The Hoffman Heart and Vascular Institute School of Cardiac Ultrasound

The Hoffman Heart and Vascular Institute School of Cardiac Ultrasound

114 Woodland Street

Hartford, CT 06105

1-860-714-5698 (Phone)

1-860-714-8001 (FAX)

Name of program: (Choose one) Adult echocardiography ______

Pediatric echocardiography ______

Applicants must submit a $50.00 non refundable fee to The Hoffman Heart and Vascular Institute School of Cardiac Ultrasound

Complete all information as requested on the application and FAX it to 1-860-714-8001 or Scan and email it back to .

Incomplete applications will not be processed.

Name ______

Mailing Address ______

City ______State ______Zip ______

Residence Address (If different from Mailing Address) ______

______

City ______State ______Zip ______

Contact Phone Number (_____) ______Email Address ______

Please Note CCI/ARDMS rules indicate that they may take action against an applicant, candidate, or Registrant in the case of conviction, plea of guilty or plea of nolo contendere to any crime. If you are presently charged with, or been convicted or found guilty of or plead nolo contendere to any crime (felony and/or misdemeanor), other than a speeding or parking violation, you may have questions concerning this rule and may wish to obtain clarification as to how it pertains to your circumstances.

Cardiovascular Credentialing International

http://www.cci-online.org/

American Registry of Diagnostic Medical Sonographers® (ARDMS®)

http://www.ardms.org/

Official copies of all high school and college transcripts must be sent to the program director Richard Palma BS, RDCS, RCS, APS, FASE 114 Woodland Street Hartford, CT 06105

Please also send essay, resume and two letters of References. One personal and one professional.

School of Cardiac Ultrasound

Application Essay

Your completed application includes an essay about your future goals in the field of sonography.

The following questions are listed to help you formulate your ideas. Please answer all of the

following questions in your essay:

1. How did your interest in Sonography develop?

2. What awards, academic or otherwise, have you received that have helped prepare you for

a career in cardiac ultrasound?

3. What outside interests or hobbies do you have?

4. How has your formal training prepared you for a career in Sonography?

5. What specific experiences have you had in the medical field that have influenced your

career choice?

6. What personal characteristics do you feel would be the most helpful to a person who

chooses a medical career?

I hereby certify that my answers to the above questions are true and that any falsification, misrepresentations or omission of facts may disqualify me or cause my termination.

Date ______Signature ______

Please be advised that all information you provide will be shared with the members of the Admission Committee and will subsequently be kept on file in the office of the The Hoffman Heart and Vascular Institute School of Cardiac Ultrasound