This worksheet is completed by the admission committee, not by the applicant. You can fill it in on screen and then print it. Entries are not saved or submitted electronically, so print the completed worksheet before closing this page.

Applicant and term

Applicant identification

Applicant name

Application term

Fall

Spring

Year

Required for admission ranking

Any “No” will result in applicant disqualification.

Eligibility requirements, marked yes or no by the admission committee
Requirement	Met
Temple College acceptance	Yes No
Prerequisites complete, or in progress and will be completed by the start of the program	Yes No
Information session attended	Yes No
AASRT application submitted	Yes No
TSI compliant	Yes No
ATI TEAS individual performance profile submitted	Yes No
ATI TEAS minimum composite score of 65 percent	Yes No
Final transcripts for prerequisites received	Yes No
Prerequisite cumulative GPA of 2.5 or higher	Yes No
All prerequisites completed with a 2.0 or higher	Yes No
Requirements for applicant ranking met	Yes No

Ranking points

Prerequisite courses Max 15 points

Each of the following courses must be completed with a 2.0 GPA or higher to be eligible for consideration.

Prerequisite course point values

A equals 5 points
B equals 4 points
C equals 3 points
IP (in progress) equals 0 points

Prerequisite course grades and points
Course	Grade	Points
BIOL 2401 Human Anatomy and Physiology I	Grade for BIOL 2401 Human Anatomy and Physiology I	Points for BIOL 2401 Human Anatomy and Physiology I
MATH 1314 College Algebra for Non-STEM Majors	Grade for MATH 1314 College Algebra for Non-STEM Majors	Points for MATH 1314 College Algebra for Non-STEM Majors
HPRS 2302 Medical Terminology for Allied Health	Grade for HPRS 2302 Medical Terminology for Allied Health	Points for HPRS 2302 Medical Terminology for Allied Health

Points earned, prerequisite courses Adds up automatically from the three course point entries above.

ATI TEAS Max 15 points

ATI TEAS point values by composite score

92 to 100 equals 15 points
85 to 91 equals 12 points
78 to 84 equals 9 points
71 to 77 equals 6 points
65 to 70 equals 3 points

ATI TEAS composite score

Points earned, ATI TEAS

Prerequisite courses taken at Temple College Max 3 points

Temple College course point values

3 courses equals 3 points
2 courses equals 2 points
1 course equals 1 point
0 courses equals 0 points

Courses taken at Temple College

BIOL 2401 Human Anatomy and Physiology I

MATH 1314 College Algebra for Non-STEM Majors

HPRS 2302 Medical Terminology for Allied Health

Points earned, courses taken at Temple College Counts the boxes checked above.

Written referral Max 2 points

Written referral from a Temple College alumnus, a Temple College faculty member, or an affiliated clinical site. The referral form is attached to the application packet. Only one referral will be accepted.

Written referral point values

Yes equals 2 points
No equals 0 points

Written referral received?

Yes

Points earned, written referral Set automatically by the answer above.

Total points Max 35 points Adds up automatically from the four categories above.

Comments

Committee comments