•
All applicants must meet the admissions criteria as stated in this packet and are accepted on a
first come
first come
first come
first come, first qualified
first qualified
first qualified basis.
first qualified
•
The Respiratory Therapy courses begin each Fall semester and are offered during the daytime
daytime
daytime on
daytime
on
only
on
ly
ly
ly.
•
There is a maximum of 16 seats available each petitioning year.
•
Clinical rounds are done at Crozer Chester Medical Center (Upland), Saint Christopher’s
(Philadelphia), Children’s Hospital (Philadelphia), and Pro
2Health Care Services (King of Prussia).
•
All petitions and supporting documentation must be received no later than Thursday, July 21, 2011
Thursday, July 21, 2011
Thursday, July 21, 2011,,,,
Thursday, July 21, 2011
to be considered a candidate for the program.
•
Petitions must be submitted in
in
in
in----person
person
person at the Admissions Office, Marple Campus, Media, PA.
person
•
The Admissions Office encourages you to complete and submit your requirements before
before
before
before
July 21, 2011, as the program may fill before the deadline.
Information Sessions
It is important to attend an information session to learn more about the program and the special admissions
requirements. Sessions last approximately 2 hours.
No advanced reservations are required
to attend a
session. Sessions begin promptly at the times listed below. Please arrive 10 to 15 minutes early to sign-in and
collect materials.
It is highly recommended that you review the contents of this packet in full prior to attending an information session:
Tuesday, February 15th 6:00 p.m. Marple Campus, Academic Bldg, Room 2256
Wednesday, March 9th 11:00 a.m. Marple Campus, Academic Bldg, Room 4235 Tuesday, March 15th 6:00 p.m. Marple Campus, Academic Bldg, Room 2246
Tuesday, April 12th 6:00 p.m. Marple Campus, Academic Bldg, Room 2256
Tuesday, May 4th 11:00 a.m. Marple Campus, Academic Bldg, Room 4235
For additional dates/times please view the College’s
Calendar
Calendar of Events
Calendar
Calendar
of Events
of Events at
of Events
at:
at
at
:
:
: www.dccc.edu
www.dccc.edu
www.dccc.edu
www.dccc.edu
RESPIRATORY THERAPY
ADMISSIONS
FALL 2011
Petitioning Dates
•
Candidates residing in sponsoring*
sponsoring*
sponsoring* school districts may petition beginning: Monday, November 22, 2010
sponsoring*
Monday, November 22, 2010
Monday, November 22, 2010
Monday, November 22, 2010
•
All other candidates may petition beginning: Monday, December 13, 2010.
Monday, December 13, 2010.
Monday, December 13, 2010.
Monday, December 13, 2010.
*At present, the sponsoring school district *At present, the sponsoring school district*At present, the sponsoring school district
*At present, the sponsoring school districts ares ares are Chesters areChesterChester----Upland, ChesterUpland, Garnet Valley (Bethel residents only), Upland, Upland, Garnet Valley (Bethel residents only), Garnet Valley (Bethel residents only), Garnet Valley (Bethel residents only), HHHHaverford, Interboro, Radnor, Ridley, averford, Interboro, Radnor, Ridley, averford, Interboro, Radnor, Ridley, averford, Interboro, Radnor, Ridley, Rose Tree
Rose TreeRose Tree
Rose Tree Media, Southeast Delco, Springfield,Media, Southeast Delco, Springfield,Media, Southeast Delco, Springfield, UMedia, Southeast Delco, Springfield,UUUpper Darby, Wallingfordpper Darby, Wallingfordpper Darby, Wallingfordpper Darby, Wallingford----Swarthmore (Rutledge and Swarthmore residents only), Swarthmore (Rutledge and Swarthmore residents only), Swarthmore (Rutledge and Swarthmore residents only), and Swarthmore (Rutledge and Swarthmore residents only), and and and William Penn.
William Penn.William Penn. William Penn.
