RESPIRATORY CARE PROGRAM
APPLICATION FOR ADMISSION
In order to be
considered for program selective admission process, please provide the
following information and submit prior to March 1.
Respiratory Care
Program
Name:
_______________________________________________________________________________
(Last) (First) (Middle) (Maiden)
Address:
______________________________________________________________________________
(Street) (City) (State) (Zip Code)
Telephone:
(______)__________________
E-Mail: _______________________________________
High School Attended:
_______________________________________
if GED: ___________________
(Name of School & Date of Graduation) (Date
Taken)
Have you ever been convicted
of or have charges pending against your for a felony or misdemeanor in any
state jurisdiction? No ________ Yes
________ (If yes, explain fully.)
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Do you understand the nature
of the field of Respiratory Care? Yes _________ No __________
Have you ever worked in a
healthcare setting? (if yes, how long and where)
________________________________
Have you ever attended BGTC?
No _______ Yes _______ (Date last attended ____________________)
Have you taken the ACT, SAT, or COMPASS (circle)? No ______ Yes
______ (Year: ______________, Location:
___________________________________, Scores: _________________________________
)
Have you ever attended
another college: Yes ______ No
_______ If "yes", please
answer the following: Name of the college:
_________________________________________________ from ______ to ______
Do you have a degree
_____________ if yes, what type and
major _______________________________
Have you been advised by a
Respiratory Care faculty member ______ (if "NO", you need to
make an appointment for advisement. Call 270/901-1080 [8 am to 3 pm M thru F].
Bring this application and any transcripts with you to the advisement.)
I understand that this
application is for consideration into the Respiratory Care Program, which
begins in the fall semester. I am aware that this is an Associate Degree
Program and completion of all general education and technical component classes
are required in order to graduate. In order to begin the technical component
Anatomy & Physiology and Math 109 or 110 must be completed with a minimum
grade of "C". I also affirm that the information provided by this
application is accurate.
______________________________________________
(Signature) (Date)