Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Steps to completing your application

Hello and thank you for applying to the Washburn University Diagnostic Medical Sonography (DMS) Program. Please read this document thoroughly. Incomplete applications will be scored accordingly or discarded. There are some specific instructions that you must follow for us to evaluate your application.

First, watch this short video: http://www.screencast.com/t/GczDi2TrqDA1 Complete the DMS Application by: 1. Download the DMS application 2. Open the fillable PDF Form and save it as: last name.first name (ex: Farwell.Keith) 3. Type in your information where applicable (handwritten applications WILL NOT be accepted) 4. Save your application 5. Print your application. 6. Sign and date all signature areas (these must be real signatures) 7. Include all of the items listed in the checklist in sealed manila envelopes 8. Make sure your application is in the order specified on the checklist 9. Mail your application in a manila envelope big enough to hold all documents a. emailed or faxed applications are not accepted b. Do not fold, staple, or paperclip any part of your application Washburn University Attn: Marie Valdivia Allied Health Department, Diagnostic Medical Sonography, BE107 1700 SW College Topeka, KS 66621

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Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Application Student Checklist

Initial that each step is complete. If there is no initial, then you are missing required materials. These are the required application documents. Application should be in this order. 1. Application Checklist 2. Application with signatures and dates a. Narrative Questions b. Technical Standards Signature c. BHS Understanding Signature d. Cover Letter e. Resume f. Letter of Recommendation #1 g. Letter of Recommendation #2 h. Observation Form i. Observation Evaluation j. Copy of diploma of degree k. Transcript Form l. Official Transcripts Applicant Initials

Signature (must be signature – not electronic)

Office Initials Office use only

Date

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Application

Last

First

WU ID or Last 4 of SSN

MI

Cell phone

Street Address

Maiden

other phone

City

State

Zip

Are you a US Citizen? Yes No If No, are you applying as an international student? Yes No What type of VISA are you here under? If you are not a US Citizen, please contact mailto:[email protected] to determine if you are eligible to take online courses in the US. Sonography Program Applying for Cardiac

General/Vascular

Vascular

General

Do you have any sonography experience?

Yes

No

Do you already have clinical placement?

Yes

No

If yes, where and contact: Allied Health/Medical Degree Background (must have an AS or higher) X-Ray

Respiratory Therapy

Occupational Therapist Assistant

RN

LPN

Physical Therapist Assistant

Other direct patient care specialty that has been pre-approved by Program Faculty (Other specialty & degree level) Degree(s) Earned:

Associates

Baccalaureate

Masters

Doctor

I certify that the above information is correct and complete. I understand that all transcripts from colleges attended must be on file with the DMS program before I will be eligible for consideration of admission into the Diagnostic Medical Sonography program. I understand that I am responsible for notifying the DMS faculty of any changes of address or phone.

Signature (must be signature – not electronic)

Date

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Narrative Question 1

Why do you want to pursue diagnostic medical sonography as a profession?

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Narrative Question 2 What job experiences, work skills, direct patient care skills do you possess that you feel will make you an empathetic, hard-working, and detail oriented sonographer?

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Narrative Question 3 Tell us of your professional goals that you want to achieve.

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Narrative Question 4 Tell us how you handled a difficult clinical/work experience dealing with a patient or co-worker. What skills did you use to promote a healthy workplace environment?

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Narrative Question 5 Tell us why sonography is important in the healthcare field.

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Narrative Question 6 Optional: Is there anything in your academic history which needs an explanation? Examples include poor grades, incompletes, dismissal, etc. Have you taken online courses before? If not, how are you preparing for a different style of learning? Sometimes, students “think” that online courses are going to be easy. I want to ensure you that ours are not…they are proctored and demand a lot of dedication and discipline to do well. Do not plan on working to much while in the program. Often times students end up not working at all or less than 15-20 hours a week to keep up with studies.