Page 1
Criteria for Admission – START HERE!
1. Complete a Delaware County Community College application for admission. Acceptance to the College does notguarantee acceptance to the Respiratory Therapy program. If you previously enrolled at the College and stopped attending for any reason, you must submit another application and check the box indicating you are applying for readmission.
2. Take the College’s placement test if you have not done so previously. You may waive the placement test if you successfully completed and transfer in college level English composition and college level mathematics elsewhere. To waive the placement test, you must submit official transcript(s) documenting the successful completion of these courses and complete a “Petition for Transfer of Credit” form available from the Assessment Center (Room 2195, Marple Campus, 610‐359‐5322).
3. Submit an official, final high school transcript or GED transcript indicating the date of graduation/certification. This step must be completed, regardless of post‐secondary educational experience(s). Please contact the Admissions Office admiss@dccc.edu or 610‐359‐5050, to ensure that the paper copy of this document is on file in the Records Office. Please include your DCCCid or social security number and maiden name, if applicable, in your phone calls or emails to make locating a received transcript easier. Send all official, sealed, final transcripts to:
Delaware County Community College 901 South Media Line Road
Media, PA 19063
Attention: Records Office
4. Transfer previously completed credits to Delaware County Community College.Submit an official transcript from any other college(s) attended to the Records Office (see address listed above). You must also complete a “Petition for Transfer of Credit” form available in the Assessment Center (Room 2195, Marple Campus, 610‐359‐5322). Forms are also available on the College’s website, www.dccc.edu/assess/pot.pdf. Please allow 4‐8 weeks for this evaluation; you will receive notification after the evaluation is completed. The Assessment Center will not evaluate transcripts until this form is received.
5. Complete the Health Occupations Basic Entrance Test (HOBET). This is required of all applicants and cannot be waived. You must achieve all of the following minimum scores from a single testing session.
Essential Math Skills-60% Reading Comprehension-60% Composite Percentage-60%
Test registration is conducted in-person only at the Marple Campus and payment of $40.00 is due at that time. For more information on the HOBET test, please see page five (5) of this packet.
6. Maintain “Good Academic Standing” with the College. Students must be in Good Academic Standing with the College at the time of petition through the start of RTH100/101. Students on academic probation or dismissal at the College, as defined in the Student Handbook, will not be admitted to the program. If your Academic Standing at the College falls below “good standing” (GPA 2.0) at any time after you are admitted to the program, your offer of admission will be revoked and you will not be permitted to register for, or begin, RTH100/101.
7. Be in compliance and in good standing with the College’s Code of Conduct, as defined in the Student Handbook.Students must be in good disciplinary standing with the College. Students who have outstanding sanctions or violations filed with the Office of Student Affairs will not be admitted to the program. If your Code of Conduct standing at the College falls below “good standing” at any time after you are admitted to the program, your offer of admission will be revoked and you will not be permitted to register for, or begin, RTH100/101.
8. Observe a Respiratory Therapist. All applicants are required to observe a Respiratory Therapist (RT) prior to being accepted into the program. Career exploration and observation gives interested applicants an opportunity to learn about the work environment and employability of a RT while witnessing firsthand the occupational skills necessary for practice. To schedule an appointment to observe a RT, contact Patti Curran, Respiratory Therapy Program Coordinator at : 610-447-2440.
9. Obtain current results of the Child Abuse Clearance AND a Criminal Record Check.Complete forms thoroughly and indicate yourself as the requester. Enclose a separate money order for each. The results may take 2‐8 weeks or more to be returned to you. Keep the results in a safe place. If you have not been a resident of the Commonwealth of Pennsylvania for the last two consecutive years or longer, a Federal Criminal History report is required in place of the Pennsylvania Criminal Record Check. To be considered current, both must be dated after September 1, 2010. See page four (4) for more information.
