Radiologic Technology

First Name *

Last Name *

Address *

City *

State *

Zipcode *

Daytime Phone *

Evening Phone *

Email Address *

Have you taken the SAT? *

If so, what are your scores?

Have you taken the ACT? *

If so, what are your scores?

Highest Level of Education *

H.S. or GED Graduation Date *

Estimated Start Date

How did you hear about the program? *

Have you completed two years of science courses, within the past 5 years, with a grade of C or better? *

Have you completed two years of math courses, within the past 5 years, with a grade of C or better? *