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Technical Standards – Page 1 The technical standards have been established through consideration by faculty and consultation with the following sources: The Vocational Rehabilitation Act; The Americans with Disabilities Act; Guide for Occupational Information; Dictionary of Occupational Titles; and the Occupational Skills Standards Project from the National Health Care Skills Standards Projects. Please read the following statements identifying the technical standards appropriate to Diagnostic Medical Sonography and answer the question on the last page. Physical Demands  Candidates must have the emotional and physical health sufficient to meet the demands of the position. Strength must be sufficient to lift some patients, move heavy equipment on wheels (up to approximately 500 lbs.), and to move patients in wheelchairs and stretchers. The candidate must also be able to maintain prolonged arm positions necessary for scanning. See the following list for additional technical standards related to the physical demands of Diagnostic Medical Sonographers. o Lift more than 50 lbs. routinely & push and pull routinely o Bend and stoop routinely & work standing on your feet 80% of the time o Have full use of both hands, wrists, and shoulders o Distinguish audible sounds o Adequately view sonograms, including color distinctions o Interact compassionately and effectively with the sick or injured o Assist patients on and off examining tables o Organize and accurately perform the individual steps in a sonographic procedure in the proper sequence Motor Skills  Must possess sufficient motor function to elicit information from patients by palpation, auscultation, percussion and other evaluation procedures. Candidates must be able to execute motor movements including the physical/dexterity strength to stand and ambulate and possess the physical/dexterity strength to lift and transfer patients. Candidates must also have the physical strength to perform cardiopulmonary resuscitation.  Diagnostic Medical Sonography procedures require coordination of both gross and fine muscular movements, equilibrium, and functional use of the senses of touch and vision. For this reason, candidates for admission to the Program of Diagnostic Medical Sonography must have manual dexterity and the ability to engage in procedures involving grasping, pushing, pulling, holding, manipulating, extending and rotating. Sensory / Observational Skills  Candidates must be able to observe demonstrations and participate in laboratory experiments as required in the curriculum. Candidates must be able to observe patients and be able to obtain an appropriate medical history directly from the patient or guardian. Such observation requires the functional use of vision, hearing, and other sensory modalities. Candidates must have visual perception which includes depth and acuity and must be able to distinguish the color spectrum.

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Technical Standards – Page 2 Communication Skills  Candidates must be able to communicate in English effectively and sensitively with patients. In addition, candidates must be able to communicate in English in oral and hand written form with faculty, allied personnel, and peers in the classroom, laboratory, and clinical settings. Candidates must also be sensitive to multicultural and multilingual needs. Such communication skills include not only speech, but reading and writing in English. Candidates must have the ability to complete reading assignments and search and evaluate the literature. Candidates must be able to complete written assignments and maintain written records. Candidates must have the ability to complete assessment exercises. Candidates must also have the ability to use therapeutic communication, such as attending, clarifying, coaching, facilitating, and touching. These skills must be performed in clinical settings, as well as the didactic and laboratory environments. Intellectual / Conceptual, Integrative and Qualitative Skills  Candidates must have the ability to measure, calculate, reason, analyze, and synthesize data. Problem solving and diagnosis, including obtaining, interpreting, and documenting data, are critical skills demanded of Diagnostic Medical Sonographers which require all of these intellectual abilities. These skills allow students to make proper assessments, sound judgments, appropriately prioritize diagnostic procedures and measure and record patient care outcomes. Candidates must have the ability to learn to use computers for searching, recording, storing, and retrieving information. Behavior / Social Skills and Professionalism  Candidates must demonstrate attributes of empathy, integrity, concern for others, interpersonal skills, interest, and motivation. Candidates must possess the emotional well-being required for use of their intellectual abilities, the exercise of sound judgment, the prompt completion of all responsibilities attendant to the evaluation and care of patients, and the development of mature, sensitive, and effective relationships with patients. Candidates must be able to adapt to ever-changing environments, display flexibility, and learn to function in the face of uncertainties and stresses which are inherent in the educational process, as well as the clinical problems of many patients.  Candidates must be able to maintain professional conduct and appearance maintain client confidentiality and operate within the scope of practice. Candidates must also have the ability to be assertive, delegate responsibilities appropriately, and function as part of a medical team. Such abilities require organizational skills necessary to meet deadlines and manage time.

Are you able to perform all of the technical standards (page 1 and page 2) identified in the Washburn University Diagnostic Medical Sonography Program Technical Standards? Yes

Signature (must be signature – not electronic)

No

Date

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography BHS Understanding

The Washburn University Diagnostic Medical Sonography Program is an Advanced Certificate. It is a postAssociates certificate but the courses taken in the DMS program count towards the BHS degree with a major of Medical Imaging. Not all DMS applicants come in with a background that would automatically qualify you for the Bachelors of Health Science Program (BHS). The BHS program has its own application process. Any student interested in the BHS program must contact the BHS program director to determine if he/she qualifies for that program. Being accepted into the DMS program does not necessarily qualify you for the BHS program. Please review the BHS program information at: www.washburn.edu/bhs As a student applying for the DMS program, I hereby understand that I might not qualify for the BHS program at Washburn University.

