DIXIE STATE COLLEGE OF UTAH
RESPIRATORY THERAPY PROGRAM APPLICATION
PACKET
(rev6-09)
Students are admitted into the respiratory therapy program without discrimination with respect to gender, age,
creed, ethnic origin, or marital status. Space in the program is limited; therefore, admission will be competitive,
based on an objective point system that has been developed to predict student success. Points will be calculated
and weighted from the admission criteria including: pre-requisite GPA, overall college GPA, interview, previous
healthcare experience, and program essay. We admit up to 16 students annually.
Prior to making application to the program, individuals should give careful consideration to the mental
and physical demands of the program and the pressures involved in undertaking the responsibilities of
being a full-time respiratory therapy student.
REQUIREMENTS FOR ADMISSION INTO THE RESPIRATORY THERAPY PROGRAM:
 Must meet minimum eligibility requirements:
o Minimum cumulative GPA of 2.25;
o Minimum “C” (2.0) grade in each prerequisite course;
o Applicants may apply while completing prerequisite courses but all prerequisites must be
completed before the start of the first semester of the respiratory therapy program;
o Prerequisite courses may be repeated and a weighted average of the grades will be used;
o Must have possessed certified nurse assistant certificate (it is not necessary to be currently
certified as a CNA but applicants must have completed the course including passing the
certification examination);
 Applicants must be admitted to Dixie State College of Utah. http://www.dixie.edu/reg/online-app.html
 There is a $25 non-refundable program application/reapplication fee payable to the cashier’s office.
 Submit a current college/university transcript.
o Must show completion of all prerequisite courses that have been completed to date with a “C”
(2.0) or better. If your transcript has been posted to DSC you must still submit a hard copy with
your application. An Unofficial transcript is acceptable for this purpose.
o Applicants in the process of finishing prerequisite courses at the time of application must submit
an official transcript showing final grades for ALL prerequisite courses after grades are posted.
 Submit a program essay that is word processed, double spaced, and no more than two, one-sided pages.
Attach the essay to your program application; do not write your name on the essay, include a face
sheet with your name.
 Discuss the following in your essay:
o Why you want to become a respiratory therapist
o Why you feel you would be successful in the respiratory therapy program
o The specific strategies you will use to fulfill the intensive requirements of the respiratory
therapy program
o The roles and responsibilities of a respiratory therapist, including how a therapist’s role
differs from that of a CNA, nurse, or other allied health professional
o Personal and/or professional experience in health-related areas, including the length of time
spent in these experiences
 Applications must be submitted by March 1
Applications will only be initially reviewed if they are COMPLETE and submitted
by the deadline. (Deadline will be extended to the next business day if last date falls on
weekend. Late applications may be accepted and filed but they will be reviewed only if
the on-time submissions do not provide a sufficiently qualified applicant pool.)

Applicants will be contacted after March 1 to schedule Selection Committee Interview (using contact
information provided on the Application).

Written notification of acceptance status will be mailed by June 1 for fall semester.

Submit complete application by certified mail or hand-deliver to the office of the Administrative
Assistant to the Dean of Science and Health.
Dixie State College of Utah
Attn: Administrative Assistant to the Dean of Science and Health
Taylor Health Science Building #207
225 South 700 East
St. George, UT 84770
Keep a copy for your records
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DIXIE STATE COLLEGE OF UTAH
RESPIRATORY THERAPY PROGRAM
APPLICATION FOR ADMISSION
Rev 6-09
Date submitted: _____________________

DUE DATE:


