Applications for the Cabrillo College Radiologic Technology (RT) Program will be accepted with postmark dates of May 1, 2016 – July 15, 2016. Applications that are postmarked before or after these dates, or any incomplete applications, will not be considered. Please carefully review the following application instructions.

Review the RT Program Requirements on the Allied Health “How to Apply” website.

RT prerequisites must be completed before submitting an application.

Read the Allied Health application FAQ’s on the Allied Health website.

Transcripts documenting ALL completed college coursework must be submitted with your application:
 o Cabrillo College courses (if applicable): Print two (2) WebAdvisor unofficial transcripts using “My
Course History” showing all Cabrillo courses and submit with your application. o All other colleges/universities attended: Order two (2) sets of sealed, official transcripts from each college/university attended (typically ordered from the Admissions & Records Office). Allow up to 6 weeks to receive your transcripts and expect to pay fees for this service. Submit these official transcripts with your application. Unofficial transcripts, photocopies, or transcripts with opened envelopes will not be accepted.
RT prerequisite courses must be completed before applying and must be reflected on your transcripts.

AP Courses: If you include high school AP courses as part of your application you must submit AP test results/scores. Please consult with an academic counselor for more information on AP courses.

International Transcripts: If you are submitting transcripts for college courses completed outside of the U.S. please follow the instructions for Foreign Transcript Evaluation .

A Cabrillo College Student Identification Number is required on the RT Application Form. This student ID# is a unique 7-digit number assigned to all Cabrillo College students. To retrieve your student ID# log into
WebAdvisor .

If you have never attended Cabrillo College and do not have a student ID# please visit the Cabrillo College
Admissions & Records website to apply for admission to Cabrillo. Allow enough time for this process
(approximately one week) to receive your student ID#.

Complete the current RT Application Form, which is posted on the RT website under “How t o Appl y” .

The RT Application Form is only posted on the website approximately one week before the beginning of the application period (May 1, 2016) and will be removed after July 15, 2016.
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1.
Current RT Application Form with a Cabrillo College Student ID Number included. The application form must be fully complete and signed by the applicant.
2.
Transcripts: o Cabrillo College courses (if applicable): Two (2) copies of WebAdvisor unofficial transcripts printed from “My Course History” showing all Cabrillo courses. o All other colleges/universities attended: Two (2) sets of sealed, official transcripts from each college/university attended.
3.
All application items must be included together in one envelope and mailed by U.S. Postal Service Certified
Mail and Return Receipt to the RT Program.
Incomplete applications or applications submitted outside the application time period (May 1 st – July 15 th
) will not be considered. Applicants that submit incomplete packets may reapply during the next application period.
Application items cannot be returned to the applicant.
Falsification of any part of your application or transcripts will be cause for termination of the application process and/or dismissal from the program.

All application items must be submitted together in the same envelope for the application to be considered complete. A 9”x12” or 10”x13” envelope is recommended to avoid folding any documents.

Applications must be mailed using U.S. Postal Service Certified Mail and Return Receipt. Return

Receipt is the only confirmation you will receive to verify that your application has been delivered to the RT Program. It will also confirm the application postmark date. Retain this receipt for your records.
RT applications must have a postmark date during the application period (May 1 st – July 15 th
).
Applications received with a postmark date outside of the application period will not be processed or returned.

For information on Certified Mail and Return Receipt visit the U.S. Postal Service website under Certified
Mail and Return Receipt

