Radiologic Technology Admissions Checklist

Radiologic Technology

Admissions Checklist

Utilize this RT admissions checklist as a guide for successfully completing your RT application process.

All application materials must be postmarked on or before April 15 of each year for preferred

consideration.

Visit the N&AH website at

www.chattanoogastate.edu/nursing-allied-health

to find program information

and all forms needed for the Radiologic Technology program.

■ Chattanooga State Checklist:

❏ Complete college application if not a current student.

❏ Provide official high school and college transcripts to the Chattanooga State Admissions Office.

Important Note: If you are currently enrolled at another college, your transcripts will not be evaluated until

Chattanooga State receives a complete and final transcript.

❏ Take the ACT, SAT or COMPASS, if applicable

❏ Submit vaccination requirements for Chattanooga State’s Admission Office

■ Radiologic Technology Program Checklist:

❏ Attend

one required Radiologic Technology Program Information Session (2 ½ hours).

❏ Schedule an appointment with a N&AH Academic Advisor to create an academic plan.

❏ Applicant is in the process of completing all pre-requisite and all appropriate college credit courses.

• Learning Support Classes, if applicable.

• Preference will be given to students who have completed CHEM and Math 1710 (pre-requisite courses)

and BIOL 2010 and BIOL 2020 (college credit courses) and other recommended preparatory courses

noted in the Radiologic Technology brochure.

Now you’re ready to complete these important steps…….

❏

Submit the Radiologic Technology application form and attach the following:

❏

*

Submit a copy of your high school transcript (this is required).

❏

*

Submit a copy ONLY of “previous” college transcript(s). Important Note: Spring grades and GPA are

calculated in the point calculation process. Therefore, a copy of the final transcript from other colleges

MUST BE submitted as soon as your grades are posted.

❏ Submit completed Student Academic History Form.

❏ Submit a copy of the American College Test (ACT) if not on high school transcript.

❏

**

Attach a copy of your current TEAS results OR on the program application under TEAS Testing

Information - be sure to post confirmed test date on when it is scheduled or date when you are

retaking the test.

*

TRANSCRIPTS:

Submit copies of transcript(s) by using the N&AH Transcript Request Form. Copies are

only needed from previous college(s) - No transcripts are needed if attending Chattanooga State.

NOTE: DO NOT REQUEST ANY COPIES OF TRANSCRIPTS FROM THE ADMISSION’S

OFFICE AT CHATTANOOGA STATE.

**

TEAS TEST: Register early to take the TEAS Test. Results of test must accompany application if taken at

another college. The test must be taken on or before the RT deadline date. To get a copy of your results go to the

ATI website

www.atitesting.com/solutions/prenursingschool/teas.aspx.

Application, program materials, updates and inquiries: Chattanooga State Community College

N&AH Application Coordinator, HSC-2088 4501 Amnicola Hwy

Chattanooga TN 37406

423-697-2504 / Fax: 423-697-2628

N&AH Information Sessions for Degree Programs 2013-2014

IMPORTANT NOTES:

*

If a deadline date ends on a weekend, the

following Monday will be considered the last

day to turn in all materials.

▲

SPECIAL DAY AND/OR TIME

Division-wide information

Sessions January 7, 2014

Pub. No.

11-70-204101-2-7/13/jc/bap*form#42*PDF*Chattanooga State Community College is an AA/EEO employer and does not discriminate on the basis of race, color, national origin, sex, disability or age in its program and activities. The following person has been designated to handle inquiries regarding the non-discrimination policies: Director and Affirmative Action Officer, 4501 Amnicola Highway, Chattanooga, TN 37406, 423-697-4457.

DENTAL HYGIENE

Attendance: Strongly encouraged; but not required

Need Reservation: NO

Where: HSC Building, Room 2031

When: Dates and times below

Length of Session: Approx. 1.5 hours

Program Deadline Date: 2/3/14

2013

2014

September 13 (Fri 1 pm) January 7 (Tues 9 am)

October 10 (Thurs 5 pm) January 23 (Thurs 5 pm)

November 12 (Tues. 1 pm) April 4 (Fri 1 pm)

June 12 (Thurs 9 am)

NURSING

Attendance: Strongly encouraged; but

not required

Need Reservation: NO

Where: HSC Building, Room 1083

When: TUESDAYS, 9 am & 5 pm

Length of Session: Approx. 2 hours

Program Deadline Date:

