722.8.21.08 Student Selection Criteria - Regional West Medical Center
722.8.21.08 Student Selection Criteria - Regional West Medical Center
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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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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SCHOOL OF RADIOLOGIC TECHNOLOGY<br />
POLICY <strong>722.8.21.08</strong><br />
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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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SCHOOL OF RADIOLOGIC TECHNOLOGY<br />
POLICY <strong>722.8.21.08</strong><br />
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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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SCHOOL OF RADIOLOGIC TECHNOLOGY<br />
POLICY <strong>722.8.21.08</strong><br />
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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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SCHOOL OF RADIOLOGIC TECHNOLOGY<br />
POLICY <strong>722.8.21.08</strong><br />
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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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POLICY <strong>722.8.21.08</strong><br />
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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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POLICY <strong>722.8.21.08</strong><br />
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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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POLICY <strong>722.8.21.08</strong><br />
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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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POLICY <strong>722.8.21.08</strong><br />
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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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POLICY <strong>722.8.21.08</strong><br />
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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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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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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 />
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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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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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