br />

(Alliance, Bridgeport and Torrington - <strong>Student</strong>s must supply their own<br />

transportation for these rotations).<br />

4. Are students expected to complete assignments and homework outside<br />

scheduled didactic class times?<br />

(Yes and there is a fair amount to accomplish. Therefore students entering<br />

the Program will need to immediately adjust their schedules for homework<br />

for almost every evening).<br />

5. What types of learning activities will the student experience while in the<br />

Program?<br />

(Clinical – Examples include hands-on situations of touching another<br />

person for positioning; using radiation to make exposures; experiences in<br />

the emergency department, surgery, neonatal intensive care, and morgue;<br />

experiencing patients who are bleeding, vomiting, have infectious<br />

diseases, are under the influence of alcohol or drugs, or are deceased.)<br />

(Didactic – Examples include laboratory assignments, reading<br />

assignments, completing worksheets, math problems, reading professional<br />

journals, doing research and writing research papers, developing<br />

PowerPoint presentations for case studies and in-class teaching<br />

assignments, developing an educational poster, and being tested over<br />

learned material in a variety of formats)<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

Was the student cognizant of the format of the Program ____ Yes ____ No<br />

Does this person in your opinion have the aptitude and skills necessary to be<br />

successful in the Program?<br />

____ Yes ____ No<br />

Reasons for your opinion?<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

STUDENT INTERVIEW WRITTEN QUESTION<br />

APPLICANT'S NAME___________________________<br />

Question – changes from year to year<br />

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EXAMPLES OF STUDENT INTERVIEW WRITTEN QUESTIONS<br />

REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

THERE IS CURRENTLY A SHORTAGE OF TECHNOLOGISTS THROUGHOUT THE<br />

NATION. WHAT FACTORS DO YOU BELIEVE IS THE CAUSE OF THIS SHORTAGE?<br />

PLEASE DESCRIBE WHY YOU WISH TO MAKE RADIOLOGIC TECHNOLOGY<br />

YOUR PROFESSION AND WHY THE ADMISSIONS COMMITTEE SHOULD SELECT<br />

YOU FOR A POSITION IN THE UPCOMING CLASS.<br />

IN YOUR OPINION WHAT ARE THE RESPONSIBILITIES OF A RADIOGRAPHER?<br />

HOW DOES THE ROLE OF THE RADIOGRAPHER IMPACT THE HEALTH CARE<br />

TEAM?<br />

WHY DO YOU WISH TO MAKE RADIOLOGIC TECHNOLOGY YOUR PROFESSION<br />

AND IN YOUR OPINION WHAT ARE THE RESPONSIBILITIES OF A<br />

RADIOGRAPHER.<br />

HOW WILL THE DEVELOPMENTS IN TECHNOLOGY IMPACT THE FIELD OF<br />

RADIOLOGIC TECHNOLOGY?<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

WRITING COMMITTEE EVALUATION FORM<br />

Applicant's Number _______ Essay _______ Observation ________<br />

Interviewer_________________ Date_________________<br />

Evaluation Scale:<br />

4 - Excellent 3 - Good 2-Acceptable 1 - Poor U - Unable to Evaluate<br />

Please circle one rating for each section.<br />

A. Grammar/Spelling U 1 2 3 4<br />

B. Content/Accuracy U 1 2 3 4<br />

C. Critical Thinking U 1 2 3 4<br />

Comments:<br />

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REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

CUMULATIVE REFERENCE EVALUATION FORM<br />

Committee Member _________________ Date_________________<br />

1. STUDENT: _______________________ Score: ___________<br />

Comments:<br />

2. STUDENT: _______________________ Score: ___________<br />

Comments:<br />

3. STUDENT: _______________________ Score: ___________<br />

Comments:<br />

4. STUDENT: _______________________ Score: ___________<br />

Comments:<br />

5. STUDENT: _______________________ Score: ___________<br />

Comments:<br />

6. STUDENT: _______________________ Score: ___________<br />

Comments:<br />

7. STUDENT: _______________________ Score: ___________<br />

Comments:<br />

STUDENT SELECTION CRITERIA -POLICY <strong>722.8.21.08</strong> page 19 of 23


REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

PROGRAM EVALUATION<br />

Dear Applicant,<br />

As one of the recent applicants offered a position to the <strong>Regional</strong> <strong>West</strong> <strong>Medical</strong> <strong>Center</strong><br />