Transition – 1/15/14 &

*

RN – 3/15/14

2013

2014

August 6

January 7

September 10 February 11

October 1

*

March 18

November 5 April 8

May 13

June 10

July 8

August 5

RADIOLOGIC TECHNOLOGY

Attendance: YES, REQUIRED

Need Reservation: NO

Where: HSC Building. Room 2060

When: THURSDAYS, 5:30 PM

▲

SPECIAL DAY / TIME

Length of Session: Approx. 2.5 hours

Program Deadline Date: 4/15/14

2013

2014

October 10

January 7

▲

Tues 9 am

November 14 February 6

Summer Sessions

March 20 May 15 ▲3:30 pm

April 14

▲

Mon July 10

▲

3:30 pm

HEALTH INFORMATION

MANAGEMENT

Attendance: YES, REQUIRED

Need Reservation: NO

Where: HSC Building, Room 2106

When: TUESDAYS 5:30 pm

▲

SPECIAL TIME

Length of Session: Approx. 1 hour

Program Deadline Date: 5/5/14

2013 2014

September 24 January 7

▲

10 am

October 29

February 25

March 25

April 22

PHYSICAL THERAPIST

ASSISTANT

Attendance: Strongly encouraged; but not required

Need Reservation: NO

Where: HSC Building, Room 2029

When: WEDNESDAYS (times below)

▲

SPECIAL DAY

Length of Session: Approx. 1.5 hours

Program Deadline Date: 3/3/14

2013 2014

October 2 (noon)

January 7

▲

Tues 9 am

November 6 (3 pm) February 5 (3 pm)

April 2 (3 pm)

RESPIRATORY CARE

Attendance: Strongly encouraged; but not required

Need Reservation: NO

Where: HSC Building, Room 2117

When: WEDNESDAYS (times below)

▲

SPECIAL DAY

Length of Session: Approx. 1.5 hours

Program Deadline Date: 5/15/14

2013

2014

September 11 (noon)

January 7

▲

Tues 10:30 am

October 9 (3 pm)

February 19 (3 pm)

November 13 (noon) April 9 (3 pm)

IMPORTANT TOPICS ARE DISCUSSED WHEN YOU ATTEND AN INFORMATION SESSION

Application: Process/Admission Requirements/Selection Program: Overview/Curriculum/Details/Opportunities/Answers

LOCATION AT THE MAIN CAMPUS

- EASTERN TIME ZONE -

Chattanooga State Community College

Health Science Center Building (HSC)

4501 Amnicola Hwy

Chattanooga TN 37406

(423) 697-4450 or for more information visit

Nursing &Allied Health Division

Radiologic Technology Application Form

IMPORTANT NOTE:

Refer to the Radiologic Technology Admission Checklist (on the last page of this application) to

successfully complete the application process. Preferred application deadline is April 15 of each year. Personal Data:

Date ____________ Social Security # _____________________ ChSCC Banner “A” ID (if applicable) ______________________ Name ___________________________________________________________________________________________________ Last First Middle Maiden Street ___________________________________________________________________________________________________ City ____________________________________________________ State _____________Zip __________________________ Phone Number (Home) ___________________________ (Work) ________________________ (Cell) ________________________ E-mail Address ______________________________________________________________________________________________ In case of emergency please notify ______________________________________________ Phone __________________________ In compliance with Title VI Civil Rights Act 1964 (Please check one in each area)

Sex: M ___ F ___ Race: Asian/Pacific Islander ___ American Indian ___ Black ___ Hispanic ___ White ___ Bi-racial ___ Date of Birth: Month _________________ Day _________ Year __________

Education:

Name of High School ________________________________________________________________ Year of Graduation _________ Street Address _________________________________________________ City __________________ State _____ Zip __________ GED Year Completed ____________ GED Test Score ____________

Are you currently enrolled at a college? Yes _____ No _____ if Yes, where? ___________________________________________ Previous Colleges Attended: Address Dates Attended Degree Earned _____________________________________________________________________ _____ to _____ ___________________ _____________________________________________________________________ _____ to _____ ___________________ _____________________________________________________________________ _____ to _____ ___________________ Military Service:

Branch of Service __________________________________ Where ____________________________ When __________________ Schooling (if applicable), type & ranking in school __________________________________________________________________ Testing Information:

• The TEAS is required for Radiologic Technology. Have you taken this test Yes _____ No _____

If yes, attach a copy of your current TEAS results or record date you took the test __________ Note: To get a copy of your

results, go to the ATI website www.atitesting.com/solutions/prenursingschool/teas.aspx.

