School of Radiologic Technology Application

To apply online for the School of Radiologic Technology, please fill out the application form listed below. Your information will be submitted via a secure server. In order for your application to be complete, you must also submit the following information.

  • Three letters of recommendation (download recommendation form)
  • Official high school and college transcripts (mailed directly from school or college)
  • Handwritten statement as to why you’re considering radiologic technology as your career choice (signed and dated)
  • $25 application fee (non-refundable)

All requirements must be postmarked by Jan. 31 to be eligible for the September class.

If you have additional questions about admission, please reference the admission information portion of this site or contact us.

Personal Information

Prefix
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First Name
Middle Initial
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Last Name
Suffix
Previous Name(s)

Maiden/Other, separate with commas

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Address 1
Address 2
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City
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State
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Postal Code
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Country
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Day Phone
Evening Phone
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E-Mail Address
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What is the best time to contact you?
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Will you be over 18 years of age by the start of the program?
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Are you a U.S. citizen?
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Have you ever been convicted of a felony?

Education

High School

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School Name
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Location
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Did you graduate high school?
In lieu of a high school diploma, did you receive a GED?

Post-Secondary

School 1 Name

Please list any education beyond high school - including college, trade, business or correspondence schools.

School 2 Name
School 3 Name

Employment History

Employer 1

Please provide any current and/or previous employment information. List the most recent employer first.

Employer 2
Employer 3

Health Care Experience

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Do you have any previous hospital, radiology or related experience?
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May we perform a reference check?
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How did you hear about this program?

Applicant's Statement

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I certify that the information contained in this application is true and correct to the best of my knowledge. I authorize the contacting of former employers, schools and other references by the School of Radiologic Technology, unless otherwise stated. I realize that any false statement made here could be cause for non-acceptance to or dismissal from the educational program. If I agree to accept an appointment to the School of Radiologic Technology, I will abide by all of its requirements and regulations.