Marion County School of Radiologic Technology 2016 Program Application Information

(1)

Marion County School of Radiologic Technology

2016 Program Application

Information

DEADLINE: May 15, 2016

SELECTION: June 15, 2016

Community Technical & Adult Education

1014 SW 7

th

_Road

Ocala, FL 34471

www.ctae.edu

Radiography Program (352) 671-7223

Radiologic Technologists

Radiologic Technology is a high-tech, high-touch career field. Registered Technologists in Radiography, RT(R),

perform diagnostic imaging examinations and often specialize in advanced imaging modalities such as Computed

Tomography (CT), Magnetic Resonance Imaging (MR), Cardiac-Interventional Technology (CI) and more.

Radiographers routinely provide care to patients and perform tasks involving heavy lifting and pushing. Radiographers

work on their feet for long hours. The images produced by Radiographers are used for diagnostic interpretation by

Radiologists enabling physicians to diagnose and treat a vast array of patient conditions. This profession requires

critical thinking, maturity, caring, and dependability. Radiographers must have a solid knowledge base in Radiologic

Sciences and patient care, and demonstrate a reliable work ethic. Radiographers must work well in a team environment

and autonomously as an independent thinker and problem-solver.

The Program

The Marion County School of Radiologic Technology is a two-year certificate Radiography Program requiring a

full-time commitment from students, 8-hours per day, 5-days per week. The program is designed to provide students with

the knowledge and skills necessary to become radiologic technologists. The program maintains high standards of

excellence in education that assures quality patient care and safe technologist practices. Graduates of the program will

be eligible for licensure in the State of Florida as Certified Radiologic Technologists and for application to the

certification examination administered by the American Registry of Radiologic Technologists. The program

curriculum is competency-based and incorporates extensive practical experience in local hospitals and imaging

facilities. The clinical model is designed to promote competency and technical proficiency in all ARRT required

diagnostic imaging procedures for general radiography.

Program Accreditation

The program is accredited by the Joint Review Committee on Education in Radiologic Technology. www.JRCERT.org

Job Outlook

According to current ASRT wage surveys, Radiologic Technologists can expect to enter the job market at

approximately $39,000-$57,000 annually (varies by region). The demand for diagnostic imaging personnel is strong

and expected to increase sharply over the next decade (according to the U.S. Department of Labor).

Program Costs Additional Costs

Tuition for Florida residents: $7,884.00 ARRT Licensure Examination $200

Textbooks (approximately) 1,253.45 Florida Dept of Health License 55

Lab Fees 202.50 ASRT Professional Society Membership 30

Miscellaneous Fees (approximately) 817.60 Student Radiography Conference (approx) 600

Admission Policies and Procedures

(2)

Application Eligibility

• Completion of an Associate’s Degree (or higher) - AAS, AS, or AA degree from

an institution accredited by a regional accreditation agency are acceptable.

(Degree Major is unspecified)

• Minimum 2.75 GPA at completion of degree.

• Ability to meet Program’s published Technical Standards ctae.edu/radiography

• Required as either part of the degree or additional courses taken:

-

College Algebra

-

Anatomy & Physiology I (w/Lab)

-

Anatomy & Physiology II (w/Lab)

-

Medical Terminology

-

Microcomputer Applications (or approved substitution)

Applicant Advisement

• All program applicants must first attend an Information Session held at CTAE.

Dates and times may be found on the program’s website

ctae.edu/radiography.

• Applicants may contact the Program Director for individual advisement:

[email protected]

Application Timeline

• January 1 – May 15: Submit Application Package including:

-

Official College Transcripts (from every college attended)

-

High School Transcripts

-

3 Recommendation Forms from professional sources (mailed separately by

persons completing the forms).

-

CTAE Application must ALSO be submitted to Student Services ($10 fee)

Early application with UNOFFICIAL transcript is encouraged; however, final

OFFICIAL transcript MUST be submitted by 5/15.

• March-May: Applicants scheduled for Seminar & Career Observation Tour. All

applicants receive notification via email.

• 1

st

_{Week June: Selection Committee Interviews}

• Mid June: Acceptance letters mailed out.

• Mid July: Program Orientation for selected students.

• August: Program (classes) begin.

Applicant Acceptance

• Radiography is a limited access/selected admission program.

• Selection is made on a point-scale basis. The point-scale criteria may be

downloaded from ctae.edu/radiography.

-

50% based on academic performance

-

40% based on Selection Committee Interview

-

10% Other (prior healthcare experience, prior application, Applicant Tour)

Financial Aid

• Complete FAFSA at www.fafsa.gov School Code: 031039

• Scholarships and grants are available to qualifying students. Contact the

Financial Aid Office at CTAE (352)671-7200.

