Biographical Data
First Name
Last Name
Email
Home Phone
Cell Phone
Mailing Address
City
State
Zip
Prerequisites
Choose one
Two year allied health educational program that is patient care related
Bachelor's Degree in any major
High School Diploma with required college classes
Degree Major
School Name
Graduation Month and Year
Have you or will you have an official transcript sent to SMAHE?
Yes
No
Name on transcript if different than current name
Unofficial Transcript
The file must be a pdf or jpg no larger than 10 MB
One file only.
10 MB limit.
Allowed types: pdf, jpg, jpeg.
Program Choice
Choose One
Diagnostic Medical Sonography (18 Months)
Vascular Sonography Program (12 Months)
Desired start month
- Select -
January
February
March
April
May
June
July
August
September
October
November
December
Clinical Site Information
Applicants must have received a verbal approval from the listed clinical site PRIOR to submitting the application.
Name of Site
Phone Number
Mailing Address
City
State
Zip
Contact's Name
Contact's Email
Contact's Phone
Has the above listed clinical site given you verbal approval to do your clinical internship at the site?
Yes
No
Application Questions
Have you ever been convicted of a felony crime?
Yes
No
I certify that the information provided with this application is true and correct and I make application for admission to Southwest Missouri Allied Health Education. I understand that Southwest Missouri Allied Health Education does not guarantee employment or salary.
Do you agree to the above statement?
I agree
I disagree