Perfusion Program Application


In compliance with federal law, including the provisions of Title IX of the Education Amendment of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, Vanderbilt University Medical Center and its Center for Programs in Allied Health do not discriminate on the basis of race, sex, religion, color, national or ethnic origin, age, disability, or military service in its administration of educational policies, programs, or activities; its admissions policies; scholarship or loan programs; or employment. In addition, the Vanderbilt University Medical Center and its Center for Programs Allied Health do not discriminate on the basis of sexual orientation consistent with the Medical Center nondiscrimination policy.

PERSONAL INFORMATION

EMERGENCY CONTACT INFORMATION

MILITARY STATUS

CITIZENSHIP / RESIDENCY INFORMATION

NOTE: US Citizenship, permanent residency (i.e., green card), or legal eligibility to study in the country (i.e., student visa) is required for all applicants.

HIGH SCHOOL EDUCATION

POST-SECONDARY EDUCATION


List all higher education institutions attended below. Transcripts of postsecondary education are required for all institutions attended, this includes both completed and courses in progress. Official transcripts should be sent to CPiAHadministration@vumc.org

REFERENCES


List names and affiliations of three professionals you have asked to submit a survey on your behalf. Recommendations from academic and work-related experiences are considered professional. Only three references will be evaluated with your application; additional references should not be sent. Applicants will be responsible for emailing the URL where the Reference Survey may be accessed https://www.vumc.org/perfusion-program/prospective-applicants

PERSONAL STATEMENT


Your personal statement should address why you wish to become a cardiovascular perfusionist, and what experiences you have had that will allow you to succeed in the program and in the profession of perfusion. Your statement should include a brief description of the job responsibilities of a perfusionist and what attributes you possess that will help you develop competencies in those roles of a perfusionist. Your personal statement should not exceed two pages in length.

PERFUSION CASE SHADOW FORM


If you have more than one Observation Form to submit, please combine the forms into one seamless PDF or Word document.

ADDITIONAL DOCUMENT UPLOADS


BLS certifications and copy of health insurance cards are not required at the time of application submission, but will be required upon acceptance.


Passport or state issued photo ID.

APPLICANT SIGNATURE


I certify that the information given on this application is complete and correct to the best of my knowledge. I understand that willfully withholding information or making false statements in this application may be used as the basis for dismissal or denial of consideration. I understand that an offer of admission will require compliance with the Technical Standards and Immunization Requirements outlined on the entrance requirements page of the VUMC Perfusion Program website and the school catalog. I understand that if selected for admission to this program, my acceptance is conditional on successfully completing a background check and drug screen conducted by Vanderbilt University Medical Center. I understand that my acceptance to the program is contingent upon the successful completion of any outstanding prerequisites (if applicable) and that verification must be provided to the Program prior to matriculation. I understand that all documents submitted to Vanderbilt University Medical Center will be retained permanently by the Program regardless of my admission status.

NOTE: TITLE IV FEDERAL FINANCIAL AID (FAFSA) IS NOT AVAILABLE THROUGH THE VUMC CENTER FOR PROGRAMS IN ALLIED HEALTH (CPiAH). THIS INCLUDES LOAN DEFERMENT OPTIONS FOR ANY EXISTING LOANS. PLEASE CONTACT US WITH QUESTIONS IF YOU NEED ADDITIONAL CLARIFICATION AT CPiAHadministration@vumc.org.
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