Application for Registration for Internationally Educated MRTs

Application for Registration

Internationally Educated MRT Applicant
Section 1: Demographic Information
Legal Name*

First NameMiddle NameLast Name
Previous Name (maiden name etc.) *if any

First NameMiddle NameLast Name
Proof of name change (government issued)

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Practice Name (if any)
Your preferred name in professional settings
Date of Birth*

DayMonthYear
Phone Number*

Country CodeArea CodePhone Number
Gender*

FemaleMaleSelf Describe
Home Address*

Street Address / P.O. Box

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
1. Valid government issued photo ID*

example: drivers license, citizenship card, permanent resident card or identification card
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2. Valid government issued ID*

example: birth certificate or passport
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Section 4: Language Assessment
- Council Policy states that an applicant for registration as a regulated member must be reasonably proficient in English to be able to engage safely and competently in the practice of medical diagnostic and therapeutic technology.
Was your education instructed in English?*

YesNo
Supporting documentation *

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Note: If your qualifying education was instructed in a language other than English, upload your English language test results below.
English Language Test Results

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Section 5: Currency of Practice and Professional Experience
- Please fill out a Currency of Practice Hours Form(s) for each employer you've had for the past five years from the date of application.
- If you had multiple employers in the last five (5) years, each employer must verify a separate form.
- Download the Currency of Practice Hours Form. When completed, upload your form(s) below.
Have you graduated in the last two years and not yet started practicing?*

YesNo
Practice hours form (Employer 1)

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Practice hours form (Employer 2)

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Practice hours form (Employer 3)

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Section 6: Character Reference
- Please upload a reference letter from your current or former supervisor that will attest to your character regarding your work responsibilities.
- Click here to read more about the requirements of a reference letter.
Character reference*

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Section 7: Competence

7.1 Competency Checklist
- Download the applicable Competency Checklist:
- Upload the completed supervisor-approved competency checklist that relates to your specialty.
7.1 Competency Checklist*

Multiple files may be uploaded in the this section
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7.2 Self-Assessment of Clinical Practice Form
- Please click on the applicable Self-Assessment of Clinical Practice Form that relates to your specialty.
- Upload the completed Self-Assessment of Clinical Practice Form.
7.2 Self Assessment Form*

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Application for Registration