Columbus State Community College
Respiratory Care Application

Student First Name            MI    Last Name
        

Maiden Name                   Other Last Name(s) Under Which Transcripts Have Been Recorded
   

Your Email Address (Please use your Columbus State e-mail, if you are a student)

Student Cougar ID

Address

City                                             State     Zip Code     County
                  

Home Phone            Work                  Ext.          Other
               

If you are not a student at Columbus State Community College, please apply for admission.  You can apply to the college on-

line at www.cscc.edu or by calling (614) 287-5353 or 1-800-621-6407, ext. 5353 OR by visiting the Welcome Center, 101 Madison Hall at Columbus State Community College’s main campus.

Admissions Requirements — Grades and GPA: You must have an official transcript sent to the Columbus State Community College, Records Office, 550 East Spring Street, P. O. Box 1609, Columbus, Ohio  43216-1609, directly from your high school or college.   


Please list ALL progress on pre-requisite courses:
Enter Date Completed as month/year (example: 10/03)

Written Statement of Interest and Intent:    
Write a brief statement explaining your interest in respiratory care and your career goals.

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All information on this application that I have completed is correct and true. I have read and understand all policies and procedures regarding application to the Respiratory Therapy Program.  Submission of the form implies that you agree with the above statement.