Fill - Free fillable ApplicationMRI (Howard Community College) PDF form

Howard Community College MRI Program

Application Form for Admission

Note. All MRI applicants MUST have at least a valid ARRT registration in either Radiography or

Sonography.

First Name

_________________________

Last Name

______________________________

Mailing Address

_______________________________

Apt #

_____

County

__________________

City

______________________________

Zip Code

_____________

State

__________________

Enter your ARRT score for

Radiography

__________

Sonography

__________

What year did you first earn ARRT certification in either Radiography, Nuclear Medicine Technology, or

Radiation Therapy degree or certificate _____________________ (only year).

What program did you attend for your Radiography degree or certificate? _______________________

How many years of experience do you have in either Radiography, Nuclear Medicine Technology, or

Radiation Therapy _____________________ (round to the nearest year)

Have you worked or currently working as MRI / CT technologist / Neither (Check one or both, if

applicable, neither if you have not)

I prefer to be enrolled as single or dual certification (choose one)

A. MRI only

B. CT and MRI – one at a time (Check preferred certification)

C. CT and MRI – simultaneously

Can you provide the following list of documents (Yes/No)

A. Copy of ARRT certification ___________

B. Copy of ARRT certification exam score ________________

C. Supervisor’s or professor’s referral ________________

Please Return to Adrienne Summers. Email: asummers@howardcc.edu or Fax: 443-518-4332

Fill Online, Printable, Fillable, Blank ApplicationMRI (Howard Community College) Form