Fall Admission – Deadline is March 1

DIRECTIONS:
Please type or print and complete ALL of the information requested.
Incomplete applications will not be processed.
1. PERSONAL INFORMATION
Last Name _________________________First _____________________ Middle Initial _____
Student ID ___ ___ ___ ___ ___ ___ ___ ___ or SS #___ ___ ___ /___ ___ /___ ___ ___ ___
Home Address______________________________ Primary Phone: (__ __ __)__ __ __- __ __ __ __
City___________________ State___ Zip_________ Secondary Phone: (__ __ __)__ __ __-__ __ __ __
E-mail Address__________________________________________________________
Please list the name, address and phone number of a person to be notified in case of emergency.
Last Name _________________________First _____________________ Relationship______________
Home Address______________________________ Primary Phone: (__ __ __)__ __ __- __ __ __ __
City___________________ State___ Zip_________ Secondary Phone: (__ __ __)__ __ __-__ __ __ __
2. _____DIXIE STATE COLLEGE OF UTAH ADMISSION PROCESS – COMPLETED
_____I am currently a student in good standing at Dixie State College of Utah. OR
_____I have completed the admission process for Dixie State College of Utah.
3. _____NON-REFUNDABLE $25.00 APPLICATION FEE - COPY OF RECEIPT ATTACHED
4. _____PROGRAM ESSAY - COMPLETED and attached
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5. _____ PREREQUISITE COURSE COMPLETION - TRANSCRIPTS ENCLOSED*
Complete the following table with the appropriate information regarding completion of the
Respiratory Therapy Program prerequisites.
Required
Course
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3
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College or
University
Semester
Completed
Grade
Anticipated Completion
date
Chemistry**
(CHEM 1010 or 1110; 3 cr)
Human Physiology**
(BIOL 2420 3 Cr)
Human Physiology Lab**
(BIOL 2425 1 Cr)
Quantitative Literacy**
(Math 1030, 1040, or 1050)
Math
Introduction
to Writing
(Mat1104,10o010110101050;)
(ENGL
1010 3 Cr)
Information Literacy*
(LIB 1010 1 cr)
Psychology
(PSYCH 1010 or 1100)
OR
Sociology
(SOC 1010, 1020, or 1200)
Intermediate Writing
(ENGL 2010 3 Cr)
Certified Nursing Assistant (CNA)
*Applicants who are transferring ENGL 1010 from another institution may have LIB 1010 waived.
**Prerequisites that have been completed more than 7 years prior to application are subject to individual
review and may not be accepted.
Note: It is recommended that you
keep a copy of all of items you are submitting.
Please note:
To be licensed as a Respiratory Therapist [Respiratory Care Practitioner] in the State of Utah, the
applicant must be in compliance with the Utah Respiratory Care Practices Act. Applicants who
have been convicted of a felony or who have been treated for mental illness or substance abuse
should discuss their eligibility status for licensure with the Utah State Respiratory Care Licensing
Board. Acceptance into and completion of the respiratory therapy program does not assure
eligibility to be licensed to practice in Utah. The Utah Respiratory Care Licensing Board makes the
final decision as to whether a license will be issued to practice respiratory care in the State of Utah.
If you have questions regarding this please contact the Division of Occupational and Professional
Licensing, 160 East 300 South, P.O. Box 146741, Salt Lake City, UT 84114-6741; Phone number
(801) 530-6495.
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Acknowledgement of Program Requirements for Personal Effort and Commitment
The nature of the Dixie State College of Utah Respiratory Therapy program, as with most allied health
education programs, requires a substantial time commitment to fulfill the intensive requirements of the program in
the classroom, laboratory, and clinical settings. The Respiratory Therapy program faculty recognizes its
responsibility as facilitators of your learning and is committed to helping you succeed in the program.
It is important that you are aware of your responsibilities for your own learning while in the Respiratory
Therapy program. As part of your application to the program, please read the following and sign below. Your
signature is an acknowledgement of your understanding of the expectations of the program.
1.
There is a minimal study expectation of two hours of study per week for each credit enrolled. Each
semester/term of the program has 12-16 credits, therefore, a minimal study expectation for these courses
would be 24-32 hours of study per week (outside of class, in addition to class attendance). Most students
spend more time than the minimal study expectation.
2.
Although we hold an appreciation for your possible need to work to support yourself and/or a family, most
students find it extremely difficult to work full time and still achieve the grades they may have received in
other courses. Some students may be able to organize their schedules to work 10-20 hours a week; if it is
