AZ Heart Foundation – Ultrasound Program Application Step 1 of 4 – Contact Information 0% I am applying for:* Cardiac Ultrasound – TUCSON Campus – starts in January Vascular Ultrasound DAY – Phoenix Campus – starts in January Cardiac Ultrasound DAY – Phoenix Campus – starts in January Cardiac Ultrasound EVENING (1pm-7:30pm) – Phoenix Campus – starts in January Cardiac Ultrasound – TUCSON Campus – starts in August Cardiac Ultrasound – Phoenix Campus – starts in October Vascular Ultrasound – Phoenix Campus – starts in July Cardiac Ultrasound – Phoenix Campus – starts in July We have two programs, two campuses, and many different start dates. Please be sure to choose the correct option above.Personal InformationName* First Middle Last Email* Phone*Is this a cell phone? Yes Alternate PhoneIs this a cell phone? Yes Preferred Contact* Email Phone Alternate Phone Date of Birth* MM slash DD slash YYYY Add your date of birth. Current AddressStreet Address* Address Line 2 City* State* Zip* Is your permanent address different than your current address? Yes Permanent AddressStreet Address* Address Line 2 City* State* Zip* Education & Experience Note: you will be asked to upload or email letters of recommendation and transcripts in order to complete this application. Please gather these items as soon as possible.High SchoolIMPORTANT: You must have a High School Diploma or GED to apply for this program.Name & Location of High School (or GED)*Years Attended Major (if applicable) Graduation Date (or Date GED Received)* GPA College or UniversityName & LocationYears Attended Major (if applicable) Graduation or Degree Date GPA Graduate / Post GraduateName & LocationYears Attended Major (if applicable) Graduation or Degree Date GPA Medical TrainingName & LocationYears Attended Major (if applicable) Graduation or Degree Date GPA Ultrasound TrainingName & LocationYears Attended Major (if applicable) Graduation or Degree Date GPA Additional ExperienceOther pertinent information relating to professional background or experience: Letters of RecommendationTwo letters of recommendation must be submitted with this application or emailed to admissions@azheartfoundation.org.FileAccepted file types: pdf, jpg, jpeg, png, Max. file size: 3 MB.FileAccepted file types: pdf, jpg, png, gif, jpeg, Max. file size: 3 MB.TranscriptsCopies of all transcripts must be submitted with this application or emailed to admissions@azheartfoundation.org.FileAccepted file types: pdf, jpg, jpeg, png, Max. file size: 3 MB.FileAccepted file types: pdf, jpg, jpeg, png, Max. file size: 3 MB.OR Email Letters of Recommendation and TranscriptsEmail DocumentsRememberYou can NOT be considered for acceptance until your transcripts and letters of recommendations have been received.NameThis field is for validation purposes and should be left unchanged. Δ
