APPLICATION FOR PROGRAM
DATE
NAME
SSU ID
ADDRESS STREET
CITY STATE ZIP
HOME PHONE NO CELL PHONE NO
PREFERRED EMAIL ADDRESS
Health Sciences Building Room
SHAWNEE STATE UNIVERSITY
RESPIRATORY THERAPY PROGRAM
Application for Admission and Autobiography Form
Name Student ID
Street
City State Zip
Phone: Day ( ) Evening ( )
Cell ( ) Email Address
Applying to enter program: Fall Semester Year
AUTOBIOGRAPHICAL INFORMATION
In the space below please write an account of: (use another sheet if additional space is needed)
1. Your non-working experiences and activities. (Include community service)
2. Work experiences including dates (starting with most recent employment)
3. Work or voluntary experiences you have had in a healthcare setting that you have not listed above.
(Include job shadowing)
4. Reasons for selecting the Respiratory Therapy Program as a career at Shawnee State University
Next page
ACCEPTANCE OF RESPONSIBILITIES
I understand that if admitted to the Respiratory Therapy Program I will be responsible for:
1. Traveling to a clinical site 50-60 miles away and arriving by as early as 6:00 a.m.
2. Securing a reliable source of transportation.
3. Devoting up to 12 hours a day to my education, including reading, group study, and clinical preparation.
4. Spending up to 25-40 hours a week in the classroom, lab, or hospital setting.
5. Dealing with patients of all ages, ethnic, and social backgrounds.
6. Obtaining and/or documenting completion of Hepatitis B vaccination series.
7. Keeping program officials updated with current telephone number, address, and email.
8. Obtaining Federal and State background checks and drug screenings when required.
PLEASE NOTE: The Director of the Respiratory Therapy Program will notify you when to obtain these at a later
date.
9. Purchasing clinical uniforms and supplies.
10. Maintaining a professional attitude and behavior throughout the program.
____________________________________ _________ ______
Signature Date
Clinical Education Centers
The Respiratory Therapy Program is affiliated with the following Medical Centers. Students are required to
rotate each of the different clinical sites during the program:
Adena Regional Medical Center, Chillicothe, OH
King’s Daughters Medical Center, Ashland, KY
St. Mary’s Medical Center, Huntington, WV
Our Lady of Bellefonte Hospital, Ashland, KY
Pike Community Hospital, Waverly, OH
Southern Ohio Medical Center, Portsmouth, OH
Return this completed form to Office of Admission, Shawnee State University
940 2
nd
Street, Portsmouth, OH 45662
RESPIRATORY THERAPY PROGRAM Application for Admission and Autobiography Form
Page 2
SHAWNEE STATE UNIVERSITY
MINIMUM CRITERIA FOR ADMISSION CONSIDERATION
To be considered for admission to the Respiratory Therapy Program, the following items must be received
in the Admissions Office by April 1:
Application to Shawnee State University
Respiratory Therapy Application and $30.00 Health Science Application fee
Official High School Transcript; or,
Official GED Score Transcript and Partial H.S. Transcript
Official College Transcripts, if applicable
Proof of Algebra, Biology and Chemistry with "C" or above
Overall GPA of 2.0 or greater
ACT Score with "18" in Science Reasoning and comprehensive scores
Please note that meeting the minimum criteria for admission consideration does not guarantee admittance
into the Respiratory Therapy Program. All candidates meeting the minimum criteria for admission
consideration are subsequently ranked and only a selected number are admitted due to clinical site
limitations. In most years the number of applicants meeting the minimum criteria far exceeds the numbers
of seats available. As a result, the qualifications of those students admitted a
re much higher than the
minimum requirements for admission consideration.
To further explain these requirements, please read the following information completely. If you have questions
regarding these requirements, please contact the Health Sciences Representative, at (740) 351-3209.
1. You must first submit an application to Shawnee State University, then the Respiratory Therapy Application
together with the Health Science Application fee of $30.
2. Students should request official copies of both high school and college transcripts be sent to the Office of
Admission at Shawnee State University. Transcripts should be sent to Shawnee State, after application has
been made, in order to avoid confusion. If the transcript was under a different name, please request your current
name and/or social security number be included. Transcripts sent under other names may not be traceable and
may
not be credited to your file.
High School transcripts can be submitted by the following methods:
a. Mailed directly from the high school; or,
b. Hand carried in an envelope with the high school guidance counselor or high school official's signature across
envelope seal; or,
c. Sent via FAX from the high school.
Previous College/University Transcripts: Official transcripts must be mailed directly from the
college/university. Hand-carried or faxed copies will not be accepted as official transcripts. The University
reserves the right to verify the final, official authenticity of any student's transcript. Any transcript document found
to be fraudulent becomes the student's responsibility and the University reserves the right to withdraw admission
acknowledgment and/or approval of acceptance.
3. ALL applicants to the Respiratory Therapy Program must have completed high school or college level Algebra,
Biology and Chemistry with a grade of "C" or above by April 1 to be considered for admission. (NOTE: A "C-"
is not accepted and Pre-Algebra is not accepted.) The only exception is that if you are currently a senior in high
school and are currently enrolled in one of these classes, you must have your counselor send us a transcript at
the end of the first semester, showing your current grade average in the course.
If you are submitting a 7
th
or 8
th
grade junior high algebra class grade to meet a requirement, it will not be reflected
on your partial high school transcript. Therefore, you MUST do the following for the course to be considered:
a. Request that your guidance counselor submit the relevant, official grade transcript/report which lists the
cla
ss, and
b. Do NOT assume that the course (even though titled Algebra) will meet the math requirement. Request
your guidance counselor submit a detailed course description of the class including the specific
proficiencies contained in the class.
