UHC Neurodiagnostic Tech Application 2025

Application for Admission: Professional Training Component, Neurodiagnostic Technology Program

University of Holy Cross Department of Health Sciences
I am applying for...*

Bachelor of Science in Neurodiagnostic TechnologyAssociate of Science in Neurodiagnostic Technology
Name*

First NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permanent Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number*
Please enter a valid phone number.
2nd Phone Number
Please enter a valid phone number.
Date of birth:*

MonthDayYear
Date
Personal Email (Not UHC email)*
example@example.com
For Statistical Purposes (optional):
Race:
Gender:
Marital Status:
Place of Birth:
Children:
Ages of Children:
Religion:
Person to be notified in case of emergency: *

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship to contact: *
Emergency Contact Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
University, College, or Vocational School Attended (beginning with most recent, list all schools) include Institution, Dates Attended, Major, and Degree/Diploma*
*If you are not currently enrolled as a student at University of Holy Cross please request that official copies of all transcripts be sent to: University of Holy Cross, Admissions Department, 4123 Woodland Drive, New Orleans, LA 70131-7399
Have you ever before applied to the clinical UHC Neurodiagnostic Technology Program?*

YesNo
If yes, when?
Are you currently enrolled at UHC?*

YesNo
Are you enrolled in another college or university?*

YesNo
If yes, where?
If you are not currently enrolled in UHC, have you been accepted to UHC?

YesNo
(If not, applicant must apply to UHC before Application for Admission to the Neurodiagnostic Technology Program Professional Training Component can be processed.)
List your honors, awards, and/or scholarships: *
List your student organizations/leadership positions:*
List other outstanding achievement and/or community involvement:*
Is there any reason you feel that would prevent you from fulfilling the physical or emotional aspects of hospital patient care?*

YesNo
If yes, please explain below.
Please request three persons (excluding relatives) to complete the Applicant Recommendation Form on your behalf and send to:

University of Holy Cross
Department of Health Sciences/ NDT Program Attn: Dr. B. Wizer
4123 Woodland Drive
New Orleans, LA 70131-7399
I hereby certify that the information given in this application is true, correct, and complete. Please sign below: *

Clear
Date*

MonthDayYear
Date
Should be Empty:

Application for Admission: Professional Training Component, Neurodiagnostic Technology Program