If no, when are you scheduled to take the test ________________

• The ACT is required for Radiologic Technology. Have you taken the ACT Yes _____ No _____ If yes, when? ____________ Total Composite ______

If you have not taken any of the above tests, when is the expected date of testing? ___________________________ Information Sessions: One information session is required

Have you attended an information session? Yes _____ No _____

if yes, when ____________ if no, when do you plan to attend? _______________ Prerequisites:

1. Did you have chemistry in high school with a “C” or better? Yes _____ No _____ If no, you must take CHEM 1010 prior to beginning the RT program.

2. You must take MATH 1710 prior to beginning the RT program.

All applicants must attach a copy of their high school transcript to this application.

PLEASE CONTINUE TO NEXT PAGE

Finances:

Numerous types of financial aid are readily available at Chattanooga State. The Student Aid Office is eager to help applicants complete the forms. The key to receiving aid is to apply early. Call the Student Aid Office at (423) 697-4401 for more details. Will you have to work while in school? Yes _____ No _____ If yes, how many hours per week do you plan on working? ______ Employment Record: (Start with most recent)

Employer __________________________________________________________________________________________________ Address ___________________________________________________________________________________________________ Dates: From ______________________ To ________________________ Position _______________________________________ Reason for Leaving __________________________________________________________________________________________ Employer __________________________________________________________________________________________________ Address ___________________________________________________________________________________________________ Dates: From ______________________ To ________________________ Position _______________________________________ Reason for Leaving __________________________________________________________________________________________ Employer __________________________________________________________________________________________________ Address ___________________________________________________________________________________________________ Dates: From ______________________ To ________________________ Position _______________________________________ Reason for Leaving __________________________________________________________________________________________ Medical/Legal Information:

Have you ever been convicted of a crime other than a minor traffic violation? Yes __ No __ If yes, Date: _____________ Describe __________________________________________________________________________________________________ __________________________________________________________________________________________________________ Have you previously been accepted into a Nursing/Allied Health program at Chattanooga State? Yes __ No __ If yes, When: ______ Which program _____________________________________________________________________________________________ Are you now or have you ever been licensed/credentialed in a health care career? Yes ___ No ___ If yes, are you currently licensed/credentialed in a health care career?

Please give license number, state, and health care career and attach a copy of all valid state/national licenses/certificates. __________________________________________________________________________________________________________ Have you ever applied for a license/credential in a health care career and been denied? Yes ___ No ___ If yes, please explain __ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Has your license/credential ever been suspended, revoked, or put on probation? Yes ___ No ___ If you are not currently licensed but have previously been licensed/credentialed in a health care career, indicate the status and reason for the status of licensure /credentialed:

________________________ Suspension (please explain) _____________________________________________________ _________________________ Probation (please explain) _____________________________________________________ _________________________ Revoked (please explain) _____________________________________________________ _________________________ Inactive (please explain) _____________________________________________________

Please answer these important questions:

What are your hobbies or other outside interests, in addition to work and school? _______________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ How did you find out about the Radiologic Technology program at Chattanooga State?____________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Why are you interested in the Radiologic Technology program at Chattanooga State? _____________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ What do you know of the job responsibilities required of Radiologic Technologists? _______________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ (You may attach additional sheets to complete your answers, if necessary.)

Criminal Background:

Following acceptance and prior to entering the first career course in designated healthcare programs, each student must undergo a criminal background check in order to comply with policies of affiliating clinical practice agencies. It shall be the student’s responsibility to comply with instructions provided upon acceptance and provide the results by a designated date. The check will be at the expense of the student. Students who do not meet this requirement in a timely manner or whose background does not meet agency standards will not be able to successfully complete the program. Additionally, a criminal background may preclude licensure or employment. Individuals with a question concerning this should schedule an appointment with the Program Director.

Radiologic Technology Admission Checklist to successfully complete the

application process.

All RT program forms and important information are available on the RT website. • Attend one required RT information session

• Turn in RT program application and attach the following: 1) Copy of high school transcript

2) Copy of all college transcripts with the exception of Chattanooga State 3) RT Student Academic History Form

4) Copy of ACT test if not on high school transcript

5) Attach a copy of your current TEAS results or record date you took it – The TEAS test should be taken on or before the preferred deadline date of April 15 of each year.