10. Submit the following items TOGETHER and in-person at the Marple Campus Admissions Department: These items may be submitted even before all the criteria for admission listed on this page have been completed. However, applicants will not be offered an available seat in the program until all steps listed in this page have been completed. Submit the following:
1. 1.1.
1. A PetA Petition for Entry into the RespirA PetA Petition for Entry into the Respirition for Entry into the Respiratory Therapy program (see page 9ition for Entry into the Respiratory Therapy program (see page 9atory Therapy program (see page 9atory Therapy program (see page 9) ) ) ) 2.
2.2.
2. Legible photocopy of a current Proof of Residence Legible photocopy of a current Proof of Residence Legible photocopy of a current Proof of Residence Legible photocopy of a current Proof of Residence
Acceptable documents include: a permanent driver’s license, utility bill, pay stub, recent income tax return, or property tax. Documents must be in your name and the address on the proof of residence must match the address provided on the petition.
3. 3.3.
3. Original, current results of a Child Abuse Clearance Original, current results of a Child Abuse Clearance Original, current results of a Child Abuse Clearance Original, current results of a Child Abuse Clearance 4.
4.4.
4. Original, current results of a PA Criminal Record Check Original, current results of a PA Criminal Record Check orOriginal, current results of a PA Criminal Record Check Original, current results of a PA Criminal Record Check oror Federal Criminal History ChorFederal Criminal History ChFederal Criminal History CheckFederal Criminal History Checkeckeck 11. Complete ONE of the following: Testing Option or Credit Option (see next page)
Page 2
If you attended high school and/or college outside the United States, you must submit evaluations of your high school and college transcripts to show that you completed the necessary requirements for admission. World Education Services and Educational Credential Evaluators are transcript evaluation services recognized by the College. For more information and an application, visit their websites: www.wes.org and www.ece.
(1.) Testing Option:
Achieve the following minimum score on the
ACT
or
SAT
and have the official score report on
file with the College before the
petition deadline of July 21, 2011
.
Please note: Scores must
be current within five years of beginning clinical work (therefore, taken September 2006 or after).
ACT Composite* – 19 or higher
OR
SAT** – 910 or higher
*Delaware County Community College offers the ACT through the Assessment Center (Room 2195, Marple Campus, 610-359-5322). Please call this office for more information. **For students taking the SAT only the math and critical reading sections (not the writing section) will be used in calculating the score requirement of 910 or higher.
PLEASE NOTE
:
Please see page seven (7) for prerequisite classes that must be completed before a student can begin RTH 100 and RTH 101. They do not have to be complete at the time of petition or acceptance, but must be satisfactorily finished in order to begin the program. If you opt for the credit option (below) the prerequisite courses will be satisfied.OR
(2.) Credit Option:
Achieve a “C” or better and a cumulative GPA of 2.5 or higher in ALL FOUR of the following courses.
Please note: GPA will be calculated using only the following four courses.
English Composition I
(ENG 100)
College Mathematics
(Choose ONE -
acceptable courses are
: MAT 100, 140, 141, 150, 160, 161)
General Chemistry I
(CHE 110- 4 credit w/lab)
Human Anatomy & Physiology I
(BIO 150- 4 credit w/lab)
•
If you plan to qualify with the Credit Option, all four courses listed above must be completed and the
grades available
BEFORE
the petition can be considered complete. Courses must be completed by the
deadline of July 21, 2011. Grades for courses scheduled for the 2011 Summer II session
will not be
available by the deadline
; therefore, those choosing the credit option should complete all courses by
the end of Summer Session I.
•
Students using courses completed at other colleges / universities to fulfill this credit option should note
that their GPA will be recalculated according to the College’s grading system and credit value for
admissions purposes only.
•
According to College policy, students may repeat a course to improve their grade point average if the
initial grade was “D”, “N”, “W”, or “F”. Please see the College’s
Student Handbook
for more information.
