Rose State College > Form Test 2026 B

Form Test 2026 B

Respiratory Therapist Program Application for Admission

NAME(Required)
YOUR CURRENT ADDRESS(Required)
YOUR PERMANENT ADDRESS(Required)
ADDRESS(Required)
PERSON TO CONTACT IF WE ARE UNABLE TO REACH YOU OR IN CASE OF EMERGENCY
NAME(Required)

NOTICE:

NOTIFY YOUR PROGRAM DIRECTOR SHOULD ANY OF THE FOLLOWING SITUATIONS RELATE TO YOU:
  • CONVICTED OF A CRIME OR HAVE CHARGES PENDING;
  • COMMITTED FOR MENTAL INCOMPETENCY;
  • HABITUALLY INDULGED IN OR ADDICTED TO DRUGS OR ALCOHOL
  • BEEN REMOVED FROM OR WITHDRAWN FROM ANOTHER HEALTH CARE PROGRAM

THESE CONDITIONS MAY AFFECT YOUR ELIGIBILITY FOR LICENSURE, REGISTRY OR CERTIFICATION CREDENTIALS AND CONSEQUENTLY MAY HAVE A BEARING ON EMPLOYABILITY. CLINICAL AFFILIATES REQUIRE A SEVEN YEAR NATIONAL BACKGROUND AND SEXUAL OFFENDER CHECK AND DRUG TESTING. STUDENTS WILL BE RESPONSIBLE FOR THE COST OF THESE CHECKS AND TESTS. LIKEWISE, THESE CHECKS AND TESTS MAY BE REQUIRED BY POTENTIAL EMPLOYERS.

I affirm that the information which I have provided for this application is complete and accurate. I understand that my application will not be considered until all necessary official transcripts have been submitted and the application procedures completed.

Complete and submit this form with your application for admission.
Course
Semester/Year
Where
Grade
ENGL 1113 English Comp I
ENGL 1213 English Comp II
HIST 1483 US History to 1877 OR
HIST 1493 US History since 1877
POLS 1113 American Federal Government
PSYC 1113 Introduction to Psychology
HSBC 1113 Medical Terminology
HSBC 1224 Intro to Clinical Microbiology OR
LFSC 2035 Principals of Microbiology
HSBC 2114 Human Anatomy
CHEM 1114 Introductory Chemistry
BIOL 2424 Human Physiology
Please list any course you are currently enrolled in for Spring/Summer 2026:
Please list any course you are currently enrolled in for Spring/Summer 2026:
ACCUPLACER SCORES
Have you applied to the Rose State Respiratory Therapy Program before?(Required)
Have you been enrolled in a Health Science Program previously?(Required)

APPLICATION CHECKLIST
I have:
Submitted application for admission to Rose State College(Required)
Completed a Respiratory Therapist Program application(Required)
Degree audit (only needed if transferring out of state credit)(Required)
Signed and dated the Statement of Acknowledgement(Required)
Attended (or plan to attend) a Mandatory Orientation Session(Required)
Attach any health care experience information. Health care experience must be confirmed with a reference letter documenting the length and nature of the employment or volunteer time. Shadowing experiences should include the name of the facility, the date of the shadowing, and the name of the preceptor. Confirmation with the facility of the shadowing experience will be completed by the Program Director.
Max. file size: 50 MB.
Included Accuplacer scores for reading, writing, and pre-algebra(Required)
Completed all courses with a minimum grade of “C” or higher OR am enrolled to take and complete the class during the current year Spring or Summer session. Admission to the program is contingent on a grade of “C” or higher on all courses taken after the application period.(Required)

Respiratory Therapy Program Considerations/Requirements

Transfer Students

In the event a transfer student has been expelled, suspended, or released from another institution, the Program Director may require documentation regarding the circumstances of the dismissal. This may include contacting administrative officials at the institution.

If the student is accepted into the program, the student may be asked to complete a conference report placing the student on temporary probation. Transfer credit will be reviewed and, at the discretion of the Program Director, may or may not be accepted.

Transfer students will be required to complete all competency exams before attending clinical rotations.