Important Note:

Spring grades and GPA are used in the point calculations. Therefore, a copy of the final transcript from other colleges MUST be submitted as soon as your spring grades are posted. (A faxed copy is acceptable.)

Program application, materials, updates and inquiries: Chattanooga State Community College

N&AH Application Coordinator, HSC 2088 4501 Amnicola Highway

Chattanooga, TN 37406-1097 Telephone: (423) 697-2504 Fax: (423) 697-2628

Certificate of Application:

I affirm, agree, and/or understand that all statements on this form are true and accurate; any misrepresentation or omission of material facts may result in my expulsion from any Allied Health program. I hereby authorize Chattanooga State or other appropriate State investigative agencies to make all necessary investigations concerning me, my work habits, character, or my action in any transaction. I further authorize and request each former employer, person given as a reference, educational institution, or organization to provide all information that may be sought in connection with this application.

I understand it is my responsibility to read the program brochure and follow the RT admission checklist in order to

successfully complete the program admissions process. Copies of your high school and all previous college transcripts (other than Chattanooga State transcript) should accompany the RT application. The student’s program file should be received and complete on or before the preferred RT deadline date of April 15 of each year. It is also the student’s responsibility to notify the application coordinator of any changes (such as in address, name change, etc.) so the program file will remain up-to-date. Print Name ________________________________________________

Signature __________________________________________________ Date ___________________

Nursing &Allied Health Division

Radiologic Technology

Student Academic History Form

Name ____________________________________________________ Social Security Number ____________________________ or Banner ID

Address __________________________________________________________________________________________________ City __________________________________________________ State ________________ Zip Code ______________________ HIGH SCHOOL DATA:

Attended ________________________________________________ High School during the years from:_________ to: ________ City ____________________________________________________________ State ____________________________________ Graduated ____________ Grade Point Average __________________

year

Check courses completed in high school: Check Grade Received

Basic Science ____ _____________ Basic Math ____ _____________ Algebra I ____ _____________ Algebra II ____ _____________ Geometry ____ _____________ Trigonometry ____ _____________

Advanced Math Courses ____ _____________

Biology ____ _____________ Advanced Biology ____ _____________ Chemistry ____ _____________ Physics ____ _____________ Typing ____ _____________ COLLEGE DATA: Attended _________________________________________________________________________________________________ City __________________________________________________ State ________________ Zip Code _____________________ Graduated ____________ Major ____________________________________________ Grade Point Average ________________

year

In the last five years have you attended or are you presently attending college? _________________________________________ If yes, what subjects have you completed: Check Grade Received

High School Chemistry or

Principles of Chemistry (CHEM 1010) ____ _____________

MATH 1710 ____ _____________

*Anatomy and Physiology I (BIOL 2010) ____ _____________ *Anatomy and Physiology II (BIOL 2020) ____ _____________ Composition I (ENGL 1010) ____ _____________ Behavioral or Social Science Elective ____ _____________ Humanities Elective ____ _____________ *BIOL 2010 and BIOL 2020 must have been taken within the past 5 years.

IMPORTANT NOTE: PLEASE RECORD OTHER EXTRA CREDIT COURSES ON THE BACK. ENTRANCE EXAMS: TEAS Score: _____% ACT Scores: Composite _____ English _____ Math _____ Reading _____ Science Reasoning _____

Transcript Request Form

Nursing & Allied Health Division

IMPORTANT NOTES TO STUDENT:

• The school registrar(s) will be sending your transcript to your current address. The student is to keep

the official transcript and submit only a copy with your program application; or self-printed transcripts will also

be accepted by this division.

•

The N&AH transcript request form should be sent to your high school and all colleges previously attended.

No transcripts are needed if attending Chattanooga State or if your transfer credits are showing on the

Chattanooga State transcript. A copy of your high school transcript is required for RT applicants; and for

PTA applicants who do not have college level courses completed. If you are using high school credit for chemistry

for RN, RC or DH, a copy of high school transcripts are required.

Important Note: High School and/or other College Transcripts previously submitted to Chattanooga

State’s Admissions Office cannot be copied and forwarded to the Nursing & Allied Health Division. Do not

request the ChSCC Admissions Office to send a copy to Nursing & Allied Health.

