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APPLICATION FORM-RESPIRATORY THERAPY PROGRAM—INDIANAPOLISNameStudent C #AddressCity State Zip CodeCell Phone NumberSecondary Phone Number Email Address you check frequentlyright-6858000-1882140-446659000This is to inform you that I am applying to the Respiratory Care Program at Ivy Tech Community College of Indiana, Indianapolis. I have completed or am in the process of completing the 4 general education courses required for the application process. If I have a current license and working in any of the following fields, I’ve attached proof of my license/certifications: RN, LPN, Military Medic, EMT, or Paramedic. ____________________________________________________ ________________________Applicant’s SignatureDateCharity Bowling, MA, RRT 4/8/2020Faculty SignatureDateI acknowledge by checking the box below that I have received, read and understand the key points in the PowerPoint provided to me. It is my responsibility to email the Program Chair Charity Bowling, MA, RRT at cbowling17@ivytech.edu with any questions I might have about the application process and the program. I also understand an electronic copy of the following documents make up the application and the Program Chair must receive them by MAY 15, 2020 11:59 p.m. to be considered for the class that starts August 2020. Email the following documents:Application FormUnofficial Copy of your transcriptsIvy Tech transcriptsTranscripts from other colleges that have not been transferred into Ivy Tech and have courses that are being considered for the application processAny certificates/license that are active from RN, LPN, Military Medic, EMT, or Paramedic 62484068580CHECK BOX INTICATING YOU HAVE READ THE ABOVE INFORMAITON ................
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