• The Radiography Program does NOT qualify for GI Bill status due to curriculum

that incorporates hybrid education.

Background Check

Drug Screening

• Selected students will be required to undergo a criminal background check and

drug screening.

• The student incurs the cost of background check and drug screen.

Health Screening

• All Selected students will be required to submit a health certificate and

immunization records (signed by a healthcare provider). Forms are provided in

students’ acceptance letter.

Radiography

(3)

Marion County Public Schools “Equal Opportunity Schools” Community Technical and Adult Education

Marion County School of Radiologic Technology

Rationale Individuals admitted to The Marion County School of Radiologic Technology must possess the capability

to complete the entire curriculum and achieve certification as a licensed Radiologic Technologist. This curriculum

requires demonstrated proficiency in a variety of cognitive, problem-solving, manipulative, communicative and

interpersonal skills. The Marion County School of Radiologic Technology has therefore established technical

standards that must be met by students admitted in to the program.

Directions Read the following standards carefully before signing the Application for Admission. Make an assessment

of your cognitive, affective and psychomotor capabilities, and determine if you have any limitations that may restrict

or interfere with your satisfactory performance of any of the standards listed below.

Students must be able to:

1. Observe and participate in all didactic, clinical and practical demonstrations including group procedural

simulations and self-learning practicums.

2. Learn to analyze, synthesize, solve problems, and reach evaluative judgment.

3. Demonstrate sufficient use of the senses of vision, hearing, and touch necessary to directly perform

a radiographic examination; review and evaluate the recorded images for the purpose of identifying

proper patient positioning, accurate procedural sequencing, proper radiographic quality, and other

appropriate technical qualities of diagnostic image acquisition.

4. Relate reasonably to patients and establish a sensitive, professional and effective relationship with them;

communicate verbally in an effective manner to direct patients during radiographic examinations.

5. Provide physical and emotional support to patients during radiographic procedures, respond to situations

requiring first aid and provide emergency care in the absence of, or until the physician arrives.

6. Display judgment in the assessment of patients; demonstrate the ability to recognize limitations in their

knowledge, skills, and abilities and to seek appropriate assistance.

7. Demonstrate the ability to work collaboratively with all members of the health care team.

8. Learn and perform routine radiographic procedures; students must have the mental and intellectual capacity

to calculate and select proper technical exposure factors according to the individual needs of the patient.

9. Demonstrate sufficient physical strength, motor coordination, and manual dexterity to transport, move, lift,

and transfer patients from a wheelchair or cart to an x-ray table, or to a patient bed; lift a minimum of 30

pounds over head.

10. Move, adjust, and manipulate a variety of radiographic equipment, including the physical transportation of

mobile radiographic equipment, in order to arrange and align the equipment with respect to the patient and

the image receptor according to established procedures and standards of speed and accuracy.

11. Learn to respond with precise, quick, and appropriate action in stressful and emergency situations.

12. Accept criticism and adopt appropriate modifications in their behavior.

13. Possess the perseverance, diligence, and consistency to complete the radiologic technology curriculum and

enter into the practice of radiology as a certified technologist.

(4)

“Equal Opportunity Schools”

CTAE

Marion County School of Radiologic Technology

Marion County Public Schools

NON-DISCRIMINATORY POLICY: Marion County Schools do not discriminate on the basis of race, sex, national origin or religion.

PLEASE PRINT OR TYPE: Date Submitted:

_______________

1. Name _______________________________________________ Date of Birth

___ /_ /____

Last First Middle

2. Address ____________________________ Home Phone

______________________________________________ Cell Phone

_________________________

3. **Email* ____________@**

* (This is primary mode of communication).

4. If any official records might arrive under any names other than those listed above, enter names here:

______________________________________________________________________________________________________________________

5. SS # ___--_ DL # ___________________ U.S. Citizen? Yes No

(Circle one)

6. Emergency Contact

____________________________________________________________________

Name Relationship Phone #

7. Current Employment

: __________________________________________________________________

Company Dates

8. Military Service ________ _ Honorable Discharge: Yes No

Branch Rank Dates (Circle One)

9. Have you ever been arrested? Yes No

(Circle One)

If yes, explain the charge

: __________________________

______________________________________________________________________________________________________________________

10. Formerly in HOSA? Yes No

(Circle One)

What area of healthcare did you shadow

?

_______________________

11. Previous training or experience in Radiography? Yes No

(Circle One)

Describe

: __________________________ ______________________________________________________________________________________________________________________

12. Other medical training, or certification? Yes No

(Circle One)

Must submit copy of certification with this application

.