School of Radiologic Technology we would like your assistance in improving the quality<br />

of the Program at <strong>Regional</strong> <strong>West</strong>.<br />

Please provide input in your decision in not accepting a position to the Program. Your<br />

comments are important to us. Mark all that apply and return in the enclosed envelope.<br />

Reason for not accepting a position with <strong>Regional</strong> <strong>West</strong>?<br />

Friendliness of the staff, interviewer, and students.<br />

Excellent Above Average Average Below Average Unacceptable<br />

5 4 3 2 1<br />

Please comment:<br />

Quality of the educational facilities.<br />

Excellent Above Average Average Below Average Unacceptable<br />

5 4 3 2 1<br />

Please comment:<br />

STUDENT SELECTION CRITERIA -POLICY <strong>722.8.21.08</strong> page 20 of 23


REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

Quality of the clinical facilities.<br />

Excellent Above Average Average Below Average Unacceptable<br />

5 4 3 2 1<br />

Please comment:<br />

Tuition costs.<br />

Excellent Above Average Average Below Average Unacceptable<br />

5 4 3 2 1<br />

Please comment:<br />

____ Other Issues ___________________________________<br />

Please comment:<br />

Thank you for your time.<br />

Sincerely,<br />

Dan Gilbert, MSEd, RT(R)(CV)(MR)(CT)(QM)<br />

Program Director<br />

STUDENT SELECTION CRITERIA -POLICY <strong>722.8.21.08</strong> page 21 of 23


REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

ACCEPTANCE FORM<br />

______ I accept your offer for a position as a radiology student in <strong>Regional</strong> <strong>West</strong><br />

<strong>Medical</strong> <strong>Center</strong> School of Radiologic Technology beginning in August of<br />

20___.<br />

______ I am NOT accepting your offer for a position as a radiology student in<br />

<strong>Regional</strong> <strong>West</strong> <strong>Medical</strong> <strong>Center</strong> School of Radiologic Technology beginning<br />

in August of 20____.<br />

SIGNATURE ______________________________<br />

NAME ___________________________________<br />

\<br />

DATE____________________________________<br />

Complete and return in the envelope provided to the Program Director by the date<br />

indicated in the accompanying letter.<br />

Please complete the following and return in the enclosed envelope.<br />

PLEASE PRINT<br />

Summer Address: _________________________________________<br />

__________________________________________<br />

__________________________________________<br />

Phone number: ____________________________________________<br />

E-mail: ____________________________________________________<br />

Return to: Dan Gilbert, Program Director<br />

<strong>Regional</strong> <strong>West</strong> <strong>Medical</strong> <strong>Center</strong><br />

4021 Ave B<br />

Scottsbluff NE 69361<br />

STUDENT SELECTION CRITERIA -POLICY <strong>722.8.21.08</strong> page 22 of 23


REGIONAL WEST MEDICAL CENTER<br />

SCHOOL OF RADIOLOGIC TECHNOLOGY<br />

POLICY <strong>722.8.21.08</strong><br />

04/20/79<br />

COMPLETION OF ENTRANCE REQUIREMENTS<br />

STUDENT ________________________________<br />

Date Received:<br />

NOTIFICATION OF COMPLETION OF COURSES ______________________<br />

IMMUNIZATION RECORD _______________________<br />

DRUG FREE CAMPUS FORM ________________________<br />

RADIATION MONITOR BADGE FORM ________________________<br />

INSURANCE OR WAIVER ________________________<br />

INFORMATION SHEET _________________________<br />

NOTIFICATION OF DRUG TESTING _________________________<br />

BACKGROUND CHECK (RWMC) ________________________<br />

BACKGROUND CHECK (Banner Health) ________________________<br />

Optional Check off list for Program Director.<br />

STUDENT SELECTION CRITERIA -POLICY <strong>722.8.21.08</strong> page 23 of 23

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