Radiologic Technology Application
Date
*
-
Month
-
Day
Year
Date Picker Icon
Name
*
First Name
Last Name
BGSU ID # (If applicable)
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Academic Status
Are you currently in High School?
*
Yes
No
Expected Graduation Date
Most Recent Cumulative GPA
Have you taken any college courses?
*
Yes
No
Where?
How did you learn about this degree program?
*
Interest in Health Care
Have you volunteered in a healthcare facility?
*
Yes
No
Where and when?
Why are you interested in becoming a student in this program?
*
Have you completed 8 hours shadowing in Radiologic Technology at a hospital AND 4 additional hours at a health care facility?
*
Yes, both
No, neither
Just 8 hours shadowing in Radiologic Technology at a hospital
Just 4 hours at a health care facility
What do you think you will enjoy most about working in Radiologic Technology?
*
Where do you see yourself in five years?
*
Background Information
Have you ever been convicted of a misdemeanor or felony?
*
Yes
No
Explanation
Have you been a resident of Ohio for the past 5 years?
*
Yes
No
List previous addresses (last 7 years)
Program History
Have you applied for the Radiologic Technology program at BGSU Firelands before?
*
Yes
No
Were you interviewed?
Yes
No
Application Agreement
By signing below you understand and agree to all of the following: Authorization for the college to verify information, consent for criminal background check, consent for background investigation (references, employers, academic records), agreement to health requirements (including drug screening), agreement to fingerprinting prior to clinical placement, certification that information is accurate and complete, acknowledgment that admission is not guaranteed, understanding that falsification or omissions may result in denial or dismissal
Sign your full name below.
*
Submission Information
Program Director contact: Sara Ondrick, MHA, BS, R.T.(R), CT, MR, Mailing Address: BGSU Firelands Applied Sciences, 1 University Drive Huron, OH 44839, Email: Sondric@bgsu.edu
Save
Submit
Should be Empty: