School of Radiologic Technology - Regional West Medical Center

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environments and conditions, displays flexibility and function in the face of uncertainties inherent in the clinical setting and with patients • Possess moral reasoning and ethical behavior appropriate for a health care professional The applicant will need to be able to perform each of these tasks in a reasonably independent manner with or without accommodation. The applicant must acknowledge that they are capable of meeting the technical standards listed or that the applicant needs an accommodation. If an accommodation is necessary because of a disability, it is the applicant’s responsibility to provide documentation and to request the specific accommodation in writing by a Licensed Independent Practitioner. The program will endeavor to satisfy requests for reasonable accommodations however, the program cannot guarantee an accommodation. The program director will consult with hospital administration to determine whether the medical center can meet the applicant’s need. Determination of a reasonable accommodation will be considered on an individual basis and is an interactive collaboration with the medical center, the applicant, the Educational Advisory Committee, and the program director when indicated. Students with disabilities will adhere to the same admission, progression, dismissal and readmission policies as all students. Acknowledgement of understanding technical requirements. I understand the technical standards of Regional West Medical Center School of Radioloic Technology. I also understand the hazards that may be encountered during training and understand with proper education and protective measures these hazards can be reduced. ____________________________________ Signature _______________________ Date Do you feel you need accommodations for any of the above listed technical standards? Yes _______ No ________ If yes, please contact the program director at 308.630.1155. Application form (page 5 of 5) 66
Regional West Medical Center School of Radiologic Technology Applicant Reference Form Please make a copy of this form for each of your references. Instructions for reference form use: Have the individuals that you have chosen for references complete one of the reference forms and seal it in an envelope. The reference person must sign the back of the envelope over the sealed edge of the flap. Then you or the reference person can mail it back to Regional West Medical Center School of Radiologic Technology. Send the reference to: Regional West Medical Center School of Radiologic Technology 4021 Avenue B Scottsbluff, NE 69361 Unless these instructions are followed, the reference will not be used during the application process. Name of applicant: _______________________________________________________ The above person has listed you as a reference on the application for admission to Regional West Medical Center School of Radiologic Technology. Personal recommendations are very important in the selection of students for this program. Therefore, we ask you to provide a thoughtful and sincere appraisal of this applicant. The contents of this reference form will be kept confidential and will be destroyed at the end of the admission process. If you do not feel you can adequately evaluate the above named applicant, please return the form with a notation of your inability to complete this form. See above for mailing instructions. In what capacity have you been associated with the applicant? ____ As one of my students. ____ As one of my subordinates at work. ____ As a peer in a work situation. ____ As a friend. ____ Other capacity (specify) ______________________________________________________ How long have you known the applicant?__________________________________________ Reference form (page 1 of 3) 67
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In-Design Transperancy School of Ra
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School Calendar August 10. ........
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History History of Sponsoring Organ
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Regional West Health Services Missi
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Program Director of Private Postsec
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Clinical Educational Settings Educa
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Box Butte General Hospital, Allianc
Page 15 and 16: Application Information STUDENT SER
Page 17 and 18: Psychomotor Requirements - The appl
Page 19 and 20: • Latex exposure history 11. Cand
Page 21 and 22: The Program requires students in th
Page 23 and 24: will write a recommendation regardi
Page 25 and 26: application in the application proc
Page 27 and 28: discontinues the program any time a
Page 29 and 30: Aid for academic institution where
Page 31 and 32: 240 Radiation Physics I This introd
Page 33 and 34: Academic Policies mammography, nucl
Page 35 and 36: Fabrication Fabrication can be defi
Page 37 and 38: Clinical Setting Expectations While
Page 39 and 40: cards. Students shall not clock in
Page 41 and 42: Vacation days must be requested in
Page 43 and 44: program, the student will need to a
Page 45 and 46: imaging procedure on a patient with
Page 47 and 48: Graduation To be eligible for gradu
Page 49 and 50: to the effect that the possible dan
Page 51 and 52: feels he or she cannot go to the Di
Page 53 and 54: productivity and/or behaviors must
Page 55 and 56: Services and Activities expectation
Page 57 and 58: Committee regarding the effect on t
Page 59 and 60: of the NSRT board meetings. Student
Page 61 and 62: Observation Form To the Technologis
Page 63 and 64: Date of graduation: _______________
Page 65: • Ability to communicate proficie
Page 69 and 70: Please indicate your opinion of thi
Page 71 and 72: Regional West Medical Center School
Page 73 and 74: Notes _____________________________
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School of Radiologic Technology - Regional West Medical Center

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