MWH School of Radiologic Technology Application

MWH School of Radiologic Technology Application
Is this a reapplication? (Have you applied to the MWH School of Radiologic Technology before?)*

YesNo
Name*

First NameMiddle InitialLast Name
Maiden Name
Home Phone*
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a United States citizen?*

YesNo
Sex*

MaleFemale
Emergency Contact Information*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship*
Education History

All official college/university transcripts must be sent from the institutions from which you graduated. E-mail submission of official transcripts is preferred: shirley.cherry@mwhc.com.
High School
High school name*
City*
State*
Did you graduate?*

YesNo
Do you have a GED?

YesNo
College
College name*
City*
State*
Did you graduate?*

YesNo
Start date*

MonthDayYear
End date*

MonthDayYear
Degree*
Major*
Grad School
Grad school name
City
State
Did you graduate?

YesNo
Start Date

MonthDayYear
End Date

MonthDayYear
Degree
Major
Other school
Other school name
City
State
Did you graduate?

YesNo
Start Date

MonthDayYear
End Date

MonthDayYear
Degree
Major
Employment History
Describe any previous healthcare employment or volunteer experience. *
Admission Essay

Submit a 500-word minimum essay in which you respond to the following questions:

Why do you want to be a Radiologic Technologist?
and
Why would you like to transfer to the Mary Washington Hospital School of Radiologic Technology?
Admission Essay—Upload a PDF or DOCX*

Cancelof
Additional Information
In the space below, briefly relate in your own words any information you would like the admissions committee to be aware of with regard to your application.
I certify that the above statements are true and correct to the best of my knowledge. If accepted for admission, I will abide by the rules and regulations of the Mary Washington Hospital School of Radiologic Technology.*

Must be selected to continue
Digital Signature (Your full name)*
Today's Date*

MonthDayYear
Mail the $40 application fee to the following address:

Shirley Cherry, Ed.D, RT (R)
Mary Washington Hospital School of Radiologic Technology
2216 Princess Anne Street, Suite 100
Fredericksburg, VA 22401

Make checks or money orders payable to “MWH SoRT” and add 200-8140-49070 to the memo line of all checks or money orders. Cash is not accepted.
Please verify that you are human*
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MWH School of Radiologic Technology Application

Education History

High School

College

Grad School

Other school

Employment History

Admission Essay

Additional Information