Diagnostic MedicalSonography Program -Application

Diagnostic Medical

Sonography Program -

Application

Albany State University

Darton College of Health Professions

Health Sciences Division – DMS

2400 Gillionville Road

Albany, GA 31707

CONTACT INFORMATION

Last Name:*

First Name:*

Middle Initial:

Preferred Name (if different):

Date of Birth:*

Current Street Address, Apartment Number, or P.O. Box:*

City:*

State:*

Select

Zip Code:*

Permanent Street Address, Apartment Number, or P.O. Box:

City:

State:

Select

Zip Code:

E-mail (please provide the one most frequently checked):*

Cell Phone Number:*

ASU Ram ID #:*

EDUCATIONAL BACKGROUND

* If you attended a College/University other than Albany State University, please include an unofficial transcript (for each) with this application.

High School Name:*

City:*

State:*

Select

Date of Graduation or GED:*

1) College/University Name:*

City:*

State:*

Select

Date (Start):*

Date (End):*

Degree and Major (if applicable):*

Degree Received?*

Yes

2) College/University Name:

City:

State:

Select

Date (Start):

Date (End):

Degree and Major (if applicable):

Degree Received?

Yes

OBSERVATIONAL HOURS (a minimum of 30 hours must be completed prior to June 1st)

Please summarize your observational hours as indicated below. Be sure to include the verified/signed documentation of hours with the application.

1) Name of Facility/Office:

Type of Setting:

Hospital

Physician Office

Outpatient Imaging Center

Other

Number of Hours in EACH Setting (be specific):

2) Name of Facility/Office:

Type of Setting:

Hospital

Physician Office

Outpatient Imaging Center

Other

Number of Hours in EACH Setting (be specific):

3) Name of Facility/Office:

Type of Setting:

Select

Number of Hours in EACH Setting (be specific):

4) Name of Facility/Office:

Type of Setting:

Hospital

Physician Office

Outpatient Imaging Center

Other

Number of Hours in EACH Setting (be specific):

TOTAL OBSERVATIONAL HOURS:

Required Documents Upload

PLEASE USE THIS SECTION TO ATTACH THE FOLLOWING REQUIRED DOCUMENTS:

This form must be received no later than June 1st.

You will receive correspondence from the DMS Program Director via email by June 15, which is 2 weeks past the deadline of June 1st. Please do not call to inquire about the status of an application. The DMS Program Director will not return calls or emails regarding the status of an application (with the exception being after June 15th and the applicant never received an email). Therefore, if you wish to know the application was received, please send the application as certified mail so that you receive a confirmation from the postal service that it was delivered. If you wish to know if your application was complete, please read all directions and utilize the checklist below.

Observational Hours Form

Applicants must use the observational form within this packet.

Observational hours must be completed in a sonography setting (hospital, physician office, etc). The student cannot complete observation hours at a 3D/4D facility.

All observation hours must be completed prior to the deadline of June 1st.

Recommendation Form(s)

May be mailed separately from the application by the Sonographer completing the form. The student should provide a pre-addressed envelope with postage to Sonographer completing the form.

At least one recommendation form is required; however, up to three recommendation forms may be completed. Applicants must use the recommendation form within this packet. If additional recommendation forms are needed, the applicant can make copies as needed.

Copy of Unofficial Transcripts

Only required if you attended a College, University, or Technical Institution other than Albany State University.

Additional Documentation (not required)

Documentation for previously earned degrees, certificates, and work experience (healthcare related), if applicable, must be attached to the application packet.

Documentation of work experience must be on company letter head and contain a description of job duties that demonstrates hands on patient experience and must be signed by immediate supervisor, if applicable.

File Upload:*

Drag and drop files here or

Observational Hours Form?*

Recommendation Form(s)?*

Copy of Unofficial Transcripts?*

Additional Documentation?*

SIGNATURE

I hereby apply for admission to the Diagnostic Medical Sonography Program for the Fall Semester listed below and certify this application is both correct and complete. I have read the application packet, including the technical standards required for the profession and understand the application and selection processes. I further understand that any failure on my part to comply with these processes will result in the cancellation of my application. I am aware of the competitive nature of the application process for the DMS program and understand that meeting all minimum requirements does not guarantee admission into the program.

Have you previously applied to the ASU/Darton State College Diagnostic Medical Sonography Program?*

Yes

If yes, when?

Fall Semester:*

Fall 2025

Fall 2026

Fall 2027

Fall 2028

Applicant’s Signature:*

Signature Date:*

Personal Identifiable Information (PII) Notice:

All personal data and special categories of sensitive personal data collected or processed by Albany State University (ASU) must comply with the ASU Cybersecurity Program Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity:

https://www.usg.edu/policies

Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to:

LegalAffairs@asurams.edu

Otherwise, questions concerning GDPR can be forwarded to LegalAffairs@asurams.edu. Typing your name in the box below and submission of this application provides consent to and acknowledgment of the ASU Data Security and Privacy Policy.

Please check the box below to indicate that you have read and understood the PII policy above.

Personal Identifiable Information (PII) Consent:*

Send me a copy of my responses

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