Medical Radiography Program Application Form - Non SSO

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Medical Radiography Program Application

Please Note:

*Applying to the Medical Radiography AAS Degree Program does not guarantee program admission.

*Applications are only processed for program consideration if submitted during the application period. Applications submitted outside of the application period will not be processed for review. The application periods are as follows:

Application Periods: Spring August 1 - October 1

Summer November 1 - January 17

Fall March 1 - May 1

These documents must be submitted with application as PDF files. Transcripts should beordered as official, then scanned to a PDF
document:

Printed HESI Score Sheet - only one (1) score sheet will be accepted

Current “What If” SOS degree evaluation for Medical Radiography AAS under the catalogue year you are applying for

Transcripts from ALL colleges/universities attended INCLUDING San Jacinto College

NOTE: Final rubric scores are not determined until they have been processed through the Application Review Committee. This will be determined after the application deadline date.

General Information

What was the date of the Medical Radiography information session you attended?

What is the application code provided to you at the information session?

Are you 18 years of age or older by anticipated program start date?

San Jacinto College G#:

First Name:

Middle Initial:

Last Name:

Email Address:

Primary Phone:

Secondary Phone:

List other names under which records and may be found, including maiden names.

Street Address:

City:

State:

Postal/Zip Code:

Education Information

Have you taken classes at any other colleges or universities?

If yes, list all colleges and universities attended:

College/University

Dates Attended

Major

Certificate or degree received?

Add Entry

Do you have an associate degree?

Do you have a bachelor’s degree?

Are you currently enrolled in any courses?

Course Name & Number

Part of Term

Expected End Date

Is this a San Jac Course?

Add Entry

Have you previously applied to the medical imaging program at San Jacinto College?

Have you previously served or are you currently in any branch of the Armed Force?

Applicant Acknowledgement

I acknowledge that the information on this application is accurate, to the best of my knowledge. I understand that falsification of information provided will result in disqualification for admission.

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