Mail your application packet to:
Cabrillo College
Radiologic Technology Program
Attn: Program Coordinator
6500 Soquel Drive
Aptos, CA 95003
Please Note: Priority Mail, Express Mail, Delivery Confirmation or any other additional or special delivery options are not substitutes for the required Certified Mail and Return Receipt processes.
You may track your application packet sent by Certified Mail and Return Receipt at this link .
If you have any additional questions about the application process, please email the
Radiologic Technology Program at radtech@cabrillo.edu
.
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RADIOLOGIC TECHNOLOGY PROGRAM
APPLICATION FOR ADMISSION - 2016
* All applicants are required to include their Cabrillo College Student Identification Number on their RT Application Form. If you have never attended Cabrillo College and do not have a Student ID #, then please go to the Admissions and Records website to apply for admission to Cabrillo College.
Please save this application to your desktop, type responses, print & sign. Or, handwrite clearly in black or blue ink.
Applicant’s First Name
*Cabrillo College Student ID #
Mailing Address ( Street, City, State, Zip Code)
Email Address
Cellphone #
Middle Initial
Date of Birth
Last Name
Home Phone #
Have you previously applied to the Cabrillo College Radiologic Technology Program?
If yes, please list the date(s) of your previous application(s):
Yes No
Have you previously attended any other Radiologic Technology Program? Yes
If yes, please list the college where you attended and the reason you left the program:
No
Do you have a High School diploma or GED? Yes No
If yes, what year did you receive your High School diploma or GED?
List all colleges and universities you attended (or are currently attending) including Cabrillo College. Transcripts documenting all college and university coursework must be submitted with the RT application. For information on transcript requirements please see the RT Application Instructions .
Name of College/University
Location
(City & State)
Dates Attended
Degree Received
(if applicable)
2016 Cabrillo College Radiologic Technology Program Application for Admission Page
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RADIOLOGIC TECHNOLOGY PROGRAM
APPLICATION FOR ADMISSION - 2016
Cabrillo College Student ID #
First Name Middle Initial Last Name
The RT prerequisite courses must be successfully completed with a grade of “C” or better with the exception of MA 70:
Medical Terminology, which must be completed with a grade of “B” or better. Prerequisite courses must be successfully completed before applying to the program.
Please complete the following information regarding your RT prerequisite courses:
RT Prerequisite Course
Where did you complete this prerequisite?
Course Name & Number
Semester/Quarter
& Year
Completed
Units
Note if
Quarter or
Semester
Final
Grade
Medical Terminology -
MA 70
Human Anatomy -
BIO 4
*Human Physiology -
BIO 5
Introduction to Physics -
PHYS 10
General Psychology -
PSYCH 1/1H
College Composition -
ENGL 1A/1AH/1AMC/1AMCH
* BIO 5 Prerequisite: A college chemistry course such as CHEM 3/3L, CHEM 30A or CHEM 32 is the prerequisite for BIO 5. Intermediate
Algebra (Math 152) is a prerequisite to CHEM 3, CHEM 30A or CHEM 32.
The A.S. degree requires completion of a 21-unit general education pattern. See the Cabrillo College Catalog under A.S. degree or the A.S. degree worksheets available on the Counseling Division or Transfer and Articulation websites.
The A.S. degree G.E. requirements do not have to be completed prior to applying to the Radiologic Technology Program.
However, it is highly recommended that G.E. requirements be completed prior to starting the RT Program, due to the rigor of the core RT coursework.
A B.A./B.S. degree from a regionally accredited college or university will satisfy all general education and competency requirements for Cabrillo's non-transfer A.A. and A.S. degrees, with the exception of the Multicultural Requirement and program specific graduation requirements.
2016 Cabrillo College Radiologic Technology Program Application for Admission Page
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RADIOLOGIC TECHNOLOGY PROGRAM
APPLICATION FOR ADMISSION - 2016
Cabrillo College Student ID #
First Name Middle Initial Last Name
Please complete the following information regarding your G.E. courses:
G.E. Requirement
Cabrillo College
Course Name & Number
Where did you complete this requirement?
Course Name & Number
Area A1:
English Language
Area A2:
Communication and
Critical Thinking
Area B:
Scientific Inquiry
Area C:
Arts & Humanities
Area D:
Social Sciences
English 1A/1AH/#1AMC/#1AMCH
Any Area A2 course
(see Cabrillo Catalog )
Physics 10 satisfies
Any Area C course
(see Cabrillo Catalog )
1) History: 14, 14H, 15, 17A, 17AH,
17B, 17BH, #21A, #21AH, #21B,
#21BH, #29A, #29B; Political
Science: 1, 1H, 5
2) Psychology 1/1H satisfies
Units
Note if
Quarter or
Semester
Final
Grade
Area E:
Lifelong Learning &
Self-Development
Any Area E course
(see Cabrillo Catalog )
Multicultural
Requirement
Choose one Cabrillo College course marked with a #. This area may be double counted.
Mathematics
Competency
Requirement
May be met by successful completion of Intermediate Algebra
(MATH 142 or 152), or equivalent, or a higher-level math course with a grade of "C" or better.
Please note that falsification of any part of this application will render the application null and void or may be grounds for program dismissal.
I certify, by my signature below, that the information included in this application is true and correct to the best of my knowledge.
Applicant’s Signature Date
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RADIOLOGIC TECHNOLOGY PROGRAM
