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CAC Radiologic Technology Program Application
APPLICATIONS ARE ACCEPTED MAY 1ST THROUGH JUNE 30TH ONLY.
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Student Name
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Idaho
Illinois
Indiana
Iowa
Kansas
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Ohio
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Tanzania
Thailand
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Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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E-mail
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All correspondence will be via email. Please ensure that your email is correct.
Confirm Email
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Educational Institute #1
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Educational Institute #2
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Educational Institute #3
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Educational Institute #4
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Upload ALL relevant unofficial transcripts Transcripts MUST include grades
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PDF FORMAT IS PREFERRED. Must have 8 general education credits completed to apply. ALL GRADES must be included on transcripts. IF COMPLETING COURSES DURING SPRING SEMESTER- DO NOT SUBMIT UNTIL CLASS GRADE IS POSTED ON YOUR TRANSCRIPTS
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Employer Information
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Employer Information
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Employer Information
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Employer Information
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Veteran Status
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Yes, I served in the US Military.
No, I have no Military service history.
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Yes, I served in the US Military.
No, I have no Military service history.
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Hospital "Career Pathway" Recipient
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Yes
No
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Yes
No
This only applies to those who are currently enrolled in a tuition reimbursement arrangement with Banner Health, Dignity Health, Honor Health, or Valleywise Health.
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If you answered "yes" to Hospital "Career Pathway" Recipient, you must upload documentation that proves your status in that program. Points will not be assessed otherwise.
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Reapplication Status
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No
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No
If yes, enter your application year below.
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If yes, please list the previous application year
ex: 2020, 2021, 2022, etc.
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19
The in person Information Session is required. Please enter the date of the information session you attended. Attendance is verified.
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No
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No
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20
Upload Information Session Attendance Certificate
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Upload Information Session Attendance Certificate. Certificates expire each year in July.
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: 10.6MB
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Make sure your name is legible
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Cover Letter/Student Letter
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Limited to ONE page maximum
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: 10.6MB
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MUST be limited to 1 page
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22
Letters of Recommendation (1).
*
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It is preferred for the student to upload their letters here. However, If your letter is being emailed. Please upload a document stating that, so it can be verified and added to your file.
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: 10.6MB
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Students must upload 2 letters.
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Letters of Recommendation (2)
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It is preferred for the student to upload their letters here. However, If your letter is being emailed. Please upload a document stating that, so it can be verified and added to your file.
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: 10.6MB
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Students must upload 2 letters.
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24
While criminal violations do not automatically disqualify the student from consideration for the program, the Radiologic Technology program will conduct a background check at the beginning of the program in the Spring semester in accordance with the requirements of the clinical affiliates
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I agree & understand
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I agree & understand
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25
The American Registry of Radiologic Technology (ARRT) has an Ethics Review Board that requires all applicants to disclose all criminal violations. If you need help or have questions about the Ethics Review Process, you are encouraged to call the ARRT ethics department 651.687.0048.
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I agree & understand
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I agree & understand
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It is the student’s responsibility to handle all Ethics Review applications prior to applying for the National Registry Examination at the end of the program. The student understands that the ARRT may deny the student from testing and obtaining national licensure based on the decision of the Ethics Committee.
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I agree & understand.
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I agree & understand.
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I certify that the information on this application is complete and accurate to the best of my knowledge. I understand that withholding information or giving false information may make me ineligible for admission and enrollment. I release from all liability or damages those persons, agencies, or organizations who may furnish information in connection with my application for admission. If accepted, I agree to read and abide by all school policies and procedures.
I understand that my typing my signature, I am signing this document.
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Please verify that you are human
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