Hill College
Health and Community Services
Echocardiography Technician
Spring 2016 Application Packet
 Application Paperwork Deadline - November 1, 2015.
 HESI A2 testing deadline Noon October 30, 2015
Submission of this application does not guarantee
admission/selection in the Echocardiography Technician or
Diagnostic Medical Sonography program.
Hill College
Health and Community Services

Prospective students must contact the Health and Community Services Department to make appointment to
submit the Health and Community Services Echocardiography Technician application documents. Email:
jbritton@hillcollege.edu to schedule a time and day to pick up and/or submit documents.

The Echocardiography Technician application packet will be available in the following locations:
 Health and Community Services building – Cleburne
 Student Success and Advising - Hillsboro, Cleburne and Burleson

After submission of the Echocardiography application documents the candidate will be given the referral
form for the HESI A2. The candidate must have the completed referral form at the time of their scheduled
HESI A2. Testing Center contact information: Hillsboro 254-659-7815 or Cleburne 817-760-5815
 **TESTING NOTES**:
o **During Summer 2015 Semester – The Hill College Testing Center will be
closed on Fridays. May 15 – August 7th.
o ** The absolute last testing session for the HESI, for this testing block, will be
noon October 31, 2015.
o **You may only take the HESI test 2 (two) times in an application block.