Desribe

:_______________________________________________________________________________

13. Healthcare Volunteer? Yes No

(Circle One)

Must submit letter from organization documenting # of hours served – 60 hrs min):

______________________________________________________________________________________________________________________ Name of organization, duties

Academic Preparation

14. Official transcripts from High School and all other schools and colleges attended must accompany

this application. DEADLINE May 15.

If Completed, If Not Completed,

Colleges Attended City/State Major Date Conferred Projected Date

____________________________________________________________________________________

____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________

APPLICATION FOR ADMISSION

(5)

15. Describe why do you want to be a radiologic technologist

? ______________________________________

_____________________________________________________________________________________

Recommendation Forms

I understand that three (3) Recommendation Forms must be received by the program office by May 15 in order to be a qualified applicant.

I also understand that academic and professional acquaintances are required and that friends and relatives are ineligible to submit a

recommendation. I further understand that I must sign the Recommendation Form first to give authorization for the individual to

complete and submit the form to MCSRT. (THE INDIVIDUAL MAKING THE RECOMMENDATION MUST MAIL THE

FORM DIRECTLY TO THE PROGRAM OFFICE AT THE ADDRESS INDICATED ON THE FORM).

________________________________________________

Signature of Applicant

Technical Standards

(READ THE TECHNICAL STANDARDS PORTION OF THIS APPLICATION PACKET BEFORE SIGNING BELOW). By

my signature, I agree that I have reviewed and understand the Technical Standards and feel confident I am capable of complying with

them in every regard as identified. Further, I do NOT have any physical restrictions that will interfere with my successful performance

as a student radiographer.

_________________________________________________

Signature of Applicant

Statement and Signature

The information provided on this application is true to the best of my knowledge. I understand that any misrepresentation or omission

of personal information will result in my ineligibility to be considered for admission to this program. I also understand that admission

into the Marion County School of Radiologic Technology is made on a selective basis. I have reviewed and understand the point-scale

selection criteria provided on the School’s website. I understand that admission to the radiology program creates a contractual agreement

between the School and the applicant and that said agreement is based, in part, on the information provided on this application. I further

understand that this application will not be processed if not COMPLETE with photo, transcripts and signatures.

_________________________________________________

Signature of Applicant

(6)

Marion County School Public Schools “Equal Opportunity Schools”

Return To: CTAE

Marion County School of Radiologic Technology

1014 S.W. 7

th

_Road

Ocala, FL 34471

Applicant: _ ____

Please Print Signature*

(*By my signature, I authorize the person below to answer the following questions to the best of their ability and submit this form to MCSRT). NOT TO BE COMPLETED BY FRIENDS OR FAMILY. ONLY PROFESSIONAL REFERENCES PLEASE.

FORM MUST BE RETURNED DIRECTLY TO THE RADIOGRAPHY PROGRAM OFFICE BY THE PERSON COMPLETING IT. DEADLINE MAY 15!

1)

How do you know this individual?

______________________________________________________________

2)

Do you feel this individual would adapt and excel in a healthcare environment that is highly technological and highly

patient ?

______

Yes _No _ Not Sure

Explain: _______________________________________________

______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________

3)

I have observed the following attributes in this individual

(only check those that apply):

____ Cheerfulness

____ Maturity

____ Dependability

____ Honesty

____ Self-Motivation

____ Self-Confidence

____ Initiative

____ Punctual

____ Good Attendance

____ Team Player

____ Multi-Tasking

____Time Management

____ Critical Thinking

____ Problem Solving

____ Effective

Communication

4)

What do you feel is this individual’s greatest strength? Why? ___________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

5) What do you feel is this individual’s greatest weakness? Why? __________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

5)

Give an example of how this individual demonstrated perseverance to achieve a goal or accomplish something

important. ____________________________________________________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

6)

In what ways could this individual improve to be better prepared for a rigorous professional educational program and

demanding healthcare career? _____________________________________________________________________

___________________________________________________________________________________________________

7)

Additional comments:

_______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________

Signature (person making recommendation) ____________________________________________________________

Print Name __________________ Title/Credential _ Date __________

(7)

Return To: CTAE

Marion County School of Radiologic Technology

1014 S.W. 7

th

_Road

Ocala, FL 34471

Applicant: _ ____

1)

How do you know this individual?

______________________________________________________________

2)

Do you feel this individual would adapt and excel in a healthcare environment that is highly technological and highly

patient ?

