DURHAM TECHNICAL COMMUNITY COLLEGE ASSOCIATE DEGREE RESPIRATORY THERAPY PROGRAM

Durham Technical Community College 1637 Lawson Street / Durham, North Carolina 27703 919-536-7200 / durhamtech.edu DURHAM TECHNICAL COMMUNITY COLLEGE ASSOCIATE DEGREE RESPIRATORY THERAPY PROGRAM Dear Student: Thank you for your interest in the exciting world of respiratory care and the Associate Degree Respiratory Therapy program at Durham Technical Community College. We are very glad that you are interested in our program and are excited about having you join us in a profession that we love. We want you to succeed in your goal of becoming a respiratory therapist and we will work together to make this a reality. Respiratory therapy courses are different from other courses you have taken. In the classroom portion, you will learn about the profession of respiratory care as well as respiratory assessment and management of patient care. In the laboratory portion, you will learn how to do psychomotor skills such as physical assessment, medication administration, and sterile technique. You will be expected to demonstrate competency for each skill. In the clinical portion, you will have the opportunity to apply what you have learned in the classroom and laboratory in a clinical settng with the assistance of either a respiratory instructor or hospital preceptors. Each respiratory course will assist you to build on your knowledge of respiratory therapy and clinical expertise for your future career. It is important that you gain a good foundation in the first respiratory courses and continue to build on that knowledge as you progress through each course. To get you started toward your goal, please find included the four-page application to the Associate Degree Respiratory Therapy program. It is important to read through this and fill it out correctly. Make sure that you provide all documentation that is requested in order to have your application considered. The application deadline is strictly enforced and no application after that date will be reviewed. If there is missing documentation, your application will not be reviewed and will be discarded. Due to limited seats available, applicants for the Associate Degree in Respiratory Therapy are admitted through a first-qualified, first-admitted process. Alternates not accepted will need to reapply the following year. If you have any questions, please do not hesitate to contact either Admissions, Advising, and Enrollment Support or your advisor. Best Wishes Sincerely, The Respiratory Therapy Faculty Return this form to: Admissions, Advising, and Enrollment Support Wynn Center, room 10-200 Durham Technical Community College Application for Associate Degree Respiratory Therapy Program For Admissions use only. Date received: 11/16 1

Name Durham Tech Student ID# Address City State Zip Code County Is this a new address? Yes No Phone: Home or Cell Work ConnectMail Email Account: CHECKLIST: These forms are REQUIRED and must be completed and attached. Placement Test Verification (ex. Compass, Accuplacer, ASSET, SAT/ACT, scores) See page 3 Computer Competency Verification See page 3 If applicable, developmental courses completed (ex. RED 090, ENG 090/090A, or DRE 098 and MAT 070 or DMA 050) See page 3 Course Completion Verification See page 3 Application for Respiratory Therapy program. *Note: Only apply to one program at a time. Clinical Training Form See page 4 English Language Requirement Form Essential Skills for Admission and Progression Attended information session. Date: Interview with Respiratory Therapy Faculty member. Date: Writing Sample APPLICATION DEADLINE: February 1 Completed applications may be turned in to the Admissions and Enrollment Services November 1 - February 1 NO APPLICATIONS OR ADDITIONAL DOCUMENTS WILL BE ACCEPTED AFTER February 1 11/16 2

Student Name Durham Tech Student ID# PLACEMENT VERIFICATION: Print from Webadvisor or Self-Service and attach a copy of your placement test scores. Important: If you took the placement test at another institution and it does NOT show up on your Durham Tech test report; attach an official copy of your test scores to this form. Your application will be incomplete if testing cannot be verified. I have completed the required placement test (ex. NC DAP, COMPASS, ASSET, ACCUPLACER, SAT, and ACT) within five years from the date taken. I have completed the required computer competency: completion of CIS 110 or completion of the computer competency exam. Complete developmental education courses if required by your placement test scores. English and Reading courses: Complete or test out of ENG 070, 080 and 090/090A and RED 070, 080, and 090; OR DRE 096, 097, and 098. Math courses: Complete or test out of MAT 050, 060, 070; OR DMA modules 010, 020, 030, 040, 050, 060. I have completed the required science prerequisites: CHM 094 or biology and chemistry in high school not older than 10 years or college biology and chemistry with a lab with a grade of C or above in both the lecture and lab. COURSE COMPLETION VERIFICATION: Print from Webadvisor or Self-Service and attach a copy of your Durham Tech transcript. Important: If you have transfer credit for a course not listed on your Durham Tech transcripts, you will need to contact Student Information and Records and request a review of submitted transcripts. I have also completed the following courses (with a grade of C or better): Course Grade ACA 122 (or waiver) BIO 168 BIO 169 ENG 111 ENG 112 PSY 150 HUM For assistance printing documentation from Webadvisor: Go to the Student Information and Records offce in the Wynn Center, Room 10-201. 4/17 3

