Cardiac Sonography Online Application ATU Ozark

First Name:*

Middle Name:

Last Name: *

Mailing Address:*

City:*

State:*

Zip Code:*

Tech T#:

Date of Birth:*

Phone Number:*

Email:*

Please indicate if you are currently a student of:*

Arkansas Tech University

Arkansas Tech University-Ozark Campus

Another university

N/A

Have you previously attended another Cardiac Sonography Program or Diagnostic Medical Sonography Program?*

No

Yes

If you answered yes to the previous question, where?

Acknowledgment of Essential Functions*

Without reasonable accommodations

With reasonable accommodations

By selecting one of the choices above, I acknowledge that I have read and understand the Essential Functions for the Cardiac Sonography Student. I believe to the best of my knowledge that I have the ability to learn and perform the essential functions:

I, the undersigned applicant to the Cardiac Sonography program at Arkansas Tech University Ozark Campus, understand that participation in a clinical experience is part of the Cardiac Sonography program and that participation in a clinical experience includes working as a student at an affiliating agency. I understand that I will be responsible for all travel, meals and lodging associated with clinical education. I further understand that affiliating agencies have the right to establish requirements for participation in clinical experience.*

Yes, I understand

No

I, the undersigned applicant to the Cardiac Sonography program at Arkansas Tech University Ozark Campus, understand that additional forms that can be found on the ATU-Ozark Cardiac Sonography webpage must be submitted to the Allied Health Administrative Assistant BEFORE the program application deadline in order for my application to be considered complete. I also understand that, if I complete the online application but do not submit these additional forms, my application will not be considered for admission to the program, as my application would not be fully submitted.*

Yes, I understand and will submit the additional documents

No