RADIOGRAPHY PROGRAM APPLICATION

Transcription

1 RADIOGRAPHY PROGRAM APPLICATION Please type or print clearly. Name Last First Middle Address Number & Street Town State Zip Telephone Number Cell Phone Number 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 address below. Professional Reference Personal Reference Name Name Address Address City State & Zip City State & Zip 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: Revised 1/13 Signature Radiography Program Elizabeth Price, Director 601 Pemberton Browns Mills Road Pemberton, New Jersey 08068

2 RADIOGRAPHY PROGRAM RECOMMENDATION FORM APPLICANT S NAME TO THE RECOMMENDER: The above named applicant has applied to our Radiography Program. The mission of the Program is to provide 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. Student must demonstrate good judgment and problem solving abilities. They must be physically capable of the lifting, standing, walking for most of an 8 hour clinical 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 giving us as complete a profile of the applicant as possible. How long have you known the applicant and in what capacity? What do you consider to be this applicant s major strengths? What do you consider to be this applicant s major weakness? Please comment on why you think this applicant will be suitable for the BCC Radiography Program.

3 Please rate the applicant in the following areas: Above Average Average Below Aver. 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 and additional sheet. Please return completed recommendation form to: Director of Radiologic Sciences 601 Pemberton Browns Mill Road Pemberton, NJ Reviewed -1/11

4 RADIOGRAPHY PROGRAM RECOMMENDATION FORM APPLICANT S NAME TO THE RECOMMENDER: The above named applicant has applied to our Radiography Program. The mission of the Program is to provide 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. Student must demonstrate good judgment and problem solving abilities. They must be physically capable of the lifting, standing, walking for most of an 8 hour clinical 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 giving us as complete a profile of the applicant as possible. How long have you known the applicant and in what capacity? What do you consider to be this applicant s major strengths? What do you consider to be this applicant s major weakness? Please comment on why you think this applicant will be suitable for the BCC Radiography Program.

5 Please rate the applicant in the following areas: Above Average Average Below Aver. 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 and additional sheet. Please return completed recommendation form to: Director of Radiologic Sciences 601 Pemberton Browns Mill Road Pemberton, NJ Reviewed -1/11