Page 3
You must complete
ONE
of the following two options listed below
to be considered for a seat in
Child Abuse Clearance and Criminal Record Check
Child Abuse Clearance and Criminal Record Check
Child Abuse Clearance and Criminal Record Check
Child Abuse Clearance and Criminal Record Check
•
PLEASE NOTE
PLEASE NOTE
PLEASE NOTE
PLEASE NOTE: Students who have been convicted of a prohibitive offense contained in Act 13 and/or Act
169* may not be able to complete their s
may not be able to complete their s
may not be able to complete their s
may not be able to complete their studies
tudies
tudies
tudies because clinical experiences needed for course/program
success may be prohibited. If a student cannot complete his/her clinical studies, he/she will not be
accepted into the Respiratory Therapy program.
*A detailed list is available for review in the Admissions and Allied Health Offices.
•
Results from both the Child Abuse clearance and the Criminal Record check MUST be current within one
current within one
current within one
current within one
year of beginning
year of beginning
year of beginning
year of beginning Respiratory Therapy Principles and Practicum I (RTH 100 and 101). Therefore, clearances
clearances
clearances
clearances
must
must
must
must be dated September 1, 20
be dated September 1, 20
be dated September 1, 2010
be dated September 1, 20
10
10
10, or after to be considered valid
, or after to be considered valid
, or after to be considered valid
, or after to be considered valid. Please note that you may be required to
update the clearances you submitted for admission to the program before beginning the clinical work.
•
The Pennsylvania State Board of Medicine reserves the right to deny a license to any candidate who has
been convicted of a felony or any offense relating to the use or sale of alcohol or controlled substances in
Pennsylvania or any other state.
♦
Placement Tests
Placement Tests
Placement Tests
Placement Tests
•
Full-scale placement tests are required for any student who has not completed college-level math
or English Composition with a grade of “C” or better.
•
To waive placement tests, send an official transcript that verifies the completion of college-level
math and English Composition with a grade of “C” or better. Complete the College’s “Petition for
Transfer of Credit.”
•
Developmental and remedial courses MUST be completed before beginning RTH 100/101.
Page 4
Petitions and/or supporting documentation
Petitions and/or supporting documentation
Petitions and/or supporting documentation
Petitions and/or supporting documentation
submitted after
submitted after
submitted after
submitted after July 21, 2011
July 21, 2011
July 21, 2011,,,, will not
July 21, 2011
will not
will not
will not be accepted.
be accepted.
be accepted.
be accepted.
The information in this packet will expire on July 21, 2011
The information in this packet will expire on July 21, 2011
The information in this packet will expire on July 21, 2011
The information in this packet will expire on July 21, 2011....
SPECIAL NOTE
: If you have not been a resident of the Commonwealth of Pennsylvania for the last
two consecutive years, a Federal Criminal History check is required instead of the Pennsylvania
Criminal Record Check. The Child Abuse Clearance is also required. If a report of Federal Criminal
History is required, you must provide a full set of fingerprints to the Pennsylvania State Police.
Additional
Additional
Additional
Additional Information on the Health Occupations Basic Entrance Test (HOBET)
Information on the Health Occupations Basic Entrance Test (HOBET)
Information on the Health Occupations Basic Entrance Test (HOBET)
Information on the Health Occupations Basic Entrance Test (HOBET)
♦
Applicants must receive the following minimum scores from a single testing session of the HOBET to qualify for admission to Delaware County Community College’s Respiratory Therapy program:Essential Math Skills- 60% Reading Comprehension-60% Composite Percentage-60%.
♦
Applicants who do not meet all three minimum scores from a single testing session will not be considered for theprogram, even if all the other requirements are completed. HOBET test results taken elsewhere must be sent directly from ATI (creator of the HOBET Test) to Delaware County Community College’s Assessment Center. Student copies of test results will not be accepted. Official score reports from ATI must be received by the Assessment Center no later than July 21, 2011.
