Peconic Bay School of Radiologic Technology Application (Starting Fall 2026)

Peconic Bay School of Radiologic Technology Application (Starting Fall 2026)

Please fill out the form carefully to apply. Due March 1, 2026
Applicant Name*

Last NameFirst Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Personal Email Address*

Confirmation Emailexample@example.com
Northwell Health Email Address

Confirmation Emailexample@example.com

Current Employment (If Applicable)
Name of Employer
Department
Position/Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload copy of your Resume/CV*

Cancelof

Education
To participate in this program you must have the following:

1) An associate's degree or higher from an accredited institution, with a curriculum that includes general content in Mathematics and Reasoning, Communication, Humanities, Information Systems, Social Sciences, and Natural Sciences with a minimum overall GPA of 2.3 (C+).

2) Successful completion of the following prerequsit:

o A course in medical terminology from an accredited college or university with a grade of 2.3 GPA (C+) or higher.
To participate in this program,

1) You must either have a Bachelor's degree or higher, or

2) Be a graduate of a two-year allied health education program that is patient-care centered (i.e. radiologic technologist, respiratory therapist, occupational therapist, physical therapist, or registered nurse.)
Please select the choice that best applies to you.*

I am a college graduate with an associate's degree or higher from an accredited institution, with a curriculum that includes general content in Mathematics and Reasoning, Communication, Humanities, Information Systems, Social Sciences, and Natural Sciences with a minimum overall GPA of 2.3 (C+).I am a graduate with an Associate's degree that is patient care centered (i.e. respiratory therapist, occupational therapist, physical therapist, or registered nurse) with a 2.3 (C+) GPA or higher.I currently do not meet any of the above educational requirements. I understand that I will need to complete an associate's degree or higher from an accredited institution, with a curriculum that includes general content in Mathematics and Reasoning, Communication, Humanities, Information Systems, Social Sciences, and Natural Sciences with a minimum overall GPA of 2.3 (C+) prior to September 2026.
Please select the choice that best applies to you.*

I have successfully completed the prerequisite course in medical terminology from an accredited college or university with a grade of 2.3 GPA (C+) or higher.I do not have the prerequisite (I understand that I need to complete the prerequisite course with a 2.3 (C+) or higher prior to September 2026)
Name of Education Institution*
Educational Institution Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Graduation Month/Year*
Degree/Major*
You must have your Educational Institution send an official transcript to:

Peconic Bay School of Radiologic Technology
1300 Roanoke Avenue (1 Heroes Way)
Riverhead, New York 11901
Attention: Frank A. Zaleski, LMSW, MBA, BS RT ( R ), Program Director

Email: PCBMC-xrayschool@Northwell.edu

Licenses and Certifications
Do you have a license or certification in any allied health field?*

YesNo
List all allied health licenses/certifications and associated license/certificate number.*

Technical Standards

Please read the document below and indicate whether you are able to perform the duties of a student.
Are you able to perform the duties of a student?*

YesNo

Essay Response
Our Program of Radiologic Technology is a two-year program dedicated to providing the healthcare environment with a well-rounded and competent professional Radiologic Technologist. Please identify, in no more than 500 words, why you are choosing our school and your personal vision for your future in our profession. You should also highlight any unique healthcare experiences that are influencing your decision to become a Radiologic Technologist. *

0/500
Required Reference

Please have three (3) references fill out the Professional Letter of Recommendation form provided here. Please email these documents to PCBMC-xrayschool@Northwell.edu.
Professional Letter of Recommendation Form

Attestation
I understand that I must have my Educational Institution send an official transcript to the address above*

Yes
I understand that my classroom placement may be different from the classroom preference that I selected.*

Yes
I understand that students must provide their own transportation for all classes and clinical placements. Clinical sites can be up to 60 miles from the assigned classroom.*

Yes
I understand this is a full-time program.*

Yes
I certify that by indicating "YES" below, and submitting this application, that the information contained within this application is complete and accurate to the best of my knowledge.*

Yes
Type your full name*
Please sign here*

Clear
Once you click the "Submit" button, you will be redirected to a page where you will be required to make payment for the application/entrance exam fee of $175.00. Please be sure that your pop-up blockers are disabled, so that you are properly directed.

If you are not redirected to the payment page, the link to the page will be located at the bottom of the confirmation email that you will receive upon submission of your application. This confirmation email also contains all of your responses to this application. Please click that link to make your application payment.

Please be aware that your application is not considered complete and will not be reviewed until we receive your application/exam fee.

Students are permitted to retake the entrance exam up to two additional times, allowing for a maximum of three attempts in total (initial attempt plus two retakes).

To request a retake, please email PCBMC-xrayschool@Northwell.edu. Upon receipt of your request, a new registration link will be sent to you.

A $75 fee will be charged for each of the second and third entrance exam attempts.

Thank you for your interest in our program.
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Peconic Bay School of Radiologic Technology Application (Starting Fall 2026)

Current Employment (If Applicable)

Education

Licenses and Certifications

Technical Standards

Essay Response

Required Reference

Attestation