RADIOGRAPHY PROGRAM APPLICATION

Transcription

1 RADIOGRAPHY PROGRAM APPLICATION Please type or print clearly Name Last First Middle Address Number and Street Town State Zip Code Telephone Number Cell Phone Number Address Other name(s) used High School Attended Address Date Entered Date Left Diploma Yes No If you did not graduate from High School, have you obtained a GED? Yes No College or other post-secondary schools attended. (List others on back if necessary) Name Address List two persons (other than relatives) for references. One must be of a professional or business association. Have references supply a completed recommendation form to the address below. Professional Reference Personal Reference Name Name Address Address City City State & Zip Code State & Zip Code Attach a separate sheet stating your purpose in choosing Radiography as a career. I certify that the above information is correct. Date Return this completed document and application to: Signature

2 RADIOGRAPHY PROGRAM RECOMMENDATION FORM APPLICANT S NAMES TO THE RECOMMENDER: The above named applicant has applied to our Radiography Program. The mission of the Program is to prove the education and clinical experience necessary for individuals to become competent and compassionate radiographers. These health care professionals follow prescriptions to diagnose diseases. It is important that radiographers have a warm and compassionate personality, as well as having the ability to interact with patients, other health care practitioners, families, and visitors. The student must demonstrate good judgement and problem solving abilities. They must be physically capable of lifting, standing, walking for most of an eight hour day. The course work is challenging and demanding. Your cooperation in completing and returning this form will assist both the applicant and the Program by providing us the most complete profile as possible. How long have you known the applicant and in what capacity? What would you consider the applicant s major strengths? What would you consider the applicant s major weaknesses?

3 Please comment on why you think this applicant will be suitable for the RCBC Radiography Program. Please rate the applicant in the following areas: Above Below Unknown Academic Potential Ability to solve problems Ability to work with people Maturity Judgement Motivation Creativity Ability to accept constructive criticism Ability to express ideas in writing Ability to express ideas orally Reliability (not tardy or absent) Date Your Name Position Address Thank you for your cooperation. If the space allowed is inadequate, please feel free to insert an additional sheet. Please return the completed recommendation form to:

4 RADIOGRAPHY PROGRAM RECOMMENDATION FORM APPLICANT S NAMES TO THE RECOMMENDER: The above named applicant has applied to our Radiography Program. The mission of the Program is to prove the education and clinical experience necessary for individuals to become competent and compassionate radiographers. These health care professionals follow prescriptions to diagnose diseases. It is important that radiographers have a warm and compassionate personality, as well as having the ability to interact with patients, other health care practitioners, families, and visitors. The student must demonstrate good judgement and problem solving abilities. They must be physically capable of lifting, standing, walking for most of an eight hour day. The course work is challenging and demanding. Your cooperation in completing and returning this form will assist both the applicant and the Program by providing us the most complete profile as possible. How long have you known the applicant and in what capacity? What would you consider the applicant s major strengths? What would you consider the applicant s major weaknesses?

5 Please comment on why you think this applicant will be suitable for the RCBC Radiography Program. Please rate the applicant in the following areas: Above Below Unknown Academic Potential Ability to solve problems Ability to work with people Maturity Judgement Motivation Creativity Ability to accept constructive criticism Ability to express ideas in writing Ability to express ideas orally Reliability (not tardy or absent) Date Your Name Position Address Thank you for your cooperation. If the space allowed is inadequate, please feel free to insert an additional sheet. Please return the completed recommendation form to: rev 8/16 PJJ