To obtain N&AH Transcript Request forms go to the N&AH website www.chattanoogastate.edu/nursing-allied-health

---

STUDENT – FILL OUT CLEARLY & COMPLETELY FOR REGISTRAR:

School Registrar’s Mailing Address

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

I last attended your school in ___________________________. For identification purposes, the name under which

I attended your school was ___________________________________________________________. My birth date

is _______________________________ and my Social Security Number is ___________________________________.

SCHOOL REGISTRAR: The N&AH Division would like to request that the complete official transcript

of Academic Record be sent to the student’s current address below.

Note to Registrar: If there is any charge for this service, please bill the student at the address above: Questions: contact the N&AH Application Coordinator at 423-697-2504.

(Student - Please Print Clearly for Registrar)

Student’s Name: ________________________________________________________________________

Current Address: ________________________________________________________________________

City/State/Zip: __________________________________________________________________________

Student Phone Number(s): ________________________________________________________________

Respectfully,

_________________________________________ _________________________________________ __________

Student Print Name

Student Signature Date

Page 1

2013-2014 TEAS INFORMATION SHEET

FACTS TO KNOW ABOUT THE TEAS (TEST OF ESSENTIAL ACADEMIC SKILLS):

 Chattanooga State only gives the reading and math sections of the TEAS. The TEAS includes multiple-choice questions divided into 2 subsections: Mathematics and Reading. The test used is Version 5 and we do not give the Science and English sections of the TEAS.

• Reading – paragraph comprehension, passage comprehension, and inference/conclusions (58 minutes, 42 questions)

• Math – whole numbers, metric conversion, fractions, decimals, algebraic equations, percentages, and ratio/proportion (51 minutes, 30 questions)

 Study Manuals for the TEAS-V are available for purchase at the Chattanooga State Bookstore -. Also, online from ATI at www.atitesting.com are purchases that include learning strategies, TEAS Pre-Test Study Manual, TEAS Online Practice Assessments and TEAS Transcripts. Other sources of test review materials include the reading comprehension and mathematics (basic math up to intermediate algebra) sections of any GED, ACT or SAT prep manual. Study Manuals are also on reserve at the Chattanooga State Library.

 Calculators are NOT ALLOWED.

 The test will be taken on the computer. There is no paper and pencil option.

 In order to be a valid test, it must have been taken within two (2) years of the program application deadline. Only one test every six (6) months is valid.

 ADVANCED REGISTRATION is required due to limited seating. DON’T WAIT! Pre-register at least 4-6 weeks before the program deadline date. Remember: The test has to be taken on or before the program deadline date.

 RESULTS OF TEAS: After you take the test, keep a copy of your TEAS results. You will be attaching a copy and/or posting the test date information on your program application. The student can at any time access their results under their account at ATI testing visit http://www.atitesting.com/solutions/prenursingschool/teas.aspx or contact ATI at 800-667-7531. If the TEAS is retaken, the higher score total from one test will be used

 SCORING THE TEAS: Don’t forget to view the TEAS Sample Score Sheet – Individual Performance Profile, which is available on the N&AH website. This will help you understand how the TEAS is scored. The adjusted individual scores of the two tests are averaged to the nearest tenth (i.e. 63.8) for a composite score. Remember, each N&AH program calculates the formula points differently. Attend a program information session to go over this important process.

TESTING CENTER POLICIES – PLEASE READ IMPORTANT!

 CANCELLATION POLICY:

 A 24 hour notice is required if you have to cancel - call 423-697-2684.  To reschedule once without penalty of repayment:

 Present documentation/note from doctor, courts, etc. stating your emergency to cancel  If no documentation (as stated above), you’ll be required to repay the fee.

 Student must show picture ID or driver’s license “at time of testing”.

PROGRAM’S THAT REQUIRE THE TEAS

Program Deadline Date for 2014:

TEAS test must be taken on or before the program deadline date for 2014. Don’t wait until the last minute to register. Important: Don’t take the TEAS test

after the deadline date unless approved by the Program Director.

Respiratory Care May 15 *Veterinary Technology May 1

*Veterinary Technology (Vet Tech) is a program offered through the Math & Science Division at Chattanooga State.

Physical Therapist Assistant March 3 Radiologic Technology April 15 Registered Nursing March 15 ■

(RN: Must be registered by 3/1/14, call (423) 493-8740 if questions) ■Since RN’s deadline ends on a weekend, the following Monday will be considered the last day to turn in all materials which means the deadline will be March 17.