Criminal Background

The Program Director will consider on an individual basis admission of an applicant who has been arrested or convicted of a crime. Applicants who have been convicted of a felony may not be eligible for admission.

If accepted into the program, it is possible that a student will be denied permission to rotate at area hospitals for clinical training. All information related to criminal history is shared with the clinical sites.

Students who are denied permission to rotate through any clinical site which provides unique training that cannot be duplicated at another facility will be denied further progress in the program.

Clinical affiliates will require students to have an expanded background check. Students will be responsible for the cost of the background check, which is approximately $55.

In addition, prospective students may face challenges obtaining a license to practice following graduation. Prospective students should contact the State Medical Licensure Board prior to admission to discuss potential complications.

Drug Testing

Prior to beginning a Health Sciences Division program, students who have been conditionally accepted will be required to complete a NIDA (National Institute of Drug Abuse) Panel 10 drug test.

This test screens for amphetamines, marijuana, cocaine, PCP, opiates, benzodiazepines, barbiturates, methadone, propoxyphene, and methaqualone. Drug testing is required by health care agencies serving as clinical education sites.

A positive drug test may prevent a student from completing clinical courses or from admission to the program. Students are responsible for the cost of testing, approximately $35.00, subject to change.

A letter will be mailed to conditionally accepted students with information on the designated drug testing laboratory and deadline. Results will be maintained in strict confidentiality.

Vaccinations

Complete by enrollment period (mid-July). Vaccinations must be completed in order to enroll in the Respiratory Program.

  1. Two (2) MMR vaccinations, or positive titers for mumps, rubella, and rubeola.
  2. Two (2) Varicella vaccinations or varicella titer demonstrating immunity.
  3. TDAP vaccination within the past 10 years.
  4. A signed declination or documentation of three (3) Hepatitis B vaccinations, or a positive Hepatitis B titer.

*Complete after July 31, 2026

  1. Two (2) negative TB skin tests within the last 12 months, or documented positive TB test with negative chest x-ray, annual symptom review, and Health Department release for public contact.

The influenza vaccine is required or recommended by clinical sites early in the Fall semester. Students must either submit documentation or obtain exemptions from clinical sites.

If a COVID immunization is required by clinical sites, students will be notified. Documentation should be provided to the RT Program Director at enrollment if already completed.

CPR Certification

Current certification for the American Heart Association Healthcare Provider BLS CPR course is required. Certification must be completed before enrollment (July 2026) and remain current through at least July 2027.

Courses may be taken at Rose State College, Heartland CPR, local hospitals, or any AHA-approved provider.

Scholarships

Students must complete the General Scholarship Application to apply for all Foundation and Tuition Waiver scholarships.

General Scholarship Application

Rose State College
Respiratory Therapist Program

Statement of Acknowledgment

Physical and Mental Qualifications

The following minimal physical and mental qualifications are necessary for admission and progression through the Respiratory Therapist Program:

  • Ability to lift/carry up to 40 pounds and push/pull up to 200 pounds.
  • Ability to move around in client rooms and work areas.
  • Ability to stand/walk two-thirds of an 8 or 12-hour shift.
  • Visual acuity sufficient to assess clients and read monitors.
  • Auditory acuity sufficient to hear instructions, alarms, and auscultate sounds.
  • Motor ability to manipulate equipment and perform assessments.
  • Ability to speak, write, and comprehend English proficiently.
  • Ability to communicate professionally and establish rapport.
  • Ability to think critically and solve problems.
  • Ability to function effectively in stressful situations.

Rose State College provides reasonable accommodations for students with disabilities. Requests must be made to the Counselor for Students with Disabilities. Refer to the Rose State College Student Handbook for details.

Statement Of Acknowledgement(Required)
I understand that I must meet the above physical and mental qualifications independently or with reasonable accommodation. I understand that I am responsible for communicating requests for accommodation to the Counselor for Students with Disabilities.

Urgent Rose Alert:

Due to ongoing weather conditions, Rose State College is closed for the evening as of 6:45 PM, March 10th.