______

Yes _No _ Not Sure

Explain: _______________________________________________

______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________

3)

I have observed the following attributes in this individual

____ Cheerfulness

____ Maturity

____ Dependability

____ Honesty

____ Self-Motivation

____ Self-Confidence

____ Initiative

____ Punctual

____ Good Attendance

____ Team Player

____ Multi-Tasking

____Time Management

____ Critical Thinking

____ Problem Solving

____ Effective

Communication

4)

What do you feel is this individual’s greatest strength? Why? ___________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

5) What do you feel is this individual’s greatest weakness? Why? __________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

5)

Give an example of how this individual demonstrated perseverance to achieve a goal or accomplish something

important. _____________________________________________________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

6)

In what ways could this individual improve to be better prepared for a rigorous professional educational program and

demanding healthcare career? _____________________________________________________________________

___________________________________________________________________________________________________

7)

Additional comments:

_______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________

Signature (person making recommendation) ____________________________________________________________

Print Name __________________ Title/Credential _ Date __________

(8)

Return To: CTAE

Marion County School of Radiologic Technology

1014 S.W. 7

th

_Road

Ocala, FL 34471

Applicant: _ ____

1)

How do you know this individual?

______________________________________________________________

2)

Do you feel this individual would adapt and excel in a healthcare environment that is highly technological and highly

patient ?

______

Yes _No _ Not Sure

Explain: _______________________________________________

______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________

3)

I have observed the following attributes in this individual

____ Cheerfulness

____ Maturity

____ Dependability

____ Honesty

____ Self-Motivation

____ Self-Confidence

____ Initiative

____ Punctual

____ Good Attendance

____ Team Player

____ Multi-Tasking

____Time Management

____ Critical Thinking

____ Problem Solving

____ Effective

Communication

4)

What do you feel is this individual’s greatest strength? Why? ___________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

5) What do you feel is this individual’s greatest weakness? Why? __________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

5)

Give an example of how this individual demonstrated perseverance to achieve a goal or accomplish something

important. ____________________________________________________________________________________

_______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________

6)

In what ways could this individual improve to be better prepared for a rigorous professional educational program and

demanding healthcare career? _____________________________________________________________________

___________________________________________________________________________________________________

7)

Additional comments:

_______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________

Signature (person making recommendation) ____________________________________________________________

Print Name __________________ Title/Credential _ Date __________

(9)

APPLICATIONS ACCEPTED: Jan 01, 2016

Marion County School of Radiologic Technology DEADLINE: May 15, 2016

2016 APPLICATION CHECKLIST

SELECTION: June 15, 2016

__________________________________________________________________________________

_____ Attend Information Session at CTAE (mandatory before applying to Radiography Program).

_____ Complete degree with 2.75 GPA (or higher).

_____ Obtain Official Transcripts from all colleges attended (unopened). This may be sent directly to

Program office or submitted with Program Application.

_____ Obtain Transcripts from High School (unopened) as mandated by State. This may be sent

Directly to Program Office or submitted with Program Application.

_____ Complete Radiography Program Application entirely (do not leave any blanks).

_____ Give Recommendation Form to three individuals who know you in a professional capacity

(such as professor, work supervisor, volunteer supervisor, etc. – not friends and family please.

This must be returned to the program office directly by person completing the form).

_____ Read Technical Standards; sign if able to meet the standards. If not, contact Program Director.

_____ Download or pickup CTAE Application. Complete entirely (do not leave any blanks). If any

questions regarding CTAE Application or Residency Affidavit/documents of proof, please

contact Student Services at (352)671-4134.

_____ Plan for financial aid. Complete FAFSA at www.fafsa.gov. CTAE School Code: 031039

For questions or assistance, please contact the Financial Aid office at (352)671-7203.

_____ Submit Program Application and all Official Transcripts.

_____ Submit CTAE Application with all required documentation ($10 fee)

_____ Wait to be contacted by EMAIL for date of Applicant Seminar/Career Observation Tour.

This is mandatory. Record date in your calendar!

_____ Interview date and time will be scheduled during Applicant Seminar. Record it in your calendar.

_____ Return Career Observation/Tour Response Form (within 3 business days of tour).

(10)

An Equal Opportunity School District

-CTAE Application Directions and Checklist

_____ Provide your Valid State-Issued Identification and Social Security Card.

_____ Provide two officially recognized proofs of residency dated 12 months prior to the first day of enrollment.

SEE FINAL PAGE OF APPLICATION FOR MORE INFORMATION ABOUT ACCEPTABLE PROOFS OF RESIDENCY

______ $15 application fee.

Proofs of Residency

At least two of the following documents must be submitted with dates that show the 12-month qualifying period. Additionally, there must be no information

contradicting the applicant’s claim of residency. Proofs must be provided by the individual claiming Florida residency. If claiming residency as a dependent or

spouse, proofs of residency must be provided by the claimant, not the student.