Signature (must be signature – not electronic)

Date

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Insert a copy of your cover letter here

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A copy of your resume goes here

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Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Reference Letter Instructions

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Letter of Recommendation Instructions  If you are a recent graduate (within the last two years) of a 2 year allied health program, one of the reference letters MUST be from the program director or clinical coordinator.  The reference letters MUST be from a medical professional (supervisor, lead tech, director, or physician that you directly work with). ABSOLUTELY no personal friends, family members, or people who you do not directly work with in a medical setting.  You will provide a sealable manila envelope along with the reference letter to the referrer.  Instruct them that they should seal and sign the back of the envelope flap.  Include both letters of recommendation with your application packet. (Remember: no staples, folding, paperclips, etc.).  Do not forget to print (all 4 pages) and sign your name on the letters of recommendation  The letters of recommendation should be included in the application, NOT directly mailed to the program faculty. This is a good way to lose the referral. You may need to return to the referrer to pick up the sealed envelope to include with the application packet.

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Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Reference Letter #1 – Page 1 Applicant: Under the Federal law entitled the Family Educational Rights and Privacy Act of 1974, students are given the right to inspect their records, including letters of recommendation. While we shall consider all letters of recommendation carefully, we believe that in many instances letters written in confidence in the long run are of greater use in the assessment of a student's qualifications, abilities, and promise. I ____do ____do not waive my right to review the content of this form.

Applicant (print):

Date:

Signature:

To the Reference: The person listed above is applying to the Washburn University Diagnostic Medical Sonography Program. Please read and complete the following reference form as honestly as possible. Please indicate your impression of this applicant with regard to each of the following factors by checking the appropriate rating.

FACTORS Motivation: genuineness & depth of commitment. Maturity: personal development, ability to cope with life situations. Ability to Perform Under Adverse Conditions: performance under pressure, response to conflict. Interpersonal Relations: Ability to get along with others, rapport, cooperation; team building, attitudes toward supervision. Critical Thinking: ability to problem solve; correlate and process information. Reliability: dependability, sense of responsibility, promptness, conscientiousness. Communication Skills: clarity of expression, articulate in both spoken & written form. Self-Confidence: assuredness, capacity to achieve with awareness of own strengths and weaknesses Personal Appearance: neat, tidy, orderly, clean. Quality of Work: accuracy, consistency, timeliness

LOW 1

2

MED 3

4

HIGH 5

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Reference Letter #1 – Page 2 Applicant name (print): How well do you know the applicant? (Circle one)

Very well

Fairly well

Slightly

How long have you known the applicant? __________ Relationship: Are you related to the applicant?

Yes

No

Did the candidate provide a sealable envelope for you? ____Yes _____No In the space provided, please discuss the characteristics of the applicant you feel will make him/her a competitive candidate for the Diagnostic Medical Sonography Program. Positive Attributes:

Areas of Improvement:

_____ I recommend this applicant with confidence _____ I recommend this applicant _____ I recommend this applicant with some reservations _____ I do not recommend this potential student for admission Referrer Information: Name: Occupation:

Facility:

Address:

City:

Telephone:

E-mail:

Signature:

ST:

Zip:

Date: RETURN TO: Candidate in sealed envelope with your signature across the flap

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Reference Letter #2 – Page 1 Applicant: Under the Federal law entitled the Family Educational Rights and Privacy Act of 1974, students are given the right to inspect their records, including letters of recommendation. While we shall consider all letters of recommendation carefully, we believe that in many instances letters written in confidence in the long run are of greater use in the assessment of a student's qualifications, abilities, and promise. I ____do ____do not waive my right to review the content of this form.

Applicant (print):

Date:

Signature:

To the Reference: The person listed above is applying to the Washburn University Diagnostic Medical Sonography Program. Please read and complete the following reference form as honestly as possible. Please indicate your impression of this applicant with regard to each of the following factors by checking the appropriate rating.