Dental Hygiene February 3 Health Information Management May 5 LPN to RN Transition January 15 Paramedic to RN Transition January 15

IMPORTANT:

KEEP Pages 1 & 2

Page 2

TEAS SAMPLE SCORE SHEET

Individual Performance Profile

Test of Essential Academic Skills V - Form A

ati

Scores

Sub-Scale # Items Adjusted Individual Score Mean National Program Percentile Rank National Program Adjusted

Individual Score (% correct) 1 10 20 30 40 50 60 70 80 90 100 TEAS Reading 42

_64.3%

69.7% 71.3% 34 29 ▲

Paragraph and Passage Comprehension 19 73.7% 69.5% 71.1%

▲

Informational Source Comprehension 23 60.9% 71.7% 73.5%

▲

TEAS Mathematics 30

_63.3%

68.0% 69.4% 40 37 ▲ Numbers and Operations 19 73.7% 70.1% 71.4% ▲ Algebraic Applications 4 75.0% 67.6% 68.6% ▲ Data Interpretation 3 33.3% 63.3% 64.9% ▲ Measurement 4 25.0% 63.1% 64.9% ▲

Individual Name:

Student Number:

Institution:

Chattanooga State TEAS ADN

Program Type:

ADN

Test Date:

3/25/2011

# of Questions:

72

Attempt:

1 of 1

Days since last attempt:

0

Adjusted Individual Score

Percent scores based on the number

of questions answered correctly

divided by total number of questions

for each component of the test.

The bolded and enlarged Reading and

Math % scores are averaged together

when calculating class selection

points. Each program calculates the

formula points differently.

The other scores provide information

as to how you did in each component

in the reading and math sections.

Means

Compares

your % score

to national

and program

averages for

student who

took the test.

Percentile Rank

A comparison

score that shows

how you ranked

compared with

others who have

taken the test.

If you scored 34,

that means you

scored better than

34% of the people

who took the test.

Page 3

How to Register

: Mail or bring the TEAS Registration Form to the Chattanooga State Testing Center. There is a $55.00 test fee that is due at the time of

registration. They will accept cash or checks; checks made payable to Chattanooga State. No telephone reservations are accepted.

Location of Chattanooga State Testing Center: 4501 Amnicola Hwy, IMC Building Room 122, Chattanooga, TN 37406.

Important Note if Registering by Mail…..

Before mailing to the Testing Center, make sure these are included:

• the TEAS Registration Form

• $55.00 check for test fee made payable to Chattanooga State

•

includea self-addressed and stamped envelope

that will be used to return confirmation of your test date, reporting time and test location.

NOTE: If an envelope is not included, an attempt to confirm by phone will be made 3 times. After that, all materials will be returned or put in a file

marked “unconfirmed”.

TEAS REGISTRATION FORM 2013-2014

Read all important information from page 1. If mailing, include the 3 important items mentioned above.

Please Print

NAME: (as on driver’s license) _____________________________________________________________ Soc. Sec or “A” # ____________________

ADDRESS ____________________________________________________________ City ___________________ State _____ Zip ______________

Daytime phone # ____________________ Cell # __________________ E-mail address ___________________________________________________

□

Check here if you have educational, psychological and/or physical disabilities and may be eligible for accommodations. Information is available in the Disabilities

Support Services Office. Please Explain: __________________________________________________________________________________________________

The TEAS test is scheduled on

Mondays

, unless specified below with an asterisk (*). DIRECTIONS: For your 1

st

choice - place #1 next to a date and a time.

For your 2

nd

choice - place #2 next to a date and a time. NOTE: No TEAS testing in August due to entrance testing.

JULY 2013 SEPTEMBER 2013 OCTOBER 2013 NOVEMBER 2013 DECEMBER 2013 JANUARY 2014

DATE/(TIMES) ___ 15 (2:30) ___ 22 (5:00) ___ 29 (11:00) DATES/(TIMES) ___ 9 (__11:00 __2:30 __5:00) ___ 14 * Sat (__8:30 __11:00) ___ 16 (8:30) ___ 23 (11:00) DATES/(TIMES) ___ 7 (2:30) ___ 21 (8:30) ___ 28 (11:00) DATES/(TIMES) ___ 4 (2:30) ___ 9* Sat (__8:30 __11:00) ___ 11 (5:00) ___25 (__8:30 __ 11:00) DATES/(TIMES) ___ 16 (__8:30 __11:00 __2:30 __5:00) DATES/(TIMES) ___ 6 (__8:30 __11:00 __2:30 __5:00) ___ 11* Sat (__8:30 __ 11:00) ___ 13 (__8:30 __11:00 __2:30 __5:00) ___ 27 (__8:30 __11:00 __2:30 __5:00)