Statement of Policy Regarding Acceptance for Clinical Training In the Following Programs at Durham Technical Community College Associate Degree Nursing Medical Assisting Practical Nursing Clinical Trials Research Associate Medical Product Safety/Pharmacovigilance Opticianry Dental Laboratory Technology Occupational Therapy Assistant Respiratory Therapy Health Information Technology Pharmacy Technology Surgical Technology Students accepted into the above programs must meet the standards of both the College and the affliated clinical site in order to participate in the appropriate clinical training for the program. Each clinical site where a student receives training reserves the right to refuse clinical training to any student found to be unacceptable according to that site s policies and regulations. Clinical sites require a Criminal Background Check and Drug Screening prior to the student s placement for training at that site. Reasons for refusal could include, among other considerations, a documented police record indicating convictions for drug or alcohol related charges, child abuse or molestation, burglary, larceny, or other convictions deemed inappropriate to the particular clinical settng. The student must confirm to and be subject to all policies and regulations of the assigned clinical site. The site reserves the right to end clinical training of any student whose performance violates rules, polices, procedures, or professional standards expected by the agency. Written justification from the clinical site must be provided to the College for such suspension. The clinical site and college personnel reserve the right to take appropriate immediate action, when necessary, to maintain the proper and sage operation of its facilities and the safety of clients in the clinical settng. Criminal Background Check: A Criminal Background Check form will be given to a student at the time they are accepted into the clinical portion of their program. The background check will include reports from all states where the student has lived within the past ten (10) years or from the date that the student turned eighteen (18) years of age, whichever is shorter. Students will pay a fee directly to a designated vendor for this background check. Additional information on the Criminal Background Check requirement may be obtained from the Durham Tech website. I verify that I have read and fully understand the Statement of Policy Regarding Acceptance for Clinical Training at Durham Technical Community College. I also understand that a Criminal Background Check and Drug Screening is required for placement in clinical training sites for Durham Technical Community College. Name (Print) Student ID# Program of Study Signature Date STATEMENT OF STUDENT RESPONSIBILITY I verify that I have read all the information regarding admissions to one of the above listed health programs, and understand the steps I must take to qualify for admissions. I understand that it is my responsibility to notify the Student Information and Records offce regarding changes in name, address, or phone number. Signature Date 11/16 4