Acceptable Documents to Prove In-State Tuition Eligibility

First Tier (at least one of the two documents submitted MUST be from this

list)

Second Tier (may be used in conjunction with one document from First Tier)

State of Florida Driver’s License

Declaration of Domicile in Florida

State of Florida Identification Card

A Florida professional or occupational license

State of Florida Voter’s Registration Card

Florida incorporation

State of Florida Vehicle Registration

Proof of membership in Florida-based charitable or professional organizations

Proof of Purchase of a permanent home in Florida that is occupied as the

permanent residence

Utility bills and proof of 12 consecutive months of payments

Proof of Homestead Exemption in Florida

Lease agreements and proof of 12 consecutive months of payments

Transcripts from a Florida high school for multiple years (If Florida high school

diploma or GED was earned within last 12 months)

State of Florida court documents evidencing legal ties in Florida

Proof of full-time employment in Florida on company letterhead (One or more

jobs for at least 30 hours per week for a 12-month period)

Benefit histories from Florida agencies or public assistance programs

Helpful Contact Numbers for Marion County

Marion County Public School Records – (352) 671-7750 (Transcripts)

Marion County Supervisor of Elections (votemarion.com) – (352) 620-3290 (Voter’s Registration)

Marion County Clerk of Court – (352) 671-5630 (Declaration of Domicile, Court Documents, etc.)

Marion County Tax Collector – (352) 368-8200 (Driver’s License, ID’s, Vehicle Registration)

Marion County Property Appraiser (352) 368-8300 (Homestead Exemption)

CTAE Student Services – (352) 671-4134

CTAE Student Services Fax – (352) 671-7249

CTAE Financial Aid – (352) 671-7203

Unacceptable Documents (cannot be used)

Library Card

Hunting or Fishing License

Car Insurance

Health Insurance

Shopping Club or Rental Card

(11)

– An Equal Opportunity School District – Rev 7.20.15 EMERGENCY CONTACT Name Relationship

Address City State Zip

Phone (Home)

Phone (Work)

Phone (Cell)

Notes:

Information collected on this form is used for reporting to the Department of Education and does not determine admission to any program at CTAE

01. DO YOU HAVE A HIGH SCHOOL DIPLOMA OR GED?  31 Yes

 30 No 02. GENDER  M Male  F Female

03. WHAT IS YOUR ETHNICITY?  Hispanic

 No Hispanic or Latino descent

04. WHAT IS YOUR RACE? (Please check at least one)  W White

 B Black/African American  A Asian

 I American Indian/Alaska Native  P Native Hawaiian/Other Pacific Islander 05. I AM A FLORIDA:

 4 Resident

 5 Out-of-State Resident

06. ARE YOU A DISPLACED HOMEMAKER?  H Yes

 Z No 07. I AM A:

 S Single parent (custody of minor children)  W Single pregnant woman

 B Both single parent/single pregnant woman  Z Does not apply

08. MY GOAL AS A STUDENT IS:  A Employment

 C Retain Employment  D Pass GED

 E Obtain High School Diploma  F Advance to Postsecondary Level  I Citizenship

 Z Not Applicable

09. ARE YOU LIMITED ENGLISH PROFICIENT?  Y Difficulty speaking, reading, writing or

understanding English  N Does not apply

10. OTHER INSTITUTIONALIZED ADULT  A Patient or Resident of medical or special

institution (not correctional facility and not homeless)

 Z Does not apply 11. ARE YOU A VETERAN  V Student is a Veteran  Z Does not apply

12. WHAT IS YOUR CITIZENSHIP STATUS?  A Non-Resident Alien

 C Does not apply  P

 Permanent Resident Alien U.S. Citizen

ALL SECTIONS MUST BE FILLED OUT

COMPLETELY

Community Technical & Adult Education

Career Technical Program Application

All qualified Applicants will receive consideration without regard to race, creed, color, national origin, sex, or disability. Please complete all sides of the application. Incomplete applications will not be considered. A $15 non-refundable application fee is due at the time of submission.

Program applying for:

Have you attended a Marion County School in the past? 

Yes



No

Last Name

□

_Jr.

□

_Sr.

