East Los Angeles College / Santa Monica College
Respiratory Therapy Program Application

Academic Year Applying for: Fall ______Check the desired campus for Associate Degree* ELAC or SMC

*If accepted you will take your first year’s courses at the above selected campusand upon program completionwill apply for your Associate Degreefrom the above selected campus. Please note that, “general education” requirements differ at each campus.

Please type or print the following information clearly / Date of Birth:
ELAC -
Applicant Name: / Student ID #: / SMC -
LastFirstM.I.
Street Address: / Phone:
City, State, Zip Code / Alt. Phone:
Email: / Social Sec. #:
(Valid SS# Required for Clinical Placement Background Check)

NOTES:Official communication will be sent to you via your email address.

Notify both campuses if any of your contact information changes.

IMPORTANT:Individuals who are accepted into the ELAC/SMC Respiratory Therapy Program must have a clear criminal background check and a negative drug test

Have you ever attended another Respiratory Therapy Program or any program which included placement in a clinical facility? Yes No If yes, when/where:______

Are you eligible to return to this program? Yes No
If No, please explain______

Program Prerequisite Courses (must be completed with a C or better prior to application)

Institution/City/State / Course # and title / Sem/Year/Units / Grade
  1. Human Anatomy w/ Lab (4**)
    ELAC - ANATOMY 1 or BIO 20
    SMC - ANATMY 1

  1. Human Physiology w/ Lab*(4**)
    ELAC - PHYSIOL 1 or BIO 20
    SMC - PHYS 3

  1. Chemistry Intro w/ Lab (4-5**)
    ELAC - CHEM 51 or 65
    SMC - CHEM 10 or CHEM 19

  1. Communication (3**)
    ELAC - COMM STUDIES 101 or 121
    SMC - COMM STUDIES11, 35, or 37

  1. Intermediate Algebra
    ELAC - MATH 125 (5**)
    SMC - MATH 18 (3**) or 20 (5**)

  1. Reading and Composition (3**)
    ELAC - ENGL 101
    SMC - ENGL 1

  1. Microbiology Intro w/Lab *(4-5**)
    ELAC - MICRO 1 or 20
    SMC - MCRBIO 1

8. Respiratory Therapy Intro (2**) ⁰
ELAC - RES TH 101
SMC - RES TH 1

*Microbiology Intro and Human Physiology must be completed within the last 7 years at the time of admission.

**Semester Units

⁰May be taken prior to admission to the program; strongly advised to be taken prior to program admission.

List ALL Colleges Attended in chronological order:

College (Name and Location): / *RT Program Use Only *
Transcripts Received 

NOTE: An official transcript (photocopies are OK) for each college attended must be attached to the application. Applications will not be considered unless all transcripts are attached. Upon admission to the program, official transcripts mailed from all colleges attended will be required with the exception of LACCD/SMC transcripts. Transcripts become property of the college.

Please mark your answer to the following questions (required for accreditation, state, and federal reporting):

  1. Gender: Male Female
  2. Are you a U.S. citizen? Yes No
  3. If no, are you in the U.S. as a Permanent Resident? Yes NoDocument#
  4. If no, are you in the U.S. on a Visa? Yes NoType of Visa?Visa#
  5. If no to all of the above, please explain your status:
  6. Are you lawfully eligible to work in the U.S.? Yes No
  7. Are you currently employed? Yes NoApprox. Wage $______/hr Hrs/week? ______
  8. Are you a U.S. veteran? YesNo
  9. Are you a qualifying spouse of a U.S. veteran? Yes No
  10. Are you disabled? Yes No
  11. Are you a single parent? Yes No
  12. Are you a first generation college student? Yes No
  13. a. Where did you attend High School?

Full Name of SchoolCityStateZip Code

b. Did you receive a High School Diploma? Yes NoGraduation Date:______

c. If no HS Diploma, do you have a GED? Yes No

  1. Highest level of education completed: High School Associate Degree BachelorsMasters
  2. Home Language/s: ______

I certify that the answers I have given in this document are true and correct and I have not withheld any facts or circumstances. I understand that all answers given on this document and in the application process are subject to verification and that should I be admitted to the ELAC/SMC Respiratory Therapy Program, any falsification, misrepresentation, or omission of facts are sufficient reason for dismissal upon discovery at any time during the program.

Signature of Applicant Date

RAupdated 02/08/2017Page 1 of 3

East Los Angeles College / Santa Monica College Respiratory Therapy Program Application Instructions

The ELAC/SMC RT program will accept applications for its annual cohort from February 1 to August 12. The program starts each year during the fall semester.

Admission to the program is based on lottery; the names of the selected students will be placed on a list according to their lottery number.

This program provides veterans’ priority services under the Jobs for Veterans Act. Completed applications from U.S. veterans and the qualifying spouses of U.S. veterans receive priority for each fall class. Documentation of veteran status or qualifying spouse status is required in order to receive priority services.

Mail all transcripts directly to the selected college admissions office, SMC or ELAC. Hand-carried transcripts of any kind are NOT acceptable as official transcripts. In addition, applicants are responsible for verifying with the admissions office that all transcripts have arrived prior to making a counseling appointment for evaluation of domestic transcripts and verification of program prerequisites.

Once received by the RT program office, applications are screened to determine whether they are complete. Prospective students will be sent notification of the screening result (Completeor Incomplete). Applicants who submitted incomplete applications will be provided with a checklist of items needed to complete their application.

Applications are accepted at the following locations based on the desired campus. Applications mailed/delivered to the incorrect campus will not be forwarded. Please be sure to submit your application to the correct campus.

East Los Angeles College applications can be delivered or mailed to…

East Los Angeles College
1301 Avenida Cesar Chavez
Monterey Park, CA 91754-6099

ATTN: Respiratory Therapy Program Office, 211Q on the 2nd floor of G5 Building

Santa Monica College applications can be mailed to…

Santa Monica College
1900 Pico Blvd

Santa Monica, CA 90405

ATTN: Health Sciences, Respiratory Therapy Program Office

Santa Monica College applications can be delivered* to…
Santa Monica College Bundy Campus, 3rd Floor Health Sciences Office
3171 S. Bundy Dr.

Los Angeles, CA 90066

*applications mailed to this address will be returned to sender by the US Postal Service

RAupdated 02/08/2016