William Beaumont Hospital
School of Radiation Therapy
Application Checklist
Part A – Documents
Place items #1-12 in a large envelope and mail to Program Director by March 31 of year planning to enter program.
Forms are located at: https://www.beaumonthospitals.com/allied-health-school-of-radiation-therapy-forms-documents
General application requirements:
Yes
1
Completed Application Checklist sheet (all pages of this sheet)
2
Completed application form (on website)
3
Completed Student Disclosure and Release form (on website)
4
Signed Technical standards form (on website)
5
3 letters of recommendation (forms located in application packet)
Submit each form in an envelope, sealed by recommender with their signature across seal
6
Honor code form (on website)
7
Confidentiality Agreement (on website)
May have been submitted at time of clinical site visit
Current resume
8
9
10
All College / University transcripts-Official copies from college are acceptable if given to
students in sealed envelopes.
Application fee of $40.00 made out to William Beaumont Hospital (non-refundable)
11
Documentation of 100 volunteer hours with direct patient contact. Submit timesheet with
supervisor’s signature and hours tallied.
12
Permanent US resident status. If not born in the U.S.A., please include documentation of
permanent residency status (Greencard) from the Unites States Citizenship & Immigration
Services and / or documentation
The following should be completed prior to March 31 of year wishing to enter program:
13
Documented clinical site visit at Beaumont - Royal Oak
Call 248.551.7156 Laura Ochs or lochs@beaumont.edu to schedule visit
Documented clinical site visit at Beaumont – Troy
Call 248.964.5132 Shruti Patel or Shruti.Patel@beaumonthospitals.com to schedule visit
14
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Date attended:
Date attended:
No
Part B- Grades
Complete this table and submit it with your application
Oakland University course requirements
or equivalent
Final grade
Earned
College where
course was
completed
Requirement: 2.8 GPA or higher each course
(Lower grades may be petitioned to be reviewed on an individual basis.
Please contact Program Director for further information)
Course ID #
(if taken other than at
Oakland University)
Documentation
provided of
equivalency if
course taken at
other than at
Oakland University
If course still in
progress complete
“Part C- Plan of
Work” section
below
Yes or No
BIO 205
Anatomy
BIO 207
Physiology
BIO 206
Human Anatomy Lab
PHY 101
Physics I
PHY 102
Physics II
PHY 158
Physics Lab
MTH 141
Pre-calculus
MLS 210
Medical Terminology
MLS 450
Medical Law and Ethics
CIS 110
Introduction to Computers
RHT 160
Written Communication
Part C - Plan of Work
Complete this section for any pre-requisite items not completed at time of application and submit this form with application
Course or Activity name
Institution where you’re completing the activity
Expected date of completion
(Example: Pre-calculus, site visit, volunteer hours)
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Updated 3/2011
Application Information
Deadlines: All pre-requisite courses must have been completed within 7 years of the program start date and prior to start date of our 24-month program.
Applications are due by 11:59pm March 31.
Volunteering: Volunteer hours may be accrued through Hospice work, a nursing home setting, adult daycare, or other professional healthcare organizations. A
log sheet which is signed and dated by the volunteer supervisor is required to verify volunteer hours.
Letters of recommendations: Choose individuals who can evaluate your performance in a classroom setting, work setting, care giving capacity. Examples:
college faculty or teaching assistant, work supervisor, volunteer supervisor.
Résumé: Include your community activities, honors, awards, employment, volunteer activities
Transcripts: sealed official copies from college given to student are acceptable. Please assure school seal is across envelop flap. Include with application.
Non-US Citizen applicants must also include: Proof of permanent U.S. Residency at time of application.
Please contact Laura L. Ochs, the Program Director, if you have any questions. All application packets, including all necessary forms, are available at
www.beaumonthospitals.edu/alliedhealth or by contacting the Program Director. Office hours are 7:30 a. m. to 4:00 p.m. Monday through Friday. Requests may be
made by phone, mail, or e-mail. Speak slowly and provide a clear and detailed message of your request. Include your name, address, and daytime phone number.
Mail or drop off the application and supporting documentation in one (1) large sealed envelop to:
Laura L. Ochs, M.Ed.,R.T.(T) Program Director
William Beaumont Hospital
School of Radiation Therapy
Department of Radiation Oncology
3601 W. Thirteen Mile Road
Royal Oak, MI 48073
(248) 551-7156
lochs@beaumont.edu
C:\DOCUME~1\SSpicer\LOCALS~1\Temp\XPgrpwise\application checklist 2011_12.doc
Updated 3/2011