□

_III First Name Middle Name Alias/Former Maiden Name

Street Address/Residence City State Zip

Mailing Address (if different from above) City State Zip

Home Phone Cell Phone Work Phone Email Address

Birth Date Place of Birth (City, State) If not born in the USA, date you

entered the USA:

(12)

– An Equal Opportunity School District – Rev 7.20.15

13. WHAT IS YOUR PRIMARY LANGUAGE? English Spanish Russian Portuguese Croatian Other

14. WHAT IS YOUR ENVIRONMENT TYPE? Family Literacy-(Even Start)

Workplace Literacy Homeless

Disability Information On Public Assistance Living in a Rural Area Not Applicable

15. HOW DID YOU HEAR ABOUT CTAE? Local Job Service/One-Stop Center Job Training Program

Community Action Agency Library

High School (Official Withdrawal Letter on File) I Attended Before

Division of Rehabilitation Services Adult Vocational/Higher Education Newspaper Ad

Pamphlet, Brochure, Poster, etc. Family Member

Military

Judicial System (i.e. Court Ordered) Friend

Counselor Employer

Television/Radio Other

Online (Website, Facebook, Twitter, etc.)

16. EDUCATION UPON ENTRY – Select last grade completed

Master’s Degree 9 2 Bachelor’s Degree 8 1

AA, AS Degree 7 No Schooling

GED 6

12 5

11 4

10 3

17. EMPLOYMENT STATUS (Select one upon entry) Employed (Working as PAID employee) Unemployed – Seeking employment Unemployed – Not seeking employment

18. HAVE YOU EVER BEEN CONVICTED OF A FELONY? Yes

No

If yes, please list the charge(s): ________________________________________________________________________________________________________________________________________ 19. PLEASE LIST ANY OTHER EDUCATION OR EXPERIENCE YOU HAVE IN THE AREA OF INSTRUCTION FOR WHICH YOU ARE APPLYING FOR ADMISSION

_________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ I attest that the information stated in this application is true and accurate, and understand that the information, if misrepresented, or incomplete, may be grounds for immediate termination and/or penalties as specified by law. I give representatives of Community Technical and Adult Education permission to use my social security number as means of identification. I also hereby authorize communication of information for the purpose of determining admission decisions or for identifying services or agencies to assist me. All pertinent records and information can be released including those regarding past, present, or future information or records that may be needed for admission determination, financial assistance eligibility, or follow-up purposes. This information may include, but shall not be limited to, educational records, health/physical status/records, income/employment information and vocational rehabilitation assessment or evaluation tools.

___________________________________________________ ___________________________________________________ ____________________________________________________

Print Name Student Signature Date

(13)

- An Equal Opportunity School District -

Drug Free Workplace – Statement of Understanding

It is the policy of the Marion County School Board to maintain a drug free workplace for all employees and students. This will be done in conformity with the Drug Free Workplace Act of 1988, as amended in 1989, with passage of Public Law 101-226. Therefore, the manufacture, distribution, dispensation, possession or use of controlled substances is unlawful and prohibited at any Community Technical & Adult Education locations. Employees and students who violate this policy will be terminated. Employees and students who are convicted of violating any criminal drug stature must notify the Director at their location within 5 days of the conviction.

Community Technical & Adult Education has an obligation to you, to help you get the best education and preparation possible for your chosen career. CTAE is also obligated to the employers who hire our graduates. They trust us to provide them with the best employees in their field. We cannot follow through with these obligations if our students or employees are using drugs. CTAE is a drug free environment.

I realize that I make choices in my life. I realize that each choice I make carries consequences. I realize that I am responsible for my choices. I understand and agree to abide by this commitment to stay drug-free and to make the most of my education and my future.

___________________________________________________ ___________________________________________________ ____________________________________________________

Print Name Student Signature Date

Information for Residency Classification

 A Florida resident for tuition purposes is a person who has, or a dependent person whose parent or legal guardian has, established and maintained legal residency in Florida for at least 12 consecutive months preceding the first day of classes of the term for which Florida residency is sought. Residence in Florida must be as a domicile rather than for the purpose of maintaining a residence incident to enrollment at an institution of higher education.

 To qualify as a Florida resident for tuition purposes, you must be a U.S. citizen, permanent resident alien or legal alien granted indefinite stay by the U.S. Citizenship and Immigration Services. Other persons not meeting the 12 month legal residence requirement may be classified as Florida residents for tuition purposes only if they fall within one of the limited special categories authorized by the Florida Legislature and the State Board of Education. All other persons are ineligible for classification as a Florida resident for tuition purposes.

 Living in or attending school in Florida will not, in itself, establish legal residence. Students who depend on out-of-state parents for support are presumed to be legal residents of the same state as their parents. Residence for tuition purposes requires the establishment of legal ties to the state of Florida. Students must verify that they have broken ties to other states if the student or, in the case for dependent students, his or her parent, has moved from another state.

Dependent: a person, whether or not living with his or her parent, who is eligible to be claimed by his or her parent as a dependent under the federal income tax code.

(14)

- An Equal Opportunity School District -

Residency Affidavit Form

Florida Residents: Complete this section in full if you claim Florida residency for tuition purposes. Attach required documentation (if any).