APPLICATION FOR ADMISSION - 2016
Cabrillo College Student ID #
First Name Middle Initial Last Name
Radiologic Technology Program
In accordance with the Americans with Disabilities Act (ADA) Public Law 101-336, the Cabrillo College Radiologic
Technology Program makes every effort to make reasonable accommodation to any qualified individual with disability. The program will not discriminate against any individual because of age, gender, ethnic background, sexual orientation, political affiliation, or disability.
POSITION SUMMARY: The Radiologic Technology student learns how to accurately demonstrate body structures by determining proper exposure factors, manipulating medical imaging equipment, evaluating the radiographic image quality; and providing for patient protection, safety, and comfort during radiographic procedures. The Radiologic Technology student also assists the physician team member in specialized procedures which often require the administration of contrast media for the purpose of dynamic viewing of the anatomy and physiology of human body systems.
ESSENTIAL STANDARDS AND/OR FUNCTIONS FOR
RADIOLOGIC TECHNOLOGY STUDENTS
In order to ensure student and patient safety and welfare, the Radiologic Technology student must be able to:
PHYSICAL DEMANDS
1.
Stand and/or walk in an erect posture for up to 8 hours per day.
2.
Lift a minimum of 35 pounds from floor level to waist level, and lift a minimum of 10 pounds from waist level to shoulder level.
3.
Carry a minimum of 20 pounds directly on the arms or hands while walking a distance of 100 feet.
4.
Bend or flex the upper trunk forward up to 45 degrees, and flex the lower torso into a squatting position.
5.
Rotate the upper trunk up to 30 degrees to the right or the left from a neutral position while standing or sitting.
6.
Reach a maximum of 72" above floor level and/or a full arm's reach.
7.
Push and/or pull objects and equipment weighing up to 250 pounds.
8.
Manipulate radiographic and medical equipment and accessories utilizing fingering and/or reaching, pulling, extending.
NON-PHYSICAL DEMANDS
1.
Respond quickly and appropriately to emergency situations using the English language.
2.
Communicate with patients and staff at all times using the English language.
3.
Exhibit good listening skills.
4.
Tolerate strong, unpleasant odors sight of blood and traumatic injury.
5.
Handle stressful situations related to technical and procedural standards and patient care situations.
6.
Concentrate on fine-detailed items and follow predetermined protocol, both written and verbal.
7.
Provide physical and emotional support with compassion and empathy to patients during radiographic procedures.
2016 Cabrillo College Radiologic Technology Program Application for Admission Page
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RADIOLOGIC TECHNOLOGY PROGRAM
APPLICATION FOR ADMISSION - 2016
Cabrillo College Student ID #
First Name Middle Initial Last Name
Radiologic Technology Program
SPECIFIC PHYSICAL NEEDS
The Radiologic Technology student must possess the following capabilities:
1.
Self-mobility with the capability of propelling wheelchairs, gurneys, and portable x-ray equipment, alone or with assistance as available. The student must be ambulatory and able to maintain a center of gravity when met with opposing forces when lifting, supporting, and transporting a patient. The student must be able to transport patients within the department and in the clinical education center at large.
2.
Visual acuity that allows the student to:
A.
Distinguish whether the x-ray beam is perpendicular, horizontal, or angled through the anatomical structures that are being examined.
B.
Perform the required radiography procedures that involve the preparation of contrast agents for administration to the patient, such as syringes or IV bottles.
C.
Determine the correct dosage of contrast agents according to product labels.
D.
Identify the correct patient by reading patient identification armbands and/or charts.
E.
Correctly set the x-ray generator controls to obtain optimum diagnostic quality radiographs.
F.
Perform entry data tasks using digital and computer terminals.
G.
View and evaluate the recorded images for the purpose of identifying proper patient identification, positioning, radiographic technique, and radiographic quality.
3.
Hearing acutely and/or lip reading that is sufficient to communicate with the patients and the health care team. The student must be able to hear and respond to patient questions and directions from department and hospital staff.
4.
Manual dexterity that allows the student to grasp and manipulate small objects required to perform radiographic procedures and operate radiographic equipment such as locks, beam limiting devices, radiation protection devices, vials, syringes, intravenous systems, catheters, dressings, and sterile trays. The student must also be able to properly handle and process radiographic images using automatic processors and digital readers.
5.
Orally communicate in a voice that is clear and loud enough to be understood by a person in the radiology department, in surgery, in the clinical education at large, or on the telephone.
My signature below indicates that I read and understand each physical and non-physical standard described above in the
Radiologic Technology Program Essential Standards: Physical and Non-Physical Standards. I also understand that before clinical placement all students will be required to obtain a Healthcare Provider’s Authorization documenting the student’s ability to meet the above Essential Standards.
Applicant’s Signature Date
2016 Cabrillo College Radiologic Technology Program Application for Admission Page
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