Echocardiography Application Form

ECHOCARDIOGRAPHY APPLICATION

(CARDIAC SONOGRAPHY)
Name *

First Name Last Name
Date *

Month Day Year
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Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone *

Area Code Phone Number
Business/Mobile Phone

Area Code Phone Number
Email *
example@example.com

APPLICATION REQUIREMENTS
Completion of the Echocardiography (Cardiac Sonography) application requirements listed below does not guarantee selection into the class.
- Complete the Hill College general admission application.
- Complete the Hill College Echocardiography Program application.
- Texas State Initiative (TSI) requirement needs to be complete or in progress at by the posted deadline date.
- Copy of High School transcript or GED (no exceptions).
- TOEFL scores if applicable. See TOEFL procedure.
- HESI test - Math 55%; Reading 65%; Composite 60%
- Echocardiography Questionnaire
- Complete or in-progress of the required pre-requistes with a "C" or better
  - BIOL 2401
  - BIOL 2402
  - PSYC 2301
  - HITT 1305
  - MATH 1314
- Current Valid American Heart Assocation CPR BLS Provider card. Copy of the front and back of the card.
- Submit documentation of injection or positive serological titer of:
  - 2 MMR's;
  - 2 Varicellas;
  - 3 Hepatitis B's;
  - 1 Tdap as an adult within 7 years of program entry or 1 Tdap as an adult and 1 Tetanus within 7 years of program entry.
  - Current seasonal Influenza (FLU) (current flu strains to coincide with the practicum/clincal rotations)
NOTE: Once selected for the Echocardiography program I will be required to submit a negative 2 step TB results and a Health Screening (must be on the Health Science form) and a negative drug test.
I understand that failure to submit the above documents could prevent me from being considered for the Echocardiography (Cardiac Sonography) class I am applying for.

NOTE: Once selected for the Echocardiography (Cardiac Sonography) program I will be required to submit a negative 2 step TB results and a Health Screening (must be on the Health Science form) and a negative drug test.
*

HIGH SCHOOL or HIGH SCHOOL EQUIVALENCY

MANDATORY ALL APPLICANTS
High School Graduates or High School Eqivalency scores

(mandary for ALL applicants).

1. Official High School Transcript with at least 2 years and a date of graduation or acceptable General High School Proficiency (GED) scores.

OR

2. Out of Country High School Transcript. Must be translated into English by a certified translator. The original document must be also be submitted.
I have met the High School requirement #1 and will submit my official transcripts. *
I have met the Out of Country High School #2 and will submit the transcripts/documents. *

TOEFL PROCEDURE
Applicants must demonstrate English Porficiency as an admission requirement by showing:

1. 2 years of High School in the United States and its territories or General Equivalency scores (GED).

OR

2. Submission of acceptable scores from the Test of English as a Foreign Language Test (TOEFL) within two years of the posted deadline date of program application.

TOEFL minimum passing:

Internet score of 80

Computer- based TOEFL score of 250

Paper/pencil score of 600

NOTE: Scores will not be considered if they are more than 2 years old. TOEFL test scores repot must be sent directly to the Health Science Department from the testing center.

Information about the TOEFL may be obtained from the websie www.ets.org/toefl or by calling 1-800-468-6335.
I meet the High School or Equivalency requirement #1 and will submit my transript.
*
I meet the TOEFL requirement #2 and will submit my current passing scores before the posted deadline date.
*

TOEFL WAIVER
The applicant can request a TOEFL waiver from from the Health Science department if they meet the following criteria:
- Completion of the following courses with a "C" or better from an accredited US college/univeristy.
  - 4 different college level English courses.
  - 1 college level communication course.
If I meet the TOEFL waiver requirements it will be my responsibility to follow up with the Health Science department to complete this requirement.
*

Medical Experience

Optional
To recieve points for this option you must submit copies of your certification(s) 1/2 point or letter from current/former employer on company letterhead with official signature 1 point. The letter needs to show current title, how long you have worked for the company and
List all health related licenses/certificates or other health related credentials you currently hold
List all health related programs/date of completion/graduation:

*
COLLEGE TRANSCRIPTS
I understand that I will be responsible for the submission and verification that Hill College and/or the Health Science department has recieved my transcripts from all colleges I have attended.

It is in the students best interest to review their college transcripts with either a Hill College advisor or a Health Science staff member to ensure that the applicant meets the course work requirements.

If Hill College is the only college you have attended the Health Science department can retrieve a student copy of your transcript.
*

CRIMINAL BACKGROUND DISCLOSURE
As part of the Hill College Health Scieince applicaiton process, I must disclose any/all eligibility issues related to any criminal offense including those pending appeal (excluding Class C Misdemeanor trafic violations). Failure to disclose any eligibility issue(s) could result in declination of my Hill College Health Science program enrollment. I further understand the Hill College district prohibits the unlawful manufacture, possession, use or distribution of illicit drugs and alcohol by employes/student on its property or as part of any of its activities. any student who violates standards of conduct for illicit drugs, unlawful possession or use of alcohol is subject to disciplinary action including, but not limited to, dismissal from the program.
*
Have you ever been arrested and/or charged with a crime? *
Have you ever been convicted of a felony? *
Do you have any pending criminal charges? *

Criminal History

PROCEDURE
Applicant must have a clear criminal background. Complete the background with www.verifiedcredentials.com.

Students will need to create an account and use the following program code – BBKPC 26727. For students in this course who may have a criminal background, please be advised that the background could keep you from being
licensed by the State of Texas. If you have a question about your background and licensure, please speak with your faculty member or the department chair.

You also have the right to request a criminal history evaluation letter from
the applicable licensing agency.

For students in this course who may have a criminal background, please be advised that the background could keep you from being licensed by the State of Texas. If you have a question about your background and licensure, please speak with your faculty member or the department chair. You also have the right to request a criminal history evaluation letter from the applicable licensing agency.
*

HILL COLLEGE ECHOCARDIOGRAPHY (CARDIAC SONOGRAPHY) PROGRAM APPLICATION SUBMISSION

STUDENT AGREEMENT
I understand that I must submit/update a Hill College general admission application. *
I understand that I must submit 2 professional and/or academic references - must be on the approved program specific reference form. *
I understand that I will be required to complete the HESI test sections with minimum passing scores: Math 55%; Reading: 65%; Composite/Overall 60% dated within 1 year of posted deadline date. *
I understand that I will be required to complete a six (6) question Echocardiography questionnaire as part of the application process. *
I understand that it will be my responsibility to follow up with the Health Science department to ensure that all required and supplemental supporting documents have been received by the posted deadline date. APPLICATION FILE CONTENTS WILL NOT BE DISCUSSED OVER THE TELEPHONE. *
I certify that all information and statements contained in this application are true, complete, and correct to the best of my knowledge and belief. I understand that any false statements or omissions made by me in connection with my application may be grounds for rejection of my application. *
Applicant's Name *
By typing your name and clicking on the "submit" button, you've electronically signed this form.
Date *

Month Day Year
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ECHOCARDIOGRAPHY APPLICATION

APPLICATION REQUIREMENTS

HIGH SCHOOL or HIGH SCHOOL EQUIVALENCY

TOEFL PROCEDURE

TOEFL WAIVER

Medical Experience

COLLEGE TRANSCRIPTS

CRIMINAL BACKGROUND DISCLOSURE

Criminal History

HILL COLLEGE ECHOCARDIOGRAPHY (CARDIAC SONOGRAPHY) PROGRAM APPLICATION SUBMISSION