School of Nuclear Medicine Technology Applicant Checklist (pg of 2) Name (please print) Date (MM.DD.YYYY) Your application and all supporting documentation may be submitted beginning October 1st and must be submitted no later than February 1st Please complete both pages of Checklist and include with application for School of Nuclear Medicine Technology General Education and Prerequisite Courses (All requirements must be completed or in progress prior to admission.) Course Credits Grade Year Completed College where course taken Human Anatomy & Physiology I with a lab** Human Anatomy and Physiology II with a lab** College Algebra or higher Math Statistics Written Communication Speech Communication Humanities Course Social Science Course General Physics I** General Physics II** General Chemistry I with a lab** General Chemistry II with a lab** Institution Completion of Bachelor’s Degree or Enrolled at NMT Academic Affiliate Date Completed Type of Degree Earned A grade of "C" or higher in each course and a GPA of 2.5 or higher is required for these prerequisite courses Students must also have a cumulative GPA of 2.5 or higher **Course work must be completed within the last years School of Nuclear Medicine Technology Applicant Checklist (pg of 2) Bachelor’s degree with prerequisite courses completed, or enrolled in a NMT program academic* affiliate _ *Benedictine University, DePaul University, Elmhurst College, Lewis University, North Central College, Roosevelt University, University of St Francis, University of Wisconsin – La Crosse _ Minimum 2.5 GPA in prerequisite courses and in overall GPA _ Submission of all sealed official college and university transcripts Submission of application form, essay, fee, checklist, signed Technical Standards form, and sealed official Letters of Recommendation (from an educator or supervisor) _ NMH Clinical School’s application, Letter of Recommendation form, and Technical Standards form are found on the NM Clinical schools website: www.nmh.org/clinicalschools _ Mandatory shadow experience* at NMH Date of shadow: _ *Please note if out-of-state of applicant _ _ Citizen of the United States or hold permanent resident status Completion of evaluation of foreign transcripts, from outside the United States, by _ the Educational Credentials Evaluators, Inc (ECE) Bachelor Degree and pre-requisite course equivalencies must be documented _ Applicants whose native language is not English must submit official TOEFL Internet-based (iBT) scores; a minimum score of 88 is required for admission consideration _ Submission of all required documents by February 1st application deadline Submission of the TOEFL scores by application deadline, (if needed)