Health Sciences Application Form 2012_2013

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Before Applying to the Health Sciences Programs
1. Attend a Health Sciences Information Session
Attend an Information Session for your area of interest to understand the nature of the program, the
admission process and the rigor and time commitments needed to be successful. Times and dates can be
found at www.montgomerycollege.edu/healthsciences.
2. Apply to Montgomery College
If you haven’t already applied to Montgomery College, submit a Montgomery College Admissions Application
on-line at http://cms.montgomerycollege.edu/apply. If applicable, submit official copies of prior learning:
college, military, and Excelsior College Exam transcripts; results from international transcript evaluation
services; and AP, IB, CLEP, DSST or DANTES test scores to the Office of Admissions and Records for
review. NOTE: If you attended Montgomery College, DO NOT include a transcript from Montgomery College.
One will be generated when you submit your Health Sciences Application. A transcript evaluation will help
you to ensure that you do not duplicate coursework. Review the requirements for each program online:
http://cms.montgomerycollege.edu/healthsciences.
3. Make an appointment to take TEAS Test
Before applying to the Diagnostic Medical Sonography, Nursing, Radiologic Technology, Surgical
Technology, Physical Therapist Assistant, or Polysomnography Program, you must meet minimum academic
requirements listed on page 2. To assess these skills, set up an appointment to take the Test of Essential
Academic Skills (TEAS) test at Montgomery College’s Assessment Center or at any institution that offers the
test. To make an appointment for the TEAS test, go to ATI online (http://www.atitesting.com). For information
about the TEAS test, visit http://cms.montgomerycollege.edu/edu/department2.aspx?id=24050#TEAS.
See a Counselor
If you need help creating an academic plan, meet with a Montgomery College counselor in the Office of
Counseling and Advising. Be sure to complete steps 1-2 first!
4. Questions?
Visit our website at www.montgomerycollege.edu/healthsciences or contact the Office of Admissions at
240-567-5000.
Checklist for a Complete Health Sciences Programs Application
Applications submitted without the required documentation will be returned
Montgomery College Admissions Application (If not previously admitted)
Health Sciences Application
Copy of TEAS scores (DMS, Nursing, Radiologic Technology, Surgical Technology, Physical
Therapist Assistant, and Polysomnography applicants only)
Official copies of prior learning credentials, including transcripts from all colleges previously
attended
LPN-RN Applicants must also submit:
Current LPN License
Letter of recommendation from supervisor
Admission Requirements
Montgomery College health sciences programs requiring this application are available ONLY at the Takoma Park/Silver Spring Campus.
(NOTE: There are two applications-one for admission to the College and a second application for the health sciences programs.)

Must have the minimum requirement and a minimum GPA of 2.5 for consideration. This GPA is based on your most recent 24 college
credits earned. If you are a recent high school graduate with fewer than 24 college level credits, high school records will be included in this
calculation. Official transcripts are required.

For Programs Requiring the TEAS Test - GPA will be used for eligibility purposes only. You must complete the TEAS test and attach
scores to this application. You must meet the minimum Adjusted Individual Scores or above in the subjects listed below. Students may
only take the test twice during a 12 month period. The most recent score will be used. The Adjusted Individual Total Score will be
used to rank eligible students.

Health Sciences admissions will be based on courses completed and grades earned through the prior fall semester only.
Spring admission (Nursing only) will be based on courses completed through the prior spring semester only.
(Example: If applying for fall 2012 (March 1 deadline) courses completed by fall 2011 will be used; if applying for spring 2013
(August 1deadline), courses completed by the end of spring 2012 will be used).

The following list contains the minimum requirements, priority courses, and TEAS test requirements for each program. Applicants who
have completed all or some of the priority courses for their program of choice will be given first consideration. You may apply without
completing any of the priority courses; however, this will make your application less competitive. The requirements for each program
are:
Programs
TEAS Test
Requirements
Minimum Requirements
EN 101 assessment level or prior
completion of EN101/101A/102 or 109
BI 107
MA110 assessment level or prior completion
of MA 097/099/100 /101/103 or higher
PH010 or higher
EN 101 assessment level or prior
completion of EN101/101A/102 or 109
BI 107
MA110 assessment level or prior completion
of MA 097/099/100 /101/103 or higher


EN 101 assessment level or prior
completion of EN101/101A/102 or 109
BI 107
MA110 assessment level or prior completion
of MA 097/099/100/101/103 or higher




EN 101 assessment level or prior
completion of EN101/101A/102 or 109
BI 107
MA110 assessment level or prior completion
of MA 097/099/100/101/103 or higher




Polysomnography


EN101/101A assessment level
RD120 assessment level
Radiologic
Technology

Diagnostic Medical
Sonography



Health Information
Management




Nursing



Physical Therapy
Assistant



Surgical
Technology



Priority Courses
Reading = 78%
Adjusted Individual
Total Score = 66%



None (not required)




BI204: Anatomy and Physiology I*
BI205: Anatomy and Physiology II*
EN101: Techniques of Reading and Writing I or
prior completion of EN102 or 109
MA110: Survey of College Math or higher
PH010 or higher
BI130A/B: Human Body (Previously enrolled
students can use BI204 & 205: Anatomy and
Physiology 1 and II* as an alternative)
CA120: Introduction to Computer Applications
Meet prerequisites for MA110: Survey of College
Math
BI204: Anatomy and Physiology I*
BI205: Anatomy and Physiology II*
EN102/EN109: Techniques of Reading and
Writing II or Writing for Technology and Business
MA110: Survey of College Math or higher
Reading = 83%
Science = 50%
English = 72%
Math = 35%

BI204: Anatomy and Physiology I*




Reading = 74%
Science = 50%
English = 66%
Math = 35%

No priority courses identified at this time.
EN 101 assessment level or prior
completion of EN101/101A/102 or 109
BI 107
MA110 assessment level or prior completion
of MA 097/099/100/101/103 or higher




Reading = 74%
Science = 50%
English = 66%
Math = 35%



BI204: Anatomy and Physiology I*
BI205: Anatomy and Physiology II*
HI125: Medical Terminology I
EN 101 assessment level or prior
completion of EN101/101A/102 or 109
BI 107
MA110 assessment level or prior completion
of MA 097/099/100/101/103 or higher




Reading = 74%
Science = 50%
English = 66%
Math = 35%


BI204: Anatomy and Physiology I*
BI205: Anatomy and Physiology II*



Reading = 78%
Adjusted Individual
Total Score = 66%



*BI 204 and 205 older than five years of the application date may only be accepted upon permission of the program coordinator. Nursing applicants
with BI204 & 204 older than five years of the application date must take BI 218 or have consent from the nursing coordinator. Students who transfer
to Montgomery College with BI 204 and/or BI 205 do not need to complete BI 107.
HEALTH SCIENCES PROGRAMS ADMISSION APPLICATION
Fall 2012-Spring 2013
Submit complete application packet to the Office of Admissions and Records.
I.
Personal Information
Last Name____________________________________ First Name______________________________________
M Number_________________________ Previous Name(s)____________________________________________
Street Address___________________________________________ Home Phone__________________________
City___________________________ State__________ Zip______________ Work Phone____________________
E-mail __________________________________________________ Cell Phone___________________________
Citizenship*
U.S.
Permanent Resident
Not U.S. Citizen or Permanent Resident, indicate immigration
status (I-94) _______________________________
*Certain clinical sites, including the National Naval Medical Center, require students to be U.S. Citizens to be eligible
for rotations. If your citizenship status has changed since applying to Montgomery College, please bring official
documentation to update your status to the office of Admissions and Record.
Have you submitted an Admissions Application to Montgomery College?
Yes
If you answered NO, see Before Applying to the Health Sciences Programs, Step 2.
No (see note)
II. Complete Academic History (including Montgomery College):
College Name
Dates Attended/Attending
________________________________________________
______________________________________
________________________________________________
______________________________________
________________________________________________
_______________________________________
Do you have prior clinical experience such as LPN or military medic?
Yes (see note)
If you answered YES, please visit Nursing Department online for update on program.
www.montgomerycollege.edu/nursing
No
II. Program Information - Please select the program(s) to which you are applying and indicate degree or certificate
and specialty track where applicable.
DIAGNOSTIC MEDICAL SONOGRPAHY TEAS required
Indicate your preferred specialty:
Echo
A.A.S
Vascular
Abdominal/OB/GYN (Indicate order of preference)
1st Choice________2nd Choice_________3rd Choice_________
NURSING (Fall or Spring) TEAS required
A.S.
RADIOLOGIC TECHNOLOGY TEAS required
SURGICAL TECHNOLOGY TEAS required
POLYSOMNOGRAPHY TEAS required
Spring
A.A.S.
PHYSICAL THERAPIST ASSISTANT TEAS required
HEALTH INFORMATION MANAGEMENT
Fall
A.A.S.
A.A.S. or
A.A.S. or
Certificate
Certificate
Certificate
III. If you are applying to more than one program, please indicate your order of preference (1st, 2nd, 3rd choice,
etc).
1st____________ 2nd____________ 3rd____________ 4th____________ 5th____________ 6th_____________
IV. Notice of Additional Enrollment Requirements (subject to change)
All candidates who are offered admission to a Health Sciences Program should be aware of and prepared to meet
these additional requirements prior to enrollment and licensing.



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Understand and meet all requirements and/or standards imposed by recognized professional societies and all
contract requirements imposed on College students by the institution or agency where the clinical practice is to
occur.
Understand and be prepared to meet all requirements for participation in certain clinical courses involving
hospital or clinical practice. These requirements may include the passing of an appropriate health examination
and tests per CDC guidelines and Health Science program Technical Standards, e.g.: (1) complete blood count;
(2) urinalysis; (3) a complete hepatitis B vaccination series (series of three and/or positive titer); (4) annual TB
screening; (5) Tdap (tetanus,diphtheria,acellular pertussis); (6) MMR two adult vaccination(s) or positive titers for
each; (7) varicella vaccination or a varicella titer; and (8)influenza vaccine; (9) other clinical facility requirements.
DRUG TESTING and CRIMINAL BACKGROUND CHECKS of nursing and health sciences students are
REQUIRED by facilities that are the sites for the clinical learning experience of nursing and health sciences
students. These are conducted by an independent, third party outside agency at the student’s expense,
coordinated through the College, and must be completed before a nursing and health sciences student can be
placed at a facility for his or her clinical experience. The results of drug tests and criminal background checks
are available for review by designated personnel in each clinical facility and the clinical facility has the right to
refuse clinical placement for students based on such review. The College does not receive the results of these
checks. Drug tests and background checks obtained from other sources, including by the students on their own,
are not sufficient nor will they be accepted for this purpose.
Understand participation in certain Health Science programs may require a current CPR for Healthcare Provider
certification that meets standards acceptable to the facility or clinical site before beginning the student’s Clinical
Rotations.
I certify that the information on and submitted in support of this application is correct and complete. I
understand that falsification of this application may lead to program dismissal.
Applicant’s Printed Name: _______________________________________________
Applicant’s Signature: __________________________________________________ Date: _____________
Please submit the application and all required documentation to:
Montgomery College
Office of Admissions and Records
7600 Takoma Ave
Takoma Park MD 20912
AEM 09/15/11
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