Program Application - Delaware Technical Community College
ALLIED HEALTH PROGRAM APPLICATION 2015 Allied Health/Science Department Delaware Technical Community College Wilmington Campus NUCLEAR MEDICINE (NMT) Page 1 of 2 *PLEASE PRINT CLEARLY AND COMPLETE ALL SECTIONS OF THE TWO PAGE APPLICATION* *INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED* 1. General Information Name: Student ID # 700Address: City / State / Zip: Cell phone #______________________ Alternate phone # DTCC* Email Address: *IMPORTANT: DTCC Students – ALL correspondence regarding this application will be via your DTCC email account ONLY. Please do NOT provide any other email address as it will not be used. NON-DTCC Students – ALL correspondence regarding this application will be via the email address you provide here. ALL Applicants – Failure to monitor your email, read all attachments, and respond to application correspondence by deadlines noted will void this application. 2. Checklist Verification I, the undersigned, acknowledge that I have: Read all the program application support documents on the program web page Reviewed the program-specific Ranking Worksheet, and verified that I meet the minimum GPA and course completion requirements as detailed on the worksheet Attended a Wilmington Campus Allied Health Information Session between Feb 1, 2013 and Jan 31, 2015 and recorded that date as required in Section #3 below Submitted OFFICIAL (non-DTCC) transcripts in the proper timeframe to the Wilmington Campus Admissions Office for transfer credit review Read and followed the Observation instructions attached to this application (DHY, HTT, OTA and PTA programs only) Attached the necessary high school and/or Non-DTCC transcript copies to this application Made a copy for my own records before submitting this application and its supporting documents I, the undersigned, further acknowledge the following: Applications are accepted November 1 through February 1 only My submitted application will be valid and reviewed only if completed in full and submitted by the February 1, 2015 deadline My application must be submitted to the Allied Health/Science Department Office, WSE 308, Wilmington Campus Note: Stanton and Wilmington Campus students must hand deliver to WSE 308 Dover and Georgetown Campus students may hand deliver to WSE 308 OR mail to Delaware Tech AH/S Dept, 333 Shipley St, Wilmington DE 19801, attn: Louise diGenova NO applications hand delivered or postmarked after February 1 will be considered Preferred submission date is by the 3rd Friday in December…Submitting early does not alter my competitive ranking or acceptance chances, but may allow for any mistakes in process to be corrected before the deadline Questions about this application may be addressed to the Department @ (302) 571-5355 ALLIED HEALTH PROGRAM APPLICATION 2015 Allied Health/Science Department Delaware Technical Community College Wilmington Campus NUCLEAR MEDICINE (NMT) Page 2 of 2 3. Date of Allied Health Information Session attendance: _________________________________ Date entered must be between February 1, 2013 and January 31, 2015, and will be verified for application acceptance 4. Education Information List the high school/colleges attended: High School: ___________________________ Dates Attended: ___________________ College: _______________________________ Dates Attended: ___________________ College: _______________________________ Dates Attended: ___________________ College: _______________________________ Dates Attended: ___________________ Attach an unofficial transcript copy for each site listed above if courses were taken within the published age limits. EXCEPTION: If ALL applicable courses are from DTCC, no high school or college copies are necessary. Have official transcripts been submitted to the Admissions Office – Wilmington Campus? ___yes ___no 5. Application Submission I, the undersigned, acknowledge and accept that this application will be deemed VOID if not completed in accordance with the guidelines set forth on the program web page and in the checklist above: Applicant’s Printed Name: __________________________________________________ Applicant’s Signature: _____________________________________________________ Date of Application: ___________________________ Do not write below this line Office use only Received by: ___________________________________ Notes: Date: _______________
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