ARMSTRONG ATLANTIC STATE UNIVERSITY

DEPARTMENT OF MEDICAL TECHNOLOGY

Technical Standards For Completion of Program
Verification Form

As an applicant to the Medical Technology Program, you have been provided a document entitled "Technical Standards for Completion of Program" that you were asked to review. The physical and communication skills of the profession, and similarly the program have been identified in this document. At AASU, your personal health background and/or disabilities, if any, are not known to the program faculty unless outwardly evident through personal contact or an Advocacy Letter from the Office of Disability Services. Your preparedness for the behavioral tasks of Medical Technology is determined by your acknowledgment to us that you do not knowingly possess any limitations that could prohibit your ability to meet the requirements and perform the functions described in the Technical Standards document.

You are asked to confirm that you have reviewed the Technical Standards and to indicate your ability to comply with the outlined requirements, through your signature below. If you have knowledge or concerns about inability to meet all standards, do not sign below, but rather explain on an attached sheet any disability(ies), citing the standard(s) that you feel you cannot meet. The Department Head of Medical Technology will then communicate with you to address problem area(s) in consultation with the AASU Office of Disability Services.

I have read the technical Standards for Medical Technology and attest that I am not aware of any condition and/or disability that would interfere with my ability to comply with each and every requirement outlined in the document. If any such condition should occur during my program enrollment, I agree to immediately bring my problem to the attention of the Department Head.

Printed Name

Signature Date