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Radiologic Technology
Radiologic Technology Application

If you have not filled out a Belmont College application, please do so before filling out the radiology application.

It is the policy of Belmont College to provide equal admission, educational, and employment opportunities without regard to race, color, national origin, sex, age, disability, or other protected classifications.

Application Requirements
Please acknowledge all requirements:
High School Graduate or GED
Be at least 18 years of age as of the first day of fall semester.
High school and/or college GPA of 2.5 or higher.
Following acceptance to the program, submit State of Ohio BCI and FBI background checks to the Radiology program director that has been completed in the last 12 months.
Will take or have taken the radiology entrance exam (TEAS) prior to the application deadline.
Complete all admission requirements by the deadline for admission.
Personal Data
Full Name:
Current Address:
City:
State:
Zip Code:
Cell Phone:
Email Address:
Educational Data
List all high schools, trade or vocational schools you have attended:
I.
Name:
Location:
Grade Completed:
Year Graduated:
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List all colleges and universities you have attended:
I.
School Name:
Location:
Major:
Dates Attended -
From:
To:
Degree Awarded:
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Are you presently enrolled in college?
Yes
No
If yes, where?
List courses you are taking this semester:

Have you ever been suspended from any college or university for scholastic or disciplinary reasons?
Yes
No
If yes, please explain:

Employment Data

List your employment experiences over the past five years, including military service.

I.
Employer Name:
Job Title:
Start Date (month,year):
End Date (month,year):
+ Add another job
Please read carefully and respond:

If you have had a felony or misdemeanor conviction with the sole exception of speeding and parking violations, in the past ten years, the American Registry of Radiologic Technologists reserves the right to determine if you will be permitted to sit for the Certification Examination, even if you have completed all graduation requirements.

In accordance with this requirement for certification, please respond to the following question. 

Have you been convicted of a crime, including a felony or misdemeanor with the past ten (10) years?
Yes
No
If yes, please explain:
Miscellaneous
Are you able to drive 55 miles to a clinical site, when necessary?
Yes
No
Do you plan to be employed during your time in the radiology program?
Yes
No
Full-time
Part-time
Less than part-time
Documents

Both file uploads are required.

Technical Standards - Please download, complete, and attach the Technical Standards document.

Attach Technical Standards:

Typed Narrative - Please download, complete, and attach your Typed Narrative document.

Attach Typed Narrative:
Terms and Agreements
I hereby certify the facts set forth in this application of admission are true and complete to the best of my knowledge. I understand falsified statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to fully investigate all such information. I hereby release from all liability or damages, those persons, agencies and organizations that may furnish information in connection with my application for admission. I acknowledge that following acceptance I will be required to take and pass an admission physical. The admission physical is the responsibility of the student and documentation must be provided to the program director. This examination shall include, but will not be limited to, laboratory tests, drug and alcohol testing, tuberculin skin test, immunization history and communicable disease history with possible need for vaccination. If the admission physical reveals that I will not be able to perform the essential requirements of a student enrolled in the Belmont College Radiology Program with reasonable accommodations, the acceptance offer will be withdrawn. I understand that I will also be subject to a background check as required by the clinical sites. I understand my completion of this application does not guarantee my consideration for admission, nor does its completion in any way commit Belmont College to admit me as a student in the Radiology Program. I agree to the terms and conditions above.


Please complete all required fields before submitting application.

This application must be received by 4:00 PM, May 1, 2023 to be considered for admission to the Fall 2023 Semester.