El Camino College Radiologic Technology Program Application

Please fill out all the required fields and attach supporting documents below.

Legal Name*
Address*
Photo Identification card: Upload a good copy of a current California Driver’s License (CDL) or State issued ID card*
No File Chosen
File uploads may not work on some mobile devices.
El Camino College Student ID card: Upload if you already have one
No File Chosen
File uploads may not work on some mobile devices.
Upload 1st letter of recommendation in PDF format*
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Upload 2nd letter of recommendation in PDF format*
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Upload proof of American Veteran status if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.

Education

Provide educational history below.  Please list your colleges starting from your most recent. 

Did you graduate from College #1?*
Degree earned at College #1*
Upload unofficial transcripts for College #1 in PDF format
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Did you graduate from College #2
Degree earned at College #2
Upload unofficial transcripts for College #2 in PDF format
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Did you graduate from College #3
Degree earned at College #3
Upload unofficial transcripts for College #3 in PDF format
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Did you graduate from College #4
Degree earned at College #4
Upload unofficial transcripts for College #4 in PDF format
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Did you graduate from College #5
Degree earned at College #5
Upload unofficial transcripts for College #5 in PDF format
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.

Background Information

Have you ever been accused or convicted of a felony or a misdemeanor?*
Having been convicted of a felony and/or midemeanor may prevent eligibility for state and national certifications and clinical placement.
Upload a letter of explanation if you answered yes to the question above.
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Course repetition: You may repeat any of the courses below for a better grade, but you may only repeat the course one time. Please select which courses you have repeated (not to exceed 3 courses).
Have you ever filed an application to the El Camino College Radiologic Technology program?*
Have you ever attended a Radiologic Technology Program?*

Work Experience and/or Volunteer and Observation Experience

Criteria for Additional Points

Must be completed within the last 5 years from the date of the application to receive points.

Please indicate if you are attaching documentation for point consideration in any of the areas below. 

When uploading documentation be sure you label your documentation so it is clear what you are submitting. 

Combine ALL documents for each criteria submission into one document – before uploading – the file upload will only allow for one document. Here is a link for instructions to merge docs: https://www.adobe.com/acrobat/online/merge-pdf.html

If you are not sure about something- submit what you have with an explanation so that it can be evaluated for credit.  

If it is not clear on what documentation you are submitting, then no points will be credited. 

Criteria for Additional Points- Select all that apply to you (remember you must upload documentation below documentation to receive points)*
Criteria #7- Upload documents if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Criteria #8- Upload documents if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Criteria #9- Upload documents if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Criteria #10- Upload documents if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Criteria #11- Upload documents if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Criteria #12- Upload documents if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Criteria #13- Upload documents if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Criteria #14- Upload documents if applicable
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Upload any additional documents if applicable.
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Please upload the Rad Tech Course Evaluation Worksheet (GPA does not need to be calculated)*
No File Chosen
File uploads may not work on some mobile devices.
To save as a PDF document, you can use the "Print" option to save a pdf. Select the printer to SAVE as PDF. If your document has more than one page please be sure it is saved as one document.
Use your mouse or finger to draw your signature above
Date/Time*
:  
Certification*
Send an email to RadTechDirector@elcamino.edu.*

Counselor section- Radiologic Technology Program Application

Verification of coursework

Student is Ineligible
Application Status (check if applicable)
Student repeated Anatomy more than 1 time.*
I have repeated Physiology more than 1 time.*
Student repeated Rad. Tech A more than 1 time.*
Student repeated Math requirement more than 1 time.*
Upload completed Radiologic Technology Program Application Verification form and Points Worksheet
No File Chosen
File uploads may not work on some mobile devices.

Radiologic Technology department - part 1

Radiologic Technology department - part 2

Radiologic Technology department- part 3

Final Review by Radiologic Technology department