FACTORS Motivation: genuineness & depth of commitment. Maturity: personal development, ability to cope with life situations. Ability to Perform Under Adverse Conditions: performance under pressure, response to conflict. Interpersonal Relations: Ability to get along with others, rapport, cooperation; team building, attitudes toward supervision. Critical Thinking: ability to problem solve; correlate and process information. Reliability: dependability, sense of responsibility, promptness, conscientiousness. Communication Skills: clarity of expression, articulate in both spoken & written form. Self-Confidence: assuredness, capacity to achieve with awareness of own strengths and weaknesses Personal Appearance: neat, tidy, orderly, clean. Quality of Work: accuracy, consistency, timeliness

LOW 1

2

MED 3

4

HIGH 5

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Reference Letter #2 – Page 2 Applicant name (print): How well do you know the applicant? (Circle one)

Very well

Fairly well

Slightly

How long have you known the applicant? __________ Relationship: Are you related to the applicant?

Yes

No

Did the candidate provide a sealable envelope for you? ____Yes _____No In the space provided, please discuss the characteristics of the applicant you feel will make him/her a competitive candidate for the Diagnostic Medical Sonography Program. Positive Attributes:

Areas of Improvement:

_____ I recommend this applicant with confidence _____ I recommend this applicant _____ I recommend this applicant with some reservations _____ I do not recommend this potential student for admission Referrer Information: Name: Occupation:

Facility:

Address:

City:

Telephone:

E-mail:

Signature:

ST:

Zip:

Date: RETURN TO: Candidate in sealed envelope with your signature across the flap

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Observation Instructions

~DO NOT INCLUDE THIS PAGE IN YOUR APPLICATION~ A requirement of the admissions process is a minimum of four (4) hour observation with a sonographer. You will want to do this observation at a facility that you would like to do your clinical rotations. We will contact the facility regarding placement after you send us your application. During your observation, you will be observing various exams. Strict confidentiality regarding each patient must be maintained. You should dress and act professionally. You should treat this as an interview as you are observing there to hopefully do your rotations at the facility. If you have questions about appropriate attire may be directed to the observation site. Upon completion of the observation, complete the summary questions in the application. The Observation Summary is a scored element of the application review process. The review committee will assess both content and form. The document should be well written. Respond to all questions in complete sentences and exhibit knowledge about the field and role of a sonographer.

Observation Instructions  Call a local hospital to set up an observation date and time. If the facility will not allow observations, you will need to reach out to another hospital  Complete the observation, make sure to give the sonographer the Observation Evaluation  Complete the Observation Summary questions  We will contact the site when reviewing applications. If a site says they would like to take you as a student, then you would move on to the next steps. If the site says they are not taking students at this time, the observation process must be repeated each time you wish us to contact a new facility to see if they will consider you as a student. This process continues until we find a willing site, the applicant can’t commute the distance to a facility, or we reach our deadline where we discontinue looking for sites.  Do not ask if they will take a student when scheduling an observation. Your observation is like an interview. Depending on how you do, they may change their mind if they are impressed with you. Obstacles to Site Placement  Local sonography programs already have established contracts with the facilities in your area  Staffing changes at the facility  The facility does not meet accreditation requirements (volumes or no registered sonographers)  The facility would not respond to our inquiries  The facility does not want a student at this time How to improve Clinical Site Placement Chances  Gain employment at a hospital, particularly the sonography department if possible  Get to know the sonographers at a hospital/medical center  Volunteer in a sonography department  Complete an educational background that clinical sites prefer (x-ray, respiratory, physical therapy, nursing, or occupational therapy)

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Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Observation Summary Questions

Applicant Name: Facility Name:

Date of Observation: City:

State:

Sonographer Name & Credentials: Work email address:

Length of observation: Department phone number:

Exams observed (circle all that apply): Cardiac: Adult TTE, TEE, other: Vascular: Arterial, Venous, Vein Oblations, Mappings, other: General: Abdomen, OBGYN, Breast, other: Discuss the types of procedures you observed:

List five duties sonographers do on a daily basis:

After observing the duties and work environment of a sonographer, do you feel you have the physical and mental capabilities to perform these task on a routine basis? Explain:

Explain your personal reaction to the observation experience:

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Observation Evaluation Instructions