absolutely necessary for you to work full-time while a student it is unlikely that you will successfully pass
all program requirements and/or successfully pass your Board examinations.
3.
You are expected to be prepared for class, lab, and clinical. This may include extensive reading and/or
other assignments prior to your attendance.
4.
Most exams given in respiratory therapy courses are structured similarly to the Respiratory Therapy
credentialing and licensing examinations. This means that most of the items on the exams are application,
analysis, and synthesis type questions rather than simple knowledge and recall. These questions require a
higher-order of thinking to answer correctly. We will provide you with learning strategies and test-taking
strategies that will help you take the Respiratory Therapy course exams and prepare you to successfully pass
your credentialing examinations.
5.
You will find the Respiratory Therapy program very different and much more difficult than your past
educational experiences. The Respiratory Therapy program is designed to ensure the quality of the
program, to prepare you to pass your licensing examinations, and to ensure that you become a safe and
competent Respiratory Therapist .
I certify that all of the statements in this application and all of the documents submitted with this
application are true and accurate to the best of my knowledge. I acknowledge that I have read and
understand the above statements and if I am accepted into Dixie State College of Utah’s Respiratory
Therapy program, I agree to organize my time and personal affairs in order to meet the
commitment necessary to succeed.
____________________________________________
Print name of Applicant
____________________________________________
Signature of Applicant
___________________________
Date
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RESPIRATORY THERAPY PROGRAM
APPLICATION CHECKLIST
(6-09)
This checklist has been provided to guide you through the application process. If you are selected into the
Respiratory Therapy program you will need to complete items 1-9 in the lower box below (immunizations,
background check, etc.) and submit appropriate documents by August 1. Item #10 is included to inform you of
required laboratory fees.
Do NOT submit this with your application.
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REQUIREMENTS
Complete the Dixie State College of Utah admissions process. ($35 fee & OFFICAL
transcripts)
DATE DONE
Pay $25.00 non-refundable program application fee to the Dixie State College cashier's
office by March 1st for fall admission. May be done by credit card. Submit a copy of
receipt with application.
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Complete an essay according to the instructions and submit it with application.
Complete Respiratory Therapy Application form, sign (in pen), and submit to the
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Administrative Assistant to the Dean of Science and Health office. Taylor Health Science
Bldg #207. Applications accepted through March 1st
Submit current transcripts to Respiratory Therapy Program Director or the Administrative
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Assistant to the Dean of Science and Health by March 1st for fall admission. All
prerequisite courses must be completed before the program starts in the fall.
Once you have been accepted into the Respiratory Therapy Program the following items (1-10 below) will be
required. Please provide verification to the Administrative Assistant to the Dean of Science and Health by the due
date in your acceptance packet. With the exception of the CNA certification, you will be required to keep these
current during the entire program.
2
CPR Certification Health Care Provider Status [NOT Heartsaver] (American Red Cross
expires every year; American Heart Association expires every 2 years.)
Background screen http://myvci.com/dixie cost: $45
3
5 panel drug screen $30.00-$50.00
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10
Verification of 2 MMR (Measles, Mumps, Rubella) immunizations. One must be after
age 18, or Titer showing immunity.
TDaP immunization. MUST include Pertussis. Waiver required if tetanus shot received in
last 2 years.
Hepatitis B series (3 required) At least 2 must be completed before program start. Allow 4
weeks between the first 2 innoculations.
Chicken Pox vaccination or letter verifying you had Chicken Pox or titer showing
immunity
Negative Tuberculosis Skin Test (TB Skin Test), Chest X-ray or verification of prior
treatment for TB. Must be good through program completion (17 months).
Copy of CNA certificate
Student Fees. A non-refundable fee is required for name tags, lab and equipment supplies,
and the NBRC Review/Testing Package. These fees are paid with each semester's tuition.
Total due each semester: $150.00
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