VALENCIA COLLEGE Health Sciences Application B.S. Radiologic and Imaging Sciences and Advanced Technical Certificates (CT, MRI, and Polysomnography) The Radiologic and Imaging Sciences Bachelors Degree is accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT). Valencia College is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools (SACS).
Name (Last):
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PLEASE CHECK APPROPRIATE BOX AND PROVIDE SIGNATURE AND DATE American Registry of Radiologic Technologist (ARRT) or equivalent
Please check appropriate box to indicate which national certification/state licensure you possess in the respective imaging discipline:
American Registry of Diagnostic Medical Sonographers (ARDMS) or equivalent Nuclear Medicine Technology Certification Board (NMTCB) or equivalent
Note: Must attach a copy to this application.
Respiratory Care (NBRC) Respiratory Care Radiography
I possess an Associate in Science Degree from a regionally accredited institution in:
_____ I am interested in the following concentration for the BS Degree: _____ I am interested only in the Advance Technical Certificate in:
Diagnostic Medical Sonography Nuclear Medicine Technology
Computed Tomography (CT) Magnetic Resonance Imaging (MRI)
Radiation Therapy Other:
Quality Management (QM) Polysomnography
I have submitted my application to the Radiologic and Imaging Sciences Bachelor’s Degree to VC:
YES
NO
I have submitted my official transcripts to Valencia and they have been properly evaluated:
YES
NO
I understand that all courses are offered online with the exception of the practicum/clinicals: I understand that prior to beginning the practicum/clinicals I must provide the following: a) Current Criminal Background Check b) Fingerprinting (if requested) c) Drug Testing d) Physical Exam Forms e) Immunization Record:
YES
NO
YES
NO
I have reviewed all admission requirements and expectations in the Valencia Radiologic and Imaging Sciences Bachelor’s Degree/ Advance Technical Certificate Program Guide and the Valencia Allied Health Web site. I understand that it is fraudulent to misrepresent any information on this application and I affirm that all information in this application is true. I understand that, if admitted to this program, I must submit to a criminal background check, fingerprinting (if requested), drug screening, document immunizations and other requirements for clinical participation, and be free of offenses that would disqualify me from the program.
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A non-refundable Health Sciences Program Application fee of $15.00 (check or money order payable to Valencia College) must be submitted to the Business Office with this application.
FOR BUSINESS OFFICE USE ONLY
By Mail: Please mail the application and check/money order together (do not send separately) to: Valencia College, Business Office, PO Box 4913, Orlando, FL 32802 In Person: Please make payment at the West Campus Business Office (Student Services Building (SSB), Room 101 before turning in your application to the Health Sciences Advising Office located at West Campus, Building 1, Room 130. OR: Make payment at any Valencia College Business Office and request that your application and application fee receipt be forwarded to the Health Sciences Advising Office, West Campus, Mail Code: 4-30. DO NOT WRITE BELOW THIS LINE – FOR USE OF OFFICIAL HEALTH SCIENCES ADVISING STAFF ONLY
Date application received at HS Advising Office: Applicant meets requirements?
YES
Control Number:
Entered in Data System by:
NO (Reason):
NOTE: It is highly recommend that interested students meet with the Health Sciences Advisor. Appointments can be scheduled by e-mail at HealthScienceAdvising@valenciacc.edu or by phone at 407-582-1288.
Health Sciences (Form BS1)
(Rev 4-2011)