Admissions Essay Instructions and Grading Rubric Application to the Respiratory Therapy program includes completion of a brief essay. The essay should be 1-2 pages, typed and double-spaced using a font size no greater than 12. The essay should address all of the following points: What is a Respiratory Therapist? What do they do? Where do they work? Why are you choosing to go into the field of respiratory care? What characteristics or attributes do you possess that will enhance Respiratory Therapy as a profession? Each should be described with an example of experiences or observations that have molded such characteristics/attributes rather than general statements for the purpose of demonstrating the uniqueness of each individual. INTRODUCTION Background/History Thesis Statement CONCLUSION MAIN POINTS Body Paragraphs ORGANIZATION Structure Transitions STYLE Sentence flow, variety Diction MECHANICS Spelling, punctuation, capitalization 3 2 1 0 Well-developed introduction engages the reader and creates interest. Contains detailed background information. Thesis clearly states a significant and compelling position. Conclusion effectively wraps up and goes beyond restating the thesis. Well-developed main points directly related to the thesis. Supporting examples are concrete and detailed. The narrative is developed with a consistent and effective point-of-view, showing the story in detail. Logical progression of ideas with a clear structure that enhances the thesis. Transitions are mature and graceful. Writing is smooth, skillful, and coherent. Sentences are strong and expressive with varied structure. Diction is consistent and words well chosen. Punctuation, spelling, and capitalization are correct. No errors. Introduction creates interest. Thesis clearly states the position. Conclusion effectively summarizes topics. Three or more main points are related to the thesis, but one may lack details. The narrative shows events from the author s point of view using some details. Logical progression of ideas. Transitions are present equally throughout essay. Writing is clear and sentences have varied structure. Diction is consistent. Punctuation, spelling, and capitalization are generally correct, with few errors. (1-2) Introduction adequately explains the background, but may lack detail. Thesis states the position. Conclusion is recognizable and ties up almost all loose ends. Three or more main points are present. The narrative shows the events, but may lack details. Organization is clear. Transitions are present. Writing is clear, but sentences may lack variety. Diction is appropriate. A few errors in punctuation, spelling, capitalization. (3-4) Background details are a random collection of information, unclear, or not related to the topic. Thesis is vague or unclear. Conclusion does not summarize main points. Less than three main points, and/or poor development of ideas. The narrative is undeveloped, and tells rather than shows, the story. No discernable organization. Transitions are not present. Writing is confusing, hard to follow. Contains fragments and/or run-on sentences. Inappropriate diction. Distracting errors in punctuation, spelling, and capitalization. Introduction/Conclusion Main Points Organization Style Mechanics Grade Equivalent (15 points maximum): Total Points = grade of 11/16 5

Associate Degree Respiratory Therapy Essential Skills for Admission and Progression Physical and Psychological Requirements A prospective respiratory therapy candidate must demonstrate the physical and psychological ability to provide safe respiratory care. Every prospective student must assess his or her ability to provide safe and competent respiratory care prior to choosing respiratory as a career. To understand the physical and psychological qualifications needed for success, the essential abilities have been listed below. Qualifications Standard Examples of necessary Activities Identify cause-effect relationships in clinical situations Develop appropriate interventions Critical critical thinking ability sufficient for Assess risks and provide for patient safely Thinking: problem solving and clinical judgment. Consider multiple priorities and make effective decisions quickly Develop and evaluate Respiratory care plans interpersonal abilities sufficient to Establish helping relationships with patients, families, significant others and the Interpersonal interact with individuals, families and interdisciplinary healthcare team Skills: groups from a variety of social, emotional, cultural, and intellectual Cope effectively and calmly during emotions and stress in the workplace backgrounds. Demonstrate caring behaviors Communication: Mobility: Motor Skills: Hearing: Visual: communication abilities sufficient for interaction with others in verbal and written form. physical abilities sufficient to move from room to room and maneuver in small spaces. gross and fine motor abilities sufficient to provide safe and effective respiratory care. auditory ability sufficient to monitor and assess patient s needs and maintain facility safety. visual ability sufficient for observation and assessment necessary in respiratory care. Communicate relevant, accurate, and complete information in a concise and clear manner both verbally and in writing to patients and healthcare team members Utilize information technology to support and communicate the planning and provision of care Ability to conduct interviews and inservices Move around in patient rooms, bathrooms, workspaces, and treatment areas Administer cardiopulmonary resuscitation Stand, squat, reach above head, lift, push, pull Walk the equivalent of 5 miles daily at work Operate and calibrate respiratory care equipment proficiently, e.g. assemble equipment, insert needles and catheters, manipulate ventilators, and position patients Hear monitor and ventilator alarms, emergency signals and cries for help Auscultate blood pressure, breath, and heart sounds Observe patient responses to treatment, such as changes in skin color, work of breathing, or facial expression Read patient medical records Read and interpret ventilator graphics Revised June 2013

