Radiologic Technology Program (RAD) Admission
What program/course are you applying for?
txtSFName
txtSLName
txtSAddress
txtSCity
txtSState
txtSZip
txtSMobPhone
txtSEmail
No
Yes
No
Yes
txtSHomePhone
txtSPerAddress
txtSPerCity
txtSPerState
txtSPerZip
txtFullName
txtOthernames
If yes, list organizations.
txtRegListOrg
txtInstanceNo
#
Next Page
Print
Close
APPLICATION FOR ADMISSION TO THE
RADIOLOGIC TECHNOLOGY PROGRAM
School of Health Sciences
ALL areas within a red border are required fields.
txtstartdateprogramyear
txtARRTNo
txtSMName
First Name
Last Name
Middle Name
Student Information
ARRT Number (if applicable):
Start Date of Program Applying To
Registry, Certification or License No.
Student G-Number
txtRegister
txtSNumber
Zip Code
Mobile Phone #
Zip Code
Email Address
Home Phone
State
State
City
City
Permanent Address
Present Address
Please note that you must be an ARRT registered/registry eligible technologist to apply for any advanced modality course in radiologic technology.
Other name(s), if any, you have used for work or educational records
Are you registered, certified or licensed by any state and/or national organization, *other than the ARRT*?
Are you a US Citizen?
If additional space is needed, attach a file using the Attach Button on the last page.
Employment History
Note: Use the Close button if just viewing the form.
Attach
If you are not a US Citizen, attach all US immigration status documents to this application.
LIST MOST RECENT POSITION FIRST. If presently employed, may we contact?
No
Yes
CT
MAMMOGRAPHY
MRI
RAD TECH PROGRAM
txtHPCount
txtMPCount
Fall
Spring
Winter
Selection
Year
Loading