~DO NOT INCLUDE THIS PAGE IN YOUR APPLICATION~ Towards the end of your observation, you will want to give the following evaluation to the sonographer. You will need to provide a sealable manila envelope to the sonographer. You may have to return the following day to pick up a completed evaluation. Instructions 1. Give the Observation Evaluation and a sealable manila envelope to the sonographer you followed (Remember: no staples, paperclips, or folding of papers). 2. Make sure to put in your name, date, and facility name prior to giving it to the sonographer 3. You many need to leave the room for a while or even pick it up the next day 4. When you pick it up, make sure they signed it across the flap 5. Include this document with the application just like the others If the sonographer(s) state while you are there that they do not take students, you should continue to observe to maintain professionalism. If they are impressed with your eagerness, professionalism, personality, and conduct they may change their mind and want to host you.

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Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Observation Evaluation Prospective diagnostic medical sonography students are required to spend a minimum of four (4) hours in a clinical setting observing the functions of the Sonography Department. The supervising sonographer during the observation should complete this form at the conclusion of the observation. The feedback provided on this form is extremely important to the application review committee. Please provide direct feedback that truly reflects the students’ performance during the observation experience. Once completed, the sonographer should insert this form in the manila envelope provided by the student. Please seal the envelope, sign the flap and return the sealed document to the applicant to submit with other application forms. Scoring is 5=highest and 1=lowest. Applicant Name (Please Print): Facility Name:

Date of Observation: City:

State:

Sonographer Name & Credentials (Please Print): Email:

Phone:

Initiative Took the initiative to observe all procedures & related activities Professionalism Was polite and courteous in interactions with others Maintained appropriate decorum in the presence of patients Communication Articulated questions or comments in an understandable manner Asked questions appropriate to the profession Appearance Dressed appropriately for the work environment Displayed suitable hygiene Comments:

1

2

3

4

5 (highest)

1 1

2 2

3 3

4 4

5 5

1 1

2 2

3 3

4 4

5 5

1 1

2 2

3 3

4 4

5 5

Would this applicant be someone you would consider having as a student? YES NO May we contact you or someone else about a possible student placement? YES NO Who would be the correct person to ask? Name: Email: If you have any questions about clinical placement/requirements, please contact Terry Sorensen at [email protected] or 785-670-2294

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A page with a copy of your diploma of degree you marked on the face sheet (if still in school insert statement page stating you don’t have one yet)

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Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Transcript Instructions

~DO NOT INCLUDE THIS PAGE IN YOUR APPLICATION~

Transcript Instructions  Only higher education transcripts are accepted  Only official transcripts will be accepted (in sealed envelope). o This is a separate set of official transcripts for our program records, you must supply an official set upon university application as well  Complete the transcript form by entering the required information. Put your highest grade in each category. For example, if you have 3 English classes, put the highest grade in the appropriate place. Foreign transcripts  Must be evaluated on a class by class level by Education Credential Evaluators, Inc. or WES (see instructions in the International Student Admission section). Any foreign transcript not evaluated by ECE will not be evaluated

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Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Transcripts Form The following courses must be completed from an accredited higher education institution with a letter grade of C or better. Hospital based work is not acceptable, the courses MUST be for college credit.  Medical Terminology  Statistics, Intermediate Algebra, or higher mathematics course  General college-level physics and/or radiographic physics  Communication Skills (English, speech, or composition)  Human Anatomy (can be combined with Physiology)  Human Physiology (can be combined with Anatomy) State which courses you feel meet the above requirements by filling out this form. If multiple courses qualify, list the one with the highest grade. Medical Terminology Course # and name: Grade:

Semester and year completed:

Course in process, semester and year to be completed: Statistics, Intermediate Algebra, or higher mathematics course Course # and name: Grade:

Semester and year completed:

Course in process, semester and year to be completed: General college-level physics and/or radiographic physics Course # and name: Grade:

Semester and year completed:

Course in process, semester and year to be completed: Communication Skills (English, speech, or composition) Course # and name: Grade:

Semester and year completed:

Course in process, semester and year to be completed: Human Anatomy (can be combined with Physiology) Course # and name: Grade:

Semester and year completed:

Course in process, semester and year to be completed: Human Physiology (can be combined with Anatomy) Course # and name: Grade:

Semester and year completed:

Course in process, semester and year to be completed:

Washburn University School of Applied Studies – Allied Health Diagnostic Medical Sonography Transcripts

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Your transcripts should go here

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