FEBRUARY 2014 MARCH 2014 APRIL 2014 MAY 2014 JUNE 2014 JULY 2014

DATES/(TIMES) ___ 1* Sat (__8:30 __ 11:00) ___ 3 (__8:30 __11:00 __2:30 __5:00) ___ 10 (__8:30 __11:00 __2:30) ___ 17 (__8:30 __11:00 __2:30 __5:00) ___ 24 (__8:30 __11:00 __2:30) DATES/(TIMES) ___ 1* Sat (__8:30 __11:00) ___ 3 (__8:30 __11:00 __2:30 __5:00) ___ 10 (__8:30 __11:00 __2:30 __5:00) ___ 11* Tues (8:30) ___ 12* Wed. (11:00) ___ 13* Thurs. (__8:30 __ 2:30) ___ 17 (__8:30 __11:00 __2:30 __5:00) ___ 24 (__2:30 __ 5:00) DATES/(TIMES) ___ 7 (__8:30 __11:00 __2:30 __5:00) ___ 12* Sat (__8:30 __11:00) ___ 14 (__8:30 __11:00 __2:30 __5:00) DATES/(TIMES) ___ 5 (__11:00 __2:30) ___ 12 (__11:00 __2:30) ___ 19 (11:00) DATES/(TIMES) ___ 9 (11:00) ___ 16 (2:30) ___ 23 (5:00) DATES/(TIMES) ___ 14 (2:30) ___ 21 (5:00) ___ 28 (11:00)

Pub. No. 11-70-204101-2-7/13/jc/bap*form#46*PDF*Chattanooga State Community College is an AA/EEO employer and does not discriminate on the basis of race, color, national origin, sex, disability or age in its program and activities. The following person has been designated to handle inquiries regarding the non-discrimination policies: Director and Affirmative Action Officer, 4501 Amnicola Highway, Chattanooga, TN 37406, 423-697-4457.

FOR OFFICE USE ONLY 1st _{Date:_____________ Time: ________} If Rescheduled:

Radiologic Technology Admission Points

Additional Credit may be given for students who have successfully completed the following courses

with a grade of “C” or above. Highlighted courses are encouraged.



ENGL 1020 Composition II



INFS 1010 Computer Science (EC for 1 only)



SPCH 1010 Speech—required for sonography



HE 103

Medical Terminology



HS 111

Introductions to Healthcare Professions



SPAN 1002 Medical Spanish I and SPAN 1003 Medical Spanish II



BIOL 1430 Nutrition



BIOL 1110 General Biology I



BIOL 1120 General Biology II



BIOL 2230 Microbiology



MATH above 1710



CHEM 1030 Integrated Chemistry



CHEM 1110 General Chemistry I



CHEM 1210 General Chemistry II



CHEM 2020 Organic Chemistry



PHYS 1030 Integrated Physics



PHYS 2010 Physics I



PHYS 2020 Physics II



PHYS 2110 Calculus Based Physics I



PHYS 2120 Calculus Based Physics II



40 hours or more observation at a full service radiology department

Radiologic Technology 2013-2014 Estimated Costs

These are estimated program costs. Actual costs may vary due to changes in tuition and/or fee increases as

determined by the Tennessee Board of Regents. This cost will also be reduced for students since some of the

required course work is completed prior to acceptance into the program. These general and support courses

taken before the program is to lessen course load in a given semester.

Note: College fees are included in the maintenance cost.

To view current calculation table, go to Bursar’s Office on Chattanooga State website. This website will also give you information on refund policies, fee payments and the refund calendar.