♦
The computerized test lasts approximately 3 hours and will be given a number of times throughout the year at the Marple Campus in Media, PA. Students wishing to meet the deadline of Thursday July 21, 2011, should complete their testing before this deadline.♦
Test registration is conducted in-person at the Marple Campus in the Admissions Department (Room 3545)♦
A $40.00 per test fee is due at the time of test registration.♦
You may take this test a total of 3 times ONLY (NOT 3x’s a year). If you have not achieved the minimum scores required by the third test, you will not be able to schedule the test again. Students WILL NOT be permitted to schedule a retest any earlier than four (4) weeks after each testing date in order to allow for a sufficient preparation period.♦
The use of a calculator is not permitted during the test.♦
If you take the HOBET more than once, please understand that the Respiratory Therapy Admissions Committee will consider your highest scores from a single test. Scores from more than one test will not be split or mixed.♦
A test preparation book for the HOBET is available for purchase in the College’s Bookstore on the Marple Campus. Limited copies are available in the Library for students with a Delaware County Community College student ID and proof of registration for the HOBET test.♦
If you have a documented disability, please contact the Office of Disability Services (610-325-2748).♦
Once you have completed the HOBET, a testing proctor will give you an official printout of your score report. This printout is the ONLY copy of your official score report that will be produced. Keep this document in a safe place. The College recommends that you make additional copies of your score report in the event that you misplace the original. The College receives your results electronically and reviews the results along with the other admission requirements.HOW TO
HOW TO
HOW TO
HOW TO SCHEDULE THE HOBET
SCHEDULE THE HOBET
SCHEDULE THE HOBET
SCHEDULE THE HOBET
Scheduling a test date and time must be made in
in
in
in----person
person
person at the Marple Campus, Media, PA (
person
Room 3545).
Available dates and times for the HOBET are not released to students over the telephone or electronically.
You must come in
in
in----person
in
person
person
person to the College’s Admissions Department, Marple Campus.
The cost of the HOBET is $40.00 per test. Payment is required at the time of test registration. The
College accepts cash, personal check, money orders, and most major credit cards.
All balances due to the College must be paid in full prior to paying for and registering for the HOBET.
A current Delaware County Community College application must be on file with the Records Office prior to
test payment and scheduling. A one time $25.00 application fee is required.
Important Notes
•
Students will be offered a seat for the program, if one is available, when ALL steps have been
successfully completed.
•
All three prerequisites below
must be completed,
before a student can begin RTH 100 and
RTH 101. They do not have to be complete at the time of petition, unless petitioning using the
Credit Option (see page 3), or at the time of acceptance, but must be satisfactorily finished in
order to begin the program.
1.
English Composi
English Composi
English Composition
English Composi
tion
tion
tion (ENG
(ENG
(ENG
(ENG 100)
100)
100)
100)
2.
MATH
MATH
MATH ((((Choose One
MATH
Choose OneChoose OneChoose One: 1: 1: 1: 100, 140, 141, 150, 160, 16100, 140, 141, 150, 160, 16100, 140, 141, 150, 160, 161)))) 00, 140, 141, 150, 160, 1613.
3.
3.
3. General Chemistry
General Chemistry
General Chemistry ((((CH
General Chemistry
CH
CHE
CH
E 1
E
E
1
1
11
1
10
1
0
0
0))))
•
The Admissions Office will notify students by mail regarding the status of their admission into
the program. It can take 4-6 weeks to evaluate petitions. If your petition is incomplete, you will
be notified as to which item(s) you are missing. All missing items must be submitted by the
deadline date of July 21, 2011, to be considered for a seat in the program.
•
Students are not permitted to defer their enrollment into the Respiratory Therapy Program for a
future enrollment date. Students must petition and meet all admission requirements in
accordance with the policies and procedures required for the new petitioning year.