Incomplete application files will be evaluated but will be placed at a lower priority for selection than those
candidates whose files are complete by the posted deadline date.
Documents and/or files will be purged after 1 year excluding the following:
o Course evaluations
o Course waivers
o Transcripts
 Candidates who are enrolled in one or more of the pre-requisite courses
and/or incomplete files will be considered for acceptance at a lower priority
than candidates who have completed the application process as well as
completed the pre-requisites with a “C” or better by the admission deadline
date. It is the policy of Hill College, for any course re-taken, the most
recent grade will stand.
Submission of this application packet does not guarantee
admission/selection in the Echocardiography Technician program.
HILL COLLEGE
Sonography/Echocardiography
Application/Information Sheet
Associate of Applied Science
Please note that these programs are approved by the Texas Higher Education Coordinating Board and Hill College is accredited by the
Southern Association of Colleges and Schools.
INFORMATION SHEET
Echocardiography
Full Legal Name: ________________________________________________ Maiden Name:____________________
Any other names you have been known by: _____________________________________________________________
Mailing Address: _______________________________________City:___________________Zip_________________
Email address: ____________________________________________________________________________________
Telephone Number(s) Home _____________________________________Other_______________________________
Hill College Student ID ____________________________________
Please list any other states you have lived in: ____________________________________________________________
________________________________________________________________________________________________
List below any licenses/certifications or health - related credentials you currently hold. __________________________
________________________________________________________________________________________________
All college level courses below must have a grade of “C” or better. NOTE: Hill College will only accept the
most current grade for any college courses listed above.
College attended
Year
*Grade
BIOL 2401 A&P I _____________________________________________\_____________\________
BIOL 2402 A&P II _____________________________________________\_____________\________
(if science course is over 5 years old contact Health and Community Services Department)
Math 1314 ___________________________________________________\_____________\_________
PSYC 2301___________________________________________________\_____________\_________
ENGL 1301___________________________________________________\_____________\_________
HITT 1305 ___________________________________________________\_____________\_________
Art/Humanities ________________________________________________\_____________\_________
Signature: ___________________________________________
Date: _____________________
***Students need to realize that all Health and Community Services programs require intensive clinical time other
than class and these clinical sites may require extensive travel and other requirements. All candidates selected for
admission into Health and Community Services programs will be required to complete a physical and present proof of
updated immunizations including Hep B.***
Hill College
Health and Community Services
Drug testing/Criminal Conviction
I,
acknowledge that I will be required
to have a criminal background check and a drug test completed before I can register for any Hill College
Health and Community Services programs.
The Diagnostic Medical Sonography Program (Echocardiography) programs are two-year programs. All
prospective students are required to meet the admission criteria. In addition, all applicants should be free of
illegal drug use, have no felony convictions, and be clear of any misdemeanor convictions other than minor
traffic violations.
I acknowledge that all Hill College Health and Community Services programs require a “C” or better on all
required degree plan courses.
I acknowledge that clinical facilities have the right to refuse any student to attend clinical rotations at their
facility for any eligibility issue. If this occurs, the student will not be able to continue in any Hill College
Health and Community Services program.
I acknowledge that failure to disclose a potential eligibility issue not found by the Hill College Health and
Community Services Department will be considered unethical behavior and will constitute dismissal from
the program with cause.
I further acknowledge that if my drug test comes back positive I will not be allowed to register for any Hill
College Health and Community Services program. I further acknowledge that at any point within the year I
may be required to do further drug testing and/or background checks if the program director in consultation
with the instructor(s) feel there is sufficient evidence to warrant further investigation.
By my signature below I acknowledge that I have received a copy of this letter and understand what is
required for entry into the Diagnostic Medical Sonography (Echocardiography) programs.
___________________________________________
Candidate Signature
____________________
Date
Health and Community Services
(Vocational Nursing, ADN, ADN Transition, Emergency Medical Technician, Diagnostic Medical Sonography,
Echocardiography Technician)
Student Information Data Sheet
Please print the following information:
Last Name: _____________________________
Middle Name
First Name: _____________________________
Maiden Name ____________________Suffix (Jr. III) __________
Please list other names you have been known by:
_______________________________________________________________________________________
Date of Birth: _________________Texas Driver’s License #:__________________State Issued: ________
Height:
Weight:
Gender: __________
Ethnic Group (Circle all that apply):
1. White 2. African American
Other
3. American Native/Aleutian 4. Asian/Filipino 5. Hispanic
6.
Natural Color of Hair: _____________________________Color of Eyes: __________________________
Place of Birth: ______________________
Knowledge Verification
I,
, acknowledge that I have been informed of the
accreditation, registry, and clinical components of the Diagnostic Medical Sonography (Echocardiography)
Program at Hill College by initialing each topic below.
Hill College is accredited by the Commission on Colleges of the Southern Association of Colleges
and Schools to award associate degrees.
Contact:
Commission on Colleges at
1866 Southern Lane
Decatur, Georgia 30033-4097
or call 404-679-4500 for questions about the accreditation of Hill College.
Graduates of the Diagnostic Ultrasound program are encouraged to take the ultrasound
Credentialing examinations offered by the American Registry of Radiological Technologist
ARRT) and the American Registry of Diagnostic Medical Sonographers (ARDMS).
Graduates of the Echocardiography Technician Program are encouraged to take the
Cardiovascular Credentialing International (CCI) credentialing examination. These exams are
voluntary but obtaining these credentials does enhance employment opportunities. Graduates are
eligible to apply for the examinations offered by Cardiovascular Credentialing International (CCI) or
American Registry of Radiological Technologist (ARRT) upon graduation, and to apply for the
Registered Diagnostic Medical Sonographers (RDMS) exam offered by ARDMS after acquiring the
necessary experience after graduation as defined by the ARDMS.
Registration and certification requirements for taking and passing these examinations are not
controlled by Hill College but by outside agencies and are subject to change by the agency without
notice. Therefore, Hill College cannot guarantee that graduates will be eligible to take these exams,
at all or at any specific time, regardless of their eligibility status upon enrollment.
All Diagnostic Medical Sonography (Echocardiography) students are required to attend a
total of 1056 hours of clinical to meet the clinical hour component of the Diagnostic Medical
Sonography (Echocardiography) program. Students will also have to demonstrate proficiency in the
objectives of the clinical course to successfully complete the clinical component (see syllabi for
clinical objectives. Students understand that clinical time is separate from class times, and clinical
will require travel in varying distances (could be up to 100 miles one way). Students will be
responsible for arranging and financing of any travel involved. Students understand that clinical
assignments are not promised to be close to their residence.
I acknowledge that all Hill College Health and Community Services programs require a “C” or
better on all required degree plan courses.
I acknowledge that I have received a copy of this Knowledge Verification form.
___________________________________________
_____________________
Candidate Signature
Date
Hill College
Health and Community Services
Essential Clinical Performance Standards
The Hill College Health and Community Services Department has developed the following essential performance
standards which Hill College Health and Community Services students are expected to possess and demonstrate.
These standards are based upon required abilities that are compatible with effective performance in health careers
and are intended to help potential students make career decisions. Health and Community Services students unable
to meet the essential performance standards are responsible for discussing the possibility of reasonable
accommodations with the program coordinator before starting clinical and providing medical and other
documentation related to any disability and the appropriate accommodations needed to meet the standards.
Reasonable accommodation for students with disability-related needs will be determined on an individual basis,
taking into consideration the standards and essential skills which must be performed to meet program objectives as
well as personal and client dignity and safety. The Health and Community Services Department Student:
1. Has visual acuity with corrective lenses to:
a. accurately read small print on medication containers, syringes, discriminate color changes, read type at 8
font, and hand-writing on college ruled paper
b. see objects up to 20 inches away
c. accurately read monitors and equipment calibrations
d. identify call lights and unusual occurrences on a unit at a distance of 100 feet.
2. Has sufficient auditory perception with corrective devices to:
a. hear monitor alarms, emergency signals, client’s call bells, pagers, and telephone conversation
b. hear client’s heart sounds, bowel sounds, and lung sounds with a stethoscope
c. receive and understand verbal communication from others
d. distinguish sounds with background noise ranging from conversation levels to high pitched sounding alarms.
3. Has the physical ability and stamina to:
a. perform client care for an entire length of clinical experience, 8-12 hours.
b. stand for prolonged periods of time, 8-12 hours.
c. transfer/position/lift up to 150 lbs with assistance
d. lift and carry objects (up to 150 lbs) with assistance
e. push/pull equipment requiring force on linoleum and carpeted floor
f. stoop, bend, squat, reach overhead while maintaining balance as required to reach equipment, supplies, and
perform client care, including cardiopulmonary resuscitation (CPR)
g. manipulate equipment through doorways and into close fitting areas.
4. Has the manual dexterity including sufficient gross motor and fine motor coordination to:
a. pick up, grasp, and manipulate small objects with control
b. perform electronic documentation and keyboarding.
5. Must complete 1056 clinical clock hours before program completion.
6. Student must be able to travel up to 100 miles to satisfy clinical rotation requirements.
______________________________ ______________
Candidate signature
___________________________
Date
Health and Community Services
Academic Reference Form
To be completed by applicant
You must submit 2 academic references by the posted deadline date of the program you are seeking entry. All
references must be received by mail from the academic reference.
Note: Personal references or references received in any other format will not be accepted. Applicants MAY
NOT hand deliver the references.
Applicant Information:
_________________________________________________________________________________
Name
________________________________________
________________ ______
________
Address
City
State
Zip
_________________________________________ ___________________________________
Phone
Email
In compliance with the Family Education Rights and Privacy Act of 1974, effective November 21, 1974, this recommendation
form, which will be placed in the applicant’s admission file, may be reviewed by the applicant upon written request unless this
waiver is signed.
Do you waive the right to be shown information on this form, which is to be used for admission purposes only.
_____ Yes ______ No
_____________________________________
NAME OF APPLICANT (print)
_______________________________
SIGNATURE OF APPLICANT
_________________________
DATE
To be completed by Academic Reference:
The Hill College Health and Community Services programs are academic/clinical intensive programs.
Students are expected to learn from both traditional and field based academic/clinical methods and to
synthesize these approaches. Hill College Health and Community Services ask for references from a
professors or academic advisor at the college or university level. To succeed, the applicant must have a high
degree of academic and personal motivation and the ability to adjust to people of different social and
cultural backgrounds. We cannot overemphasize, therefore, the value of your candid appraisal in enabling
us to determine whether the applicant is appropriate for this kind of program and, if so to help him or her
obtain the most from the experience.
Academic Reference mail the completed 2 page reference form to the following address:
Hill College
Health and Community Services
2112 Mayfield Parkway
Cleburne TX 76033
Reference Form (continued) page 2
Print Applicant Name:
In comparison to other students you have known, please rate applicant on the following characteristics:
Excellent
Good
Average
Poor
Unknown
Good communication skills –Verbal
Good communication skills - Writing
Is punctual and regular in attendance/deadline
Learns news procedures or skills quickly
Accepts suggestions and criticism gracefully
Asks for supervision or guidance when needed
Ability to work with a group of peers
Ability to work independently
Exhibits common sense and good judgment
Maintains profession appearance
Was this student an online student? _________Yes _______No
How long and in what capacity have you known this student?________________________________________
Please choose one of the following:
_____ Recommended for Admission
_____ Not Recommended
_____ Prefer not to make a recommendation
_____ Phone me
Please choose one of the following:
____I am well acquainted with the applicant
____I am moderately acquainted with the applicant
____I do not know the applicant
Reference contact information. * required information
*Name: ___________________________________________________Occupation/Title__________________
Address_______________________________City __________________State___________ Zip _______
*Phone ___________________________________ Email_________________________________
______________________________________________
Signature of Academic Reference
______________________________
Date
Hill College Student Information
Health and Community Services
and EMS
Hill College has partnered with Verified Credentials to manage your program requirements including the
following:

