Application for Admission: Radiologic Technology Program
University of Holy Cross Department of Health Sciences
I am applying for...
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Bachelor of Science in Radiologic Technology
Associate of Science in Radiologic Technology
Name
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First Name
Last Name
Personal Email (Not UHC email)
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example@example.com
Phone Number
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Please enter a valid phone number.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth:
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Month
-
Day
Year
Date
Last 4 SSN:
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Race:
Gender:
Person to be notified in case of emergency:
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Relationship to contact:
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List every University, College, or Vocational School you have ever attended. Begin with your current school first. (Institution, Dates, Major, Degree or Diploma)
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Have you previously applied to UHC’s Radiologic Technology Program Professional Training Component?
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Yes
No
If yes, when?
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Are you currently enrolled at UHC?
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Yes
No
If you are not a student at UHC, have you been accepted to UHC?
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Yes
No
Are you enrolled in another college or university?
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Yes
No
If yes, where?
Have you ever voluntarily withdrawn – or been suspended, dismissed, or expelled from a radiologic technology educational program that you attended?
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Yes
No
List the courses you will complete in Spring 2025. (Course Title, College, Credit hours).
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List the courses you will complete in Summer 2025. (Course Title, College, Credit hours).
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List your honors, awards, and/or scholarships:
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Other outstanding achievement and/or community involvement you wish to share:
Is there any reason you feel that would prevent you from fulfilling the physical or emotional aspects of clinic or hospital patient care?
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Yes
No
If yes, please explain below.
In the space below, write a personal commentary addressing your reason(s) for desiring entry into the radiologic technology profession.
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Date
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Month
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Day
Year
Date
I hereby certify that the information given in this application is true, correct, and complete. Please sign below:
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Submit
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