Radiologic Technology Pre-Registration Screening Form This form serves as the Pre-Registration Screening for the CNM Radiologic Technology Program. Need Help? If you have any questions about this form, please call (505) 224-4111 or email cpe@cnm.edu before submitting. Before Submitting This Form Please read the screening criteria and guidelines for the Coordinated Entry Programs. Please read the instructions for the Radiologic Technology Program Pre-Registration Screening Form. You cannot "save" your work and return to it later. Submission of your form does not guarantee you a seat in the program. Screening forms will not be considered for students who have not been admitted to CNM. Last Name First Name CNM ID Number Primary Phone Please include area code when entering phone number (XXX) XXX-XXXX CNM E-Mail Address NOTE: This is the ONLY way we will contact you regarding your screening form. Make sure the address is working properly and check your account frequently. If you are experiencing any difficulties, contact Information Technology Services (ITS) at at (505) 224-4357. Entrance Examination Completion Requirement Select which entrance examination you have completed. HESI A2TEAS V (for Allied Health) TEAS for Allied Health Entrance Exam The program allows minimum required scores in Reading, Math, English and Science sections to be obtained through multiple attempts. However, each exam attempt must have a minimum overall score of 60.00%. Please enter the date(s) you passed each section of the TEAS for Allied Health exam below. Reading Section Enter the date you successfully reached the minimum required score of 70.30% (or higher) for the Reading portion of the TEAS for Allied Health Exam. Math Section Enter the date you successfully reached the minimum required score of 67.90% (or higher) for the Math portion of the TEAS for Allied Health Exam. Science Section Enter the date you successfully reached the minimum required score of 47.40% (or higher) for the Science portion of the TEAS for Allied Health Exam. English Section Enter the date you successfully reached the minimum required score of 58.50% or higher for English portion of the TEAS for Allied Health Exam. HESI Test Date Enter the date you successfully completed the HESI exam. Enter the testing date in which you scored at least a 75% in all six areas: Reading, Vocabulary, Grammar, Math, Biology and Chemistry. If you met this requirement on more than one testing date, choose the exam with the highest cumulative score. Exam dates must be from the past year. Substitutions/Transcript Issues If you received an official substitution for a course or have other transcript issues, please write a note here. If this does not apply to you leave blank. characters remaining Information and Acknowledgements For each of the following statements click the box to acknowledge you understand that you have met/will meet the following requirements. If you have any questions on any of these statements, please contact (505) 224-4111 or email cpe@cnm.edu before submitting this form. I understand that I must meet the minimum requirements for this program: Minimum Cumulative GPA of 2.75, Required Prerequisite Courses (finished or in progress), TEAS for Allied Health (formerly named the HOBET or the HESI A2) exam scores. I understand that there are limited seats for this program. I am responsible for registering for courses at the assigned date and time given to me if I am approved for registration. Enrollment is this program not guaranteed. I understand and verify that I meet the technical requirements to participate in the clinical education portion of this program and understand that if reasonable accommodations are needed I am to contact the Disability Resource Center. To view the technical requirements for the Radiologic Technology Program, please visit O*NET OnLine. I understand that failure to submit transcripts or meet program requirements will delay the approval of my Pre-Registration Screening form. I also understand that it is my responsibility to resolve any holds that may appear on my student account. I understand the information listed regarding re-entry into Term 1 of the Radiologic Technology program. It is my responsibility to review my unofficial transcripts through myCNM for previous attempts. For more information, visit the Re-Entry page. I understand that if I register for this program, I must complete pre-clinical requirements by a deadline. For more information on specific compliance requirements for this program visit the Office of Verification and Compliance. I understand that admittance into this clinical program is dependent upon acceptable results from a New Mexico Department of Health Background Screening, Urine Drug Screening and proof of specific immunizations. Failure to meet these compliance expectations will result in your removal from this program. I have read and understand the High Ethics’ Standards for the Radiologic Technology Program and career. Mandatory Ethics Requirements. I understand that if I have any unethical conduct in my past I must report this conduct to the ARRT (when applicable). Past unethical conduct may/may not exclude me from sitting for the ARRT Examination and/or exclude me from obtaining gainful employment once I graduate. I understand that I must become familiar with the School of Health, Wellness, and Public Safety Handbook. The School of Health, Wellness, and Public Safety Handbook. Signature My signature confirms that I have read and agreed to all of the terms and conditions required to qualify to register for this program. Spam Check When you click "submit" a screen will appear that will notify you that your form was submitted successfully. You will also receive an email confirmation to your CNM email account.