4.
All applicants must have completed the ACT test with a minimum score of "18" in the Science Reasoning area
(or if taken before October, 1989, a “16” in Science Reasoning or Natural Sciences).
5. Applicants must be eligible to enter MATH 1200 and ENGL 1101S as the program curriculum describes.
Therefore, students should take Shawnee State's mathematics and English placement tests as early as possible.
6. All applicants will be notified in writing when the above criteria have been met and the file forwarded to the
department for consideration. IF YOU HAVE NOT RECEIVED THIS CARD, YOUR FILE IS NOT COMPLETE.
It is your responsibility to make sure all requirements are submitted before the deadline.
7.
and meetings scheduled with Amy France, Program Leader by calling (740) 351-3240 or the Health Science
Representative at (740) 351-3209.
8. Final decisions regarding admission to the Respiratory Therapy Program will be made using an objective, point
ranking, system. Factors included in this ranking system include the following:
a. Grade received in algebra, biology, and chemistry;
b. Level of algebra, biology, and chemistry taken by the student (i.e. high school, college remedial, or college);
c. ACT Science R
easoning and Comprehensive scores; and,
d. Number of college credit hours completed with a "C" or higher;
9. Students will be notified of admission status with the Respiratory Therapy Program. Those admissions will be in
one of the following categories:
a. Full Admit - These applicants have been admitted to the Respiratory Therapy Program and are included in
the class for the following Fall Semester;
b. Alternate - These applicants will be considered for positions in the class b
eginning the following Fall
Semester if positions become available (Applicants in this category, if a position does not become available,
may work to improve their applicant status [point ranking] and apply the following year. It is strongly
recommended that these applicants contact the Chair of the Respiratory Therapy Program to determine how
to improve their status for the following year.);
or,
c.
Non-admit - These applicants may reapply to the Respiratory Therapy Program for the following year and will
be considered as though they are a new applicant (These applicants should work to improve their applicant
status [point ranking] if they plan to apply the following year. It is strongly recommended that these applicants
contact the Chair of the Respiratory Therapy Program to determine how to improve their status for the
following year.).
10. First consideration for admission will be given to those admitted and alternate students, who meet the
application criteria and submit all necessary application mat
erials prior to April 1. Anyone applying after April
1 will be ranked and admitted to the Program based on his or her ranking and the availability of positions.
11. It is important to note that the Respiratory Therapy Program does not maintain a waiting list and that each
year applicants are given an equal opportunity to compete for positions in the Program.
Applicants can schedule a meeting with the Program Leader for information. Questions may be directed to
e. Overall GPA of 2.0 or greater.
SHAWNEE STATE UNIVERSITY
RESPIRATORY THERAPY
ASSOCIATE DEGREE PROGRAM
CLASS
HOURS
LAB
HOURS
CREDIT
HOURS
Fall Semester:
AHNR 1102 - Medical Terminology
2
0
2
BIOL 1130 - Anatomy & Physiology 1
4
0
4
MATH 1200 - College Algebra
3
0
3
RPTT 1110 - Cardiopulmonary/Renal Anatomy & Physiology
4
0
4
RPTT 1111 - Intro to Respiratory Therapy
3
3
4
Totals
16
3
17
Spring Semester:
BIOL 1131 – Anatomy & Physiology 2
4
0
4
RPTT 1220 - Respiratory Procedures 1
3
3
4
RPTT 1221 - Respiratory Procedures 2
2
0
2
RPTT 1223 - Pathophysiology
3
0
3
RPTT 1290 - Clinical Application 1
0
4
1
Totals
12
7
14
Summer Semester:
BIOL 3750 - Microbiology
4
0
4
RPTT 1330 - Pediatric & Neonatal Respiratory Care
2
3
3
RPTT 1332 - Cardiopulmonary Diagnostics
2
3
3
RPTT 1390 - Clinical Application 2
0
16
4
Totals
8
22
14
Fall Semester:
ENGL 1102 – English 1
3
0
3
RPTT 2110 - Continuous Mechanical Ventilation
3
3
4
RPTT 2190 - Clinical Application 3
0
16
4
XXXX
1
- General Studies Elective 1
3
0
3
Totals
9
19
14
Spring Semester:
ENGL 1105 – English 2
3
0
3
RPTT 2220 - Respiratory Procedures 3
3
3
4
RPTT 2290 - Clinical Application 4
0
16
4
RPTT 2999 - Special Topics in Respiratory Therapy
1
0
1
XXXX
1
- General Studies Elective 2
3
0
3
Totals
10
19
15
1
General Studies Electives must be Humanities or Social Sciences courses approved by the Program Leader
and may include, but are not limited to, courses of study in the following areas: Anthropology, English, Philosophy,
Psychology and/or Sociology.
Shawnee State University
Respiratory Therapy Program
Student Shadowing Form
Date:__________________________
Prospective student’s name (please print):
____________________________________________
Medical Center at which student is shadowing (please print):
____________________________________________
Time spent at the hospital for the shadowing experience:
____________________________________________
By my signature, I declare the student listed above has participated in a shadowing experience, under my
supervision, at the facility listed above:
Signature of Therapist ________________________________________________
Therapist phone # ___________________________________________________
Signature of student__________________________________________________
There are no mandatory, minimum amount of time required for shadowing.
Schedule is dependent upon available time at the shadowing site.
Return this completed form to Office of Admission, Shawnee State University
940 2
nd
Street, Portsmouth, OH 45662