•
If offered a seat in the program, students will be required to submit a $100.00 non-refundable
deposit to hold the seat. This deposit will
only
be refunded if a student remains enrolled in RTH
100 and RTH 101 in Fall 2011 for the first three full weeks of the semester and all balances are
paid in full. All previous balances must be paid prior to paying the $100 deposit.
•
A
required
special college planning session for admitted students will be held during Summer
2011. During this session students will participate in an advisement session and register for
clinical coursework. Admitted students will be notified regarding the date of this required
session. Admitted students must pass a drug test at this time in order to be eligible for the
clinical experience.
•
It is the student’s responsibility to notify the Admissions and Records Offices of any changes in
address or phone number. We must be able to contact you.
•
Credits received for BIO 150 and BIO 151 (Human Anatomy and Physiology I & II) prior to
enrollment MUST BE CURRENT within 5 YEARS of the date you begin your first clinical course
(therefore, dated Fall 2006 or later).
•
In addition to normal tuition and fees, respiratory therapy students are required to purchase
uniforms, insurance and miscellaneous supplies.
Prerequisites to RTH 100 & RTH 101(Respiratory Therapy Principles and Practicum I):
ENG 100 English Composition…3 credits
MAT 100 College Mathematics…3 credits
CHE 110 General Chemistry with lab…4 credits
NOTE: All three (3) prerequisite courses listed above must be satisfactorily completed prior to beginning RTH100 and RTH101. If opting for the Credit Option (see page 3 – item #2), these courses will be satisfied with that admissions option. .
P
Upon completion of the two-year program with a grade of “C” or better in all respiratory therapy courses, the degree of associate in applied science is awarded. The graduate is immediately eligible for the Entry-Level Certification Examination and after passing the Entry-Level Certification Examination, the student is eligible for the Advanced Practitioner's
Examination. Upon successful completion of the Advanced Practitioner's Examination, the credential Registered Respiratory Therapist is awarded.
Delaware County Community College is an equal employment and educational opportunity institution conforming to all applicable legislation that prohibits discrimination. The College does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other characteristic protected by state or federal laws in its educational programs, activities, admission or employment policies, as required by Title IX of the Educational Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and other applicable statutes. Inquiries concerning Title IX and/or 504 compliance should be referred to: Betty Brown, associate dean for student success, room 2195, 610-359-5320; and/or Connie McCalla, vice president of human resources, room 3572, 610-359-5094. TTY for the hearing impaired: 610-359-5020.
The College is accredited by the Middle States Association of Colleges and Schools, Commission on Higher Education, 3624 Market St., Philadelphia, PA 19104.
The Respiratory Therapy program is accredited by the Commission on Accreditation for Respiratory Care (CoARC), 1248 Harwood Rd., Bedford, Texas, 76021-4244, 817-283-2835, www.CoARC.com.
Page 7
Respiratory Therapy Associate Degree Curriculum
First Year First Year First Year
First Year (fall) CreditsCreditsCreditsCredits Second YearSecond YearSecond YearSecond Year (fall) CreditsCreditsCreditsCredits
RTH 100 Respiratory Therapy 4 RTH 200 Respiratory Therapy 3 Principles I Principles III
RTH 101 Respiratory Therapy 4 RTH 201 Respiratory Therapy 6 Practicum I Practicum III
BIO 150 Human Anatomy & 4 RTH 204 Clinical Rounds I 2 Physiology I
ENG 112 English Composition II 3 AHM 220 Applied Microbiology 1
Total: 15Total: 15Total: 15 Total: 15 Total: 12Total: 12Total: 12Total: 12
First Year First Year First Year
First Year (spri(spri(spring)(spring)ng) ng) Second Year Second Year Second Year Second Year (spring)(spring)(spring)(spring)
RTH 102 Respiratory Therapy 2 RTH 202 Respiratory Therapy 3 Principles II Principles IV
RTH 103 Respiratory Therapy 6 RTH 203 Respiratory Therapy 6 Practicum II Clinical Practicum IV
BIO 151 Human Anatomy & 4 RTH 205 Clinical Rounds II 2 Physiology II
PSY 140 General Psychology 3 _______ Humanities Elective 3
Total:Total:Total:Total: 151515 15 Total: 14Total: 14Total: 14Total: 14
Firs Firs Firs
First Yeart Yeart Yeart Year (summer I) Second YearSecond YearSecond YearSecond Year (summer I)
RTH 104 Respiratory Therapy 5 RTH 206 Summer Clinical III 4 Summer Clinical I
First Year First Year First Year
First Year (summer II)
RTH 105 Respiratory Therapy 5 Summer Clinical II
Total HoursTotal HoursTotal HoursTotal Hours (including pre-requisites): 80 808080
RESPIRATORY THERAPY CLASSES/CLINICAL SCHEDULE
RESPIRATORY
THERAPY
COURSES
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
(Fall)
RTH 100, 101
RTH 101
1:25 - 4:35 p.m.