Background Report
To access Verified Credentials – Student go to:
http://scholar.verifiedcredentials.com/hillcollege
How It Works:
1. Enter code for the program you will be attending located above the “Get Started!” button on the
right side of the page

Health and Community Services and EMS
Program
BBKPC-26727
2.
3.
4.
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Create an account
Enter all required information
Provide supporting documentation
Track your progress
Information will automatically be shared with your school
If you have any questions, our Client Services Team is ready to assist you. Please call us at 800.938.6090 or
email us at ClientServices@verifiedcredentials.com
Important Please Read
Immunization requirements
The Pre-enrollment Health Screening form must be completed and in the prospective students file
before registration.
All prospective students must show proof that they are current and up to date with all required
immunizations A serological (titer) confirmation of immunity for each of the required vaccinations will be
sufficient for enrollment in the Hill College Health and Community Services program of choice.
2 inoculation series MMR’s
2 inoculation series Varicella (chicken pox)
Tdap (Tetanus, Diphtheria, Pertussis [whooping cough]) within adult lifetime
Tetanus (within 10 years)
Seasonal Influenza
Hep B 3 inoculation series
Hepatitis B Series (Hep B #1, then one month later Hep B #2, Hep B #3 [4 – 6 months after the first shot])
must be completed or in progress (with proof of completion of the Hep B #1 and Hep B #2 of the series)at
the time of enrollment in the Hill College Echocardiography Technician Program.
The student must complete the Hepatitis B series prior to direct patient care.
All students must have and maintain a current American Heart Association Health Care Provider BLS CPR
while attending the Hill College Echocardiography Program.