• If under 24 years of age, a copy of your and/or your parents’ most recent tax return or other documentation may be requested to establish independence. • A copy of marriage certificate is required in all cases of a spouse claiming a partner’s residency.

____A. I am an independent person and have maintained legal residence in Florida for at least the past 12 consecutive months.

____B. I am a dependent person and my parent or legal guardian has maintained legal residence in Florida for at least the past 12 consecutive months.

____C. I am a dependent person who has resided for five years with an adult relative other than my parent or legal guardian, and my relative has maintained legal residence in Florida for at least the past 12 consecutive months. (Required: Copy of most recent tax return on which you were claimed as a dependent or other proof of dependency.)

____D. I am married to a person who has maintained legal residence in Florida for at least the past 12 consecutive months. I now have established legal residence and intend to make Florida my permanent home. (Required: Copy of marriage certificate and other documents required to establish residency.)

____E. I was previously enrolled at a Florida state institution and classified as a Florida resident for tuition purposes. I abandoned my Florida domicile less than 12 months ago and am now re-establishing Florida legal residence.

____F. According to the U.S. Citizenship and Immigration Services, I am a permanent resident alien or other legal alien granted indefinite stay and have maintained a domicile in Florida for at least the past 12 consecutive months. (Required: USCIS documentation and proof of Florida residency status.)

____G. I am a member (or the spouse/dependent child of) of the Armed Services of the United States, and am currently stationed in Florida on active military duty pursuant to military orders, or whose home of record is Florida. (Required: Copy of military orders or DD2058 showing home of record.)

____H. I am a full-time instructional or administrative employee (or the spouse/dependent child of) employed by a Florida public school, community college or institution of higher education. (Required: Copy of employment verification.)

____I. I am part of the Latin American/Caribbean Scholarship Program. (Required: Copy of scholarship papers.)

____J. I am a qualified beneficiary under the terms of the Florida Prepaid College Program (s.1009.98, F.S.) (Required: Copy of Florida prepaid recipient card.)

____K. I am a U.S. citizen (or the spouse/dependent child of) living on the Isthmus of Panama and have completed 12 consecutive months of college work at the FSU Panama Canal Branch. (Required: Copy of marriage certificate or proof of dependency.)

____L. I am a Southern Regional Education Board’s Academic Common Market graduate student. (Required: Certification letter from state coordinator.)

____M. I am a full-time employee of a state agency or political subdivision of the state whose student fees are paid by the state agency or political subdivision for the purpose of job-related law enforcement or corrections training.

Person claiming residency must complete this section in full.

Documents supporting the establishment of legal residence must be dated, issued, or filed 12 months before the start of the term. Additional documentation also may be requested. All documentation is subject to verification.

Student Name: Student Date of Birth: Student SSN:

Name of person claiming Florida residency Claimant’s Relationship to Student: Claimant’s Telephone Number: Claimant’s Permanent Florida Address: Apt: City Zip

Claimant’s Voter Registration Number: Issue Date: / /

Claimant’s Driver’s License Number: Issue Date: / /

Claimant’s Vehicle Registration Number: Issue Date: / /

Non US Citizens Only

Resident Alien Number: Provide a copy of both

sides of your card

Issue Date: / / I do hereby swear that the above named student meets all requirements indicated in the checked category above for classification as a Florida resident for tuition purposes. I understand that a false statement in this affidavit will subject me to penalties for making a false statement pursuant to 837.06, F.S., and to 6C-6.001(6), F.A.C.

__________________________________________________________ __________________________________________________________

Signature Date

Non-Florida Residents: I understand that I do not qualify as a Florida resident for tuition purposes for the term to which I have applied. I also understand that if I should qualify for Florida residency in some future term, I must file the required documentation prior to the beginning of that term.

__________________________________________________________ __________________________________________________________

(15)

~An Equal Opportunity School District~ (Salmon) Revised 02-18-16 Form #FA1

Overview of Financial Aid at CTAE (2016-2017)

A complete Policy and Procedure manual is available in the financial aid office. The following is a brief overview of the financial aid programs available here at CTAE. Financial Aid Information is also available on our website @

ctae.edu.

Federal Pell Grant - permits a student to receive up to $5,815.00 (2016-2017) per academic year to cover educational expenses on eligible

programs. These are awarded on a graduated scale according to an (EFC) estimated family contribution. A FSA ID username and password is necessary for both student and parent if dependent, to login and complete the FAFSA application for a federal Pell Grant. This can be obtained at

www.fafsa.gov

. Our school code is 031039. Please complete your 2015 taxes if you are required to file, and then use the IRS data retrieval

tool three weeks after filing your taxes. Upon receipt of the Federal Pell Grant Award, students will be notified of the Federal dollar amount that

they are eligible to receive. Disbursements are made based on a 900 clock hour award year with payment periods of 450 clock hours or as otherwise stated in the student’s award letter.

