Radiologic Technology Application

Thank you for your interest in the Radiologic Technology program! The program is competitive and there are prerequisites and application requirements. Click here to review the Radiologic Technology application requirements and the deadline date for submission. Please note: Incomplete applications will not be processed. Any questions, please call the Admissions Office at 518-736-3622 extension 8301.

Student Information

First Name

Last Name

Birthdate

Email Address (personal or FMCC if applicable)

Program Information

Application Term

I am a:

New student (applicant)

Current FMCC student

College ID Number

Have you applied to the Radiologic Technology AAS program in the past?

Yes

No

Have you ever been enrolled in an allied health program (medical imaging and related programs, nursing, dental hygiene, respiratory therapy, occupational therapy, physical therapy, etc.)?

Yes

No

Have you been dismissed or removed from the allied health program?

Yes

No

Please explain.

Are you employed at a hospital or healthcare facility?

Yes

No

Please specify the name of hospital or healthcare facility.

Please indicate your position title.

Please describe your general responsibilities

Do you have non-professional work experience within the healthcare profession totaling 120 hours? (i.e. volunteer experience)

Yes

No

Please specify the name of the facility.

Please indicate your position title.

Please describe your general duties

Any additional information you would like to share with the Radiologic Technology Review Committee (including other relevant experience, main reasons for wanting to be a Radiologic technologist, how do you plan to be successful in the Radiologic Technology program, etc.)

Ackolwedgement

I acknowledge I have read the Radiologic Technology Mandatory Professional Licensure Disclosure located here (Radiologic Technology Mandatory Professional Licensure Disclosure (fmcc.edu).

Yes

I understand that if accepted to the Radiologic Technology program, I must submit proof of American Heart Association Basic Life Support certification and additional health form prior to the start of the program.

Yes

Additional Materials

Please upload any additional transcripts not previously provided to Admissions. Applicants must request transcripts from ALL colleges they have attended. Failure to provide all college transcripts will result in denial of consideration to the program.

College transcript (copy)

High School transcript (copy)