Skip to main content

Transfer or Returning Student Application for Admission

ARKANSAS STATE UNIVERSITY

COLLEGE OF NURSING AND HEALTH PROFESSIONS

 Radiologic Sciences Diagnostic Medical Sonography Program

APPLICATION FOR ADMISSION

(Returning or Transfer Students)

 

Application material must be postmarked by April 1st for admittance into the specialty programs. Applications are reviewed after the application deadline and are not reviewed on a first served basis. Faxed applications will not be accepted.  

 

Name: ____________________________________________________________________________________________________________________________

             Last                                                                                        First                                                         Middle

 

E-mail:  ____________________________________________________                         

 

Phone Numbers: (     ) _______________________home     (     ) _________________________ cell

 

Present Address: _______________________________________________________________________________________________________________

                                    City                                                                 State                            Zip

 

Permanent Address: _____________________________________________________________________________________________________________

                                    City                                                                 State                            Zip

 

 

List your work experiences in health care institutions:

___________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________

Have you ever participated in a MASH (Medical Applications of Science in Health) program or a CHAMPS (Community Health Applied for Medical Public Service) program? If yes, when and where? (For statistical purposes only)

 

 

 

 

Notification of admission decision should be sent to: _____ present address ______or permanent address. If applicant does not indicate choice, notification will be sent to the first address given above.

If your name, address or phone number changes during the application process, please notify the Radiologic Sciences Department of these changes. (870) 972-3073

Students applying to the Diagnostic Medical Sonography program must also apply for admission to Arkansas State University. Please see the ASU website for admission information at http://admissions.astate.edu/ or contact the Office of Admissions and Records, P. O. Box 1630, State University (Jonesboro), AR 72467. Phone: (870) 972-3024.

 

APPLICATION PACKET

Only completed packets will be accepted and must be returned to the Program Director. With this form, applicants are required to submit the following documents:

 

  1. College/Hospital Transcript(s) of all work attempted
  2. DMS application form
  3. Essay describing yourself and why you want to enter the DMS program
  4. Modality/Clinic Evaluation form

 

Students accepted into the DMS program will be expected to travel to assigned clinical affiliates and will be responsible for transportation and all expenses related to travel.

I hereby affirm that all information supplied on this application is complete and accurate. It is my understanding that I will not be considered for admission to this program until I have submitted all credentials specified by the set date.

 

____________________        _____________________________________________________________________

Date                                                                                 Signature

 

 

For applicants who are proficient in the Spanish language: Actualmente en la región que sirve ASU, se necesitan profesionales de la salud que hablen español. Por favor, indique aquí si usted tiene esta habilidad. Se da crédito adicional a los candidatos que puedan demostrar esta competencia. La facultad de idiomas extranjeros de ASU administra la prueba de habilidad en español. Por favor, póngase en contacto con el programa de Ciencia Radiologica para arreglar una cita para tomar el examen.

 

Please submit application packet to:

A-State Diagnostic Medical Sonography Program

Program Director

P.O. Box 910

State University (Jonesboro), AR 72467-0910

 

 

 

Arkansas State University

College of Nursing & Health Professions

Criminal Background

 

 

Student name: _______________________________________

 

I understand that criminal background checks may occur as part of my professional education at ASU. Evidence of a previous charge or conviction of a felony/misdemeanor on my record may affect my progress in this program. While the faculty cannot realistically determine whether this will have any future impact on my ability to work in my profession, I do understand that the following issues could arise during my time as a student or as a graduate of the program.

  1. Certain rotation sites could deny me access for rotation.
  2. Hospitals or other health care institutions could refuse to allow me access for a clinical experience.
  3. The above two issues could make it impossible for me to complete the clinical portion of my education and therefore not graduate.
  4. Upon graduation, a state licensing agency could refuse to grant me a license.
  5. As a licensed professional, certain health care institutions could refuse to grant me privileges.
  6. There could be other, unforeseen, impacts of this incident on my ability to practice as a professional.

 

Student signature: _____________________________________________

Date: __________________

Back to top