(1) Name of requesting school and its school identification number as indicated on the Department's approval to operate;

(2) For each clinical site, the following:

(3) For clinical sites outside of Department jurisdiction, an original letter on facility letterhead from the proposed clinical site verifying that the facility meets and voluntarily agrees to comply with the requirements of section 30416. The letter shall be signed by an individual who has the authority to commit the facility to comply with section 30416; and

(4) Name and signature, and date of signature, of the school official or the school's program director.

(1) Coterminous with the school's approval pursuant to section 30412(d); and

(2) Valid only if the school's approval remains valid.

(1) For diagnostic radiologic technology (RT) schools and limited permit (LP) X-ray technician schools (except that an LP school teaching the category of dermatology X-ray therapy shall use the calculation in subsection (c)(2)):

TCC = the lesser of A or B where:

A = total number of qualified practitioners, as defined in section 30400, at the clinical site who provide direct or indirect oversight.

B = total number of available physical resources determined as follows:

B = R + RF + (M4 or M5 as applicable) + (S4 or S5 as applicable) + ER

Where (do not double count rooms or units in the following categories):

R = One times the total number of radiography only rooms;

RF = One times the total number of radiography/fluoroscopy combination rooms;

M4 = 0.5 (if the site has four or fewer mobile units (e.g. radiography or fluoroscopy));

M5 = 1 (if the site has five or more mobile units);

S4 = 0.5 (if the site has four or fewer fixed units in surgery suites);

S5 = 1 (if the site has five or more fixed units in surgery suites); and

ER = One times the total number of fixed units in the emergency department, if applicable; and

(2) For therapeutic RT schools and LP schools teaching the dermatology X-ray therapy category:

TCC = the lesser of A or B where:

A = total number of qualified practitioners, as defined in section 30400, at the clinical site. Section 30417(e) shall be accounted for in determining the value of “A.”

B = total number of available physical resources determined as follows:

B = T + S + D + PC

Where:

T = One times the total number of treatment rooms;

S = One times the total number of simulators, if applicable;

D = One times the total number of dosimetry units, if applicable; and

PC = One times the total number of patient care areas.