Tactile: Weight Bearing: Emotional: Environmental: tactile ability sufficient for physical assessment the ability to maneuver/move 30-50 pounds, weekly and sometimes daily. emotional stability sufficient to maintain composure in stressful situations. the ability to tolerate environmental stressors Perform palpation, functions of physical examination and/or those related to therapeutic intervention Perform therapeutic and diagnostic modalities required on the job Position patients to perform therapies Moving and relocating heavy equipment Cope effectively with stress in the workplace Cope with client and colleague emotions calmly Receive corrective feedback calmly Adapt to variations in work schedules Work safely with chemicals used in healthcare settings Work in areas that are close, crowded or noisy Observe infection control procedures 1. A prospective student with a disability that is concerned that the disability may impact his or her ability to perform one or more of these skills, provide patient care, or participate in other job activities, is encouraged to contact a disabilities services counselor for assistance by calling 919-536-7207. 2. To verify a student s ability to provide essential respiratory care during clinical training, a physical examination is required of all students. This examination will be documented by a physician/nurse-practitioner/physician s assistant on the form provided by the Admissions and Enrollment Services office. 3. Subsequent yearly TB screening is required. Participation in clinical is contingent upon negative documentation and/or appropriate medical treatment and clearance. 4. Occasionally, a student may experience a change in the status of these requirements while progressing through the curriculum. Should this occur, the student is required to notify the program s clinical coordinator. Revised April 2017

Student Name: Student ID #: Associate Degree Respiratory Therapy Essential Skills for Admission and Progression Physical and Psychological Requirements I certify that I have read the Essential Skills for Admission and Progression form. I certify that I understand the physical and psychological requirements needed for providing safe respiratory care. I have assessed my ability to perform these skills and am able to demonstrate these essential skills. Student signature Date *Please submit only this signature page with your application and retain the list of requirements for future reference. Revised June 2013

English Language Requirement Form All health care workers (native and non-native US English speakers alike) are expected to use clear communication skills in the workplace. Students whose native language is not US English are expected to demonstrate "near native" US English language abilities. To confirm this ability, all students entering a Health Technologies program are required to meet the English language requirement. All students should submit this form to Admissions, Advising, and Enrollment Support to verify how he/she meets the English language requirement. Students meeting the following criteria must comply with this revised requirement: 1. Students who applied to a Health Technologies program on or after January 1, 2016, OR 2. Students who applied to a Health Technologies program before January 1, 2016, but have not yet met the previous English language requirement. Please check the ONE that applies: 1. I have only attended a US high school, and my first language is US English. 2. I have attended school outside the United States. 3. My first language is not US English. If you checked number 1, please sign here. There is nothing further that you need to do. I understand that this is an official Durham Technical Community College document and that any falsification on this document may result in disciplinary action according to the Student Code of Conduct. My signature below indicates that I am responding truthfully. Student Name (Print): Student ID: Student Signature: Date: If you checked number 2 or number 3, you must meet the English Language Requirement by successfully completing one of the following options: Option 1: Take the Accuplacer ESL Listening Test (obtain a score of 106 or above) OR COMPASS ESL Listening Test (obtain a score of 91 or above) AND complete a personal interview with the EFL Coordinator in order to assess your speaking skills (obtain a score of 70 or above). Option 2: Take the Test of English as a Foreign Language (TOEFL), ibt version (obtain a score of 22 in listening and above 26 in speaking. Option 3: Complete EFL 055 and/or EFL 064 and other EFL courses as recommended or as required by placement testing (obtain a score of 80 percent or above). *Note: Scores for the above tests and classes are valid for up to 5 years. January 19, 2016 1

I understand that this is an official Durham Technical Community College document and that any falsification on this document may result in disciplinary action according to the Student Code of Conduct. I answered no to questions number 2 and/or number 3; however, I have met the English Language Proficiency Requirement as follows: 1. I scored a 106 or above on the Accuplacer ESL Listening and a 70 or above on my personal interview to assess my speaking skills. 2. I took the Test of English as a Foreign Language (TOEFL), ibt version and scored above 22 in listening and above 26 in speaking. 3. I have completed one or more EFL curriculum courses in the areas listening/speaking and have scored an 80 percent or higher. My signature below indicates that I am responding truthfully. Student Name (Print): Student ID: Student Signature: Date: EFL Director (Print): EFL Director Signature: Date: This form must be submitted to your admissions counselor with other required documentation. Refer to the Health Technologies program admissions checklist to determine additional requirements. Read more information about this requirement and view test dates. January 19, 2016 2