Maintenance Fees In-State Out-of-State

Pre-Admission Costs:

College one time application fee

15.00

15.00

TEAS Admission test

55.00

55.00

First Semester (17 hours) (fall)

Maintenance fee

1,965.50

7,720.50

Truescreen: myRecord Tracker Fee:

17.50

17.50

Upload documentation for:

Physical examination and required test

300.00

300.00

Hepatitis B (estimate)

175.00

175.00

“Fit” test

20.00

20.00

CPR

25.00

25.00

Right, left and upright markers

65.75

65.75

Liability insurance

11.00

11.00

Radiation monitoring receipts

20.00

20.00

Truescreen Criminal Background Check

24.50

24.50

Truescreen Drug Screen (10 panel)

31.00

31.00

Textbooks

1,050.00

1,050.00

Second Semester (14 hours) (spring)

Maintenance fee

1,181.50

7,275.50

Uniforms, lab coats, etc.

350.00

350.00

Textbooks

150.00

150.00

Parking-Hospitals

5.00

5.00

Third Semester (4 hours) (summer)

Maintenance fee

632.00

2,372.00

Fourth Semester (17 hours) (fall)

Maintenance fee

1,965.50

7,620.50

Truescreen: myRecord Tracker Fee:

7.50

7.50

Upload documentation for:

“Fit” Test

20.00

20.00

TB Skin Test

20.00

20.00

Liability insurance

11.00

11.00

Radiation monitoring receipt

20.00

20.00

Uniforms, lab coats, etc.

350.00

350.00

Textbooks

556.00

556.00

Fifth Semester (17 hours) (spring)

Maintenance fee

1,965.50

7,620.50

Textbooks

350.00

350.00

Sixth Semester (6 hours) (summer)

Maintenance fee

939.00

3,549.00

Pub. No. 11-70-204104-77-8/13/jc/bap • Form#72 • PDF • Chattanooga State Community College is an AA/EEO employer and does not discriminate on the basis of race, color, national origin, sex, disability or age in its program and activities. The following person has been designated to handle inquiries regarding the non-discrimination policies: Director and Affirmative Action Officer, 4501 Amnicola Highway,

Nursing & Allied Health Division Chattanooga State Community College 4501 Amnicola Highway

Chattanooga, TN 37406

Name (Please Print): _______________________________ ______________________________ Date: ________________ Last Name First Name

Address: __________________________________________________________________________________________________

Street/PO Box City State Zip

Phone Number: Home: _____________________________________ Cell:_______________________________________ Email address (please print clearly): ______________________________________________________________________________ Student ID Number: ________________________________ Year you plan to enter program? _______________________ Program: Dental Health Information Physical Therapist Radiologic Respiratory

Hygiene Management Assistant Technology Care

PLEASE READ CAREFULLY: A waiver of the 5-year limit for Anatomy & Physiology and/or Microbiology will only be considered if the applicant… • Has applied for admission to Chattanooga State and submitted an application to the Allied Health program.

• Is currently licensed or certified in a healthcare career or can provide evidence as to why knowledge of the biology subject is current. • Has a grade of “B” or better in the biology course(s.). A waiver request for courses with a grade of “C” will not be considered.

• Provides documentation that the courses were completed within no more than 8 years of the date of entry into the first program course. It is the student’s responsibility to submit all requested information at the time the waiver form is submitted.

Anatomy and Physiology I, II and Microbiology must have been completed no more than 5 years from enrollment in major courses. To request a waiver of the 5-year limit, provide ALL of the following information and submit completed form to the appropriate program director prior to the application deadline:

Semester/Year Taken Grade Requesting Waiver Anatomy and Physiology I __________________ _____ Anatomy and Physiology II __________________ _____ Microbiology __________________ _____ Concepts of Physics __________________ _____

Describe in detail: “Why do you believe a 5-year waiver should be granted?” (Use back of the page or attach a typed document.) Keep in mind that the content included in these courses is not taught during your major courses. It is assumed that students have current

knowledge of the sciences upon which to build knowledge in your chosen healthcare field. Explain why you believe your knowledge is current enough to be granted a waiver of the 5-year limit. Include in this explanation such things as:

• Do you have prior health career education? What career? When were you enrolled? • Are your currently certified or licensed in a health profession?

• Describe any work experience since completion of the biology course(s) related to maintaining current knowledge.

Student Signature: ________________________________________________ Committee Action: Date: ___________

Approved (list any conditions:___________________________________________________________________________) Denied

Request for Waiver of 5-Year Limit

Lab Science Courses

NOTE: Attach a copy of your

Chattanooga State transcript verifying this information. If these courses were taken elsewhere and do not appear on your transcript in Banner Self Service attach a copy of the appropriate transcript(s).

Incomplete applications will not be considered.