RTH 100
1:25 - 3:35 p.m.
RTH 101
1:25 - 4:35p.m.
RTH 100
1:25 - 3:35 p.m.
RTH 101
1:25 - 4:35 p.m.
(Spring)
RTH 102, 103
RTH 103
1:25 - 4:35 p.m.
RTH103
1:25 - 4:35 p.m.
RTH 102
1:25 - 3:35 p.m.
RTH 103
1:25 - 4:35 p.m.
RTH 103
1:25 - 4:35 p.m.
(Summer I & II)
RTH 104 & 105
Clinical I & II
6:45 a.m. – 11:15 p.m.
(1
stor 2
ndshift)
6:45 a.m. – 11:15 p.m.
(1
stor 2
ndshift)
6:45 a.m. - 11:15 p.m.
(1
stor 2
ndshift)
6:45 a.m. - 11:15 p.m.
(1
stor 2
ndshift)
(Fall)
RTH 200, 201, 204
RTH 201
8:00 - 12:00 a.m.
RTH 204
7:30 – 11:30 p.m.
RTH 200
8:00 - 11:00 a.m.
RTH 201
6:45 – 3:15 p.m.
(Spring)
RTH 202, 203, 205
RTH 203
6:45 a.m. - 3:15 p.m.
RTH 205
7:30 - 11:30 a.m.
RTH 203
6:45 - 3:15 p.m.
RTH 202
8:00 - 11:00 a.m.
(Summer I)
RTH 206
Clinical III
6:45 a.m. – 11:15p.m.
(1
stor 2
ndshift)
6:45 a.m. - 11:15 p.m.
(1
stor 2
ndshift)
6:45 a.m. - 11:15 p.m.
(1
stor 2
ndshift)
6:45 a.m. - 11:15 p.m.
(1
stor 2
ndshift)
Student ID # (or Social Security Number)
__________- _______-_________
Legal Name:
______________________________________________________________________
Last First Middle
Maiden Name:
____________________________________________________________________
Last
Legal Address:
____________________________________________________________________
Street Address
____________________________________________________________________
City State ZIP
Home Phone:
________________________
Work Phone:
_____________________________
Email:
______________________________________________________________________
Check one: ______ High School Graduate*
_______ GED Certification*
* Official, final High School Transcript or GED results MUST be on file in the Records Office.
College(s) from which transcripts are being sent**:
___________________________________
___________________________________
** Please contact the Assessment Center (Room 2195, Marple Campus, 610-359-5322) and ask for a
“Petition for Transfer of Credit” form. This must be done in order to have your transcripts evaluated.
I chose to qualify by this option (check one only) : __________ Credit Option
__________ Testing Option – if so, please indicate:
______SAT (OR) _____ACT
I have been a resident of the Commonwealth of PA for the past 2 years or longer: ___YES ___NO*
*If you answered “no” to the previous question, you must also submit the results of a Federal criminal history check.
___________________________________________
________________________
Signature Date