(FSEOG) The Federal Supplemental Educational Opportunity Grant - may provide additional grant money to a student's financial aid package if

financial need is demonstrated. Unlike Pell Grants, the amount of this grant depends not only on financial need but on other aid sources and the availability of funds allocated to the school. To be considered, the student must be a United States Citizen or eligible noncitizen, not have obtained a bachelors degree, not have a Federal Pell Grant overpayment, not be in default on any Federal Student Loans and have a current (2016-2017) FAFSA on file. The financial aid program manager awards the funds equitably.

Florida Bright Futures – provides scholarships based on high school academic achievement and is Florida’s largest merit-based scholarship

program. To be considered, a student must submit a completed Florida Financial Aid Application during his/her last year in high school (after December 1 and prior to graduation), be a Florida resident and a U.S. citizen or eligible non-citizen. A student’s residency and citizenship status are determined by the student services department. A student must not owe a repayment or be in default under any state or federal grant, loan, or scholarship program unless satisfactory arrangements to repay have been made. Questions regarding such status should be directed to the financial aid office. Bright Futures will cover $1.30 per clock hour (Subject to change based on state legislation). Summer clock hours (May – July) are not covered. The Bright Futures school code for CTAE is 219. Submission of a (FAFSA) is NO LONGER required; however, students are encouraged to submit the FAFSA to learn of potential eligibility for additional state and federal aid. Visit the website at www.fafsa.ed.gov for online processing. Visit www.floridastudentfinancialaid.org.

Florida Public Post-Secondary Career Education Student Assistance Grant (FSAG-CE) - This grant is need based and available to Florida

residents per State allocation to students entering a program of 450 or more clock hours & must have a current error free (2016-2017) FAFSA on file.

Florida Prepaid College Plan - accepted at 100% of tuition only. No lab fees, textbooks or other costs can be applied to Florida Prepaid. The

Florida Prepaid credit hour rate will be used as there is no clock hour rate available. A student must submit a valid Florida prepaid card to the financial aid office.

Career Source – non-profit organization that provides several assistance programs for funding tuition fees to eligible applicants. The application is

available on line @ www.careersourceclm.com. Career Source requires students to have a FAFSA on file to be considered for assistance.

CTAE Financial Aid - a limited number of CTAE Financial Aid is available for eligible students entering qualifying programs. CTAE Financial Aid

covers only a portion of tuition cost, calculated at a qualifying rate of $1.00 to $2.00 per clock hour, dependent upon EFC range & fund availability. Interested parties should contact the financial aid office for information and details of availability, requirements, and eligibility. CTAE Financial Aid does not have to be repaid (Satisfactory Academic Progress is required). Students must have a current error free (2016-2017) FAFSA on file to be considered.

Rosewood Family Scholarship Fund - provides scholarship assistance to a maximum of 50 minority students to attend full time at eligible state

universities, public community colleges, or public postsecondary vocational technical schools.

Other Forms of Aid Available - Central FL Community Action Agency, Honorably Discharged Graduate Assistance Program, Native American

Tribal Scholarships, Scholarship for Children of Deceased or Disabled Veterans, Veterans Education Benefits (VA) limited program availability and Vocational Rehabilitation (VR).

Local Organization/Individual Scholarships - Scholarships may be awarded as part of a financial aid package from local organizations.

Scholarships are usually awarded for academic excellence, special talents or the special interest or circumstances of the students. Please inform the financial aid office if you have a local award.

Satisfactory Academic Progress Requirements for Financial Aid Students- Satisfactory academic progress (SAP) for students receiving financial

aid include both qualitative and quantitative measurements pursuant with regulation 668.34. Students must maintain attendance record of at least 90% of scheduled hours/weeks with a minimum of a “C” 70% average or higher as designated by the program in which they are enrolled. The maximum time frame may not exceed 110% of the published length of the program in clock hours and weeks. Students also must be on pace in the program of study as specified by instructor to complete in maximum timeframe. Checkpoints for SAP will be at the point the student successfully completes the scheduled hours/weeks for the specific payment period(s). A schedule of all maximum timeframes and checkpoints by payment periods is available in the financial aid office.

CTAE does not accept or participate in any student loans; however a self-certification form can be provided upon request to students who wish to seek a private loan on their own.

Please visit the financial aid department for more information or assistance on any of these financial aid programs or call 352-671-7203.

(16)

~An Equal Opportunity School District~ (Salmon) Revised 02-18-16 Form #FA1