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Application for the Radiologic Technology Program


Last Name: First Name:

Maiden:    M.I.:

City:          Zip code: 


Date of birth: mm / dd / yyyy

Date of High School Graduation:

Student ID:


Which of the following clinical sites are you applying for?
Cumberland Somerset Grant Memorial

If applying to more than one site, please indicate your 1st, 2nd or 3rd choice:

Have you ever attended college prior to this application? Yes    No

Are you transferring from another college? Yes    No

Are you presently enrolled in classes at Allegany College of Maryland or do you have a current application on file? Yes    No *
* If you answered no to this question you must fill out a current application with the admissions office to meet the eligibility requirements.

Have you completed all Allegany College of Maryland admissions requirements?

High School Transcripts/GED

Yes    No

College Transcripts

Yes    No

Allegany College of Maryland Placement Test

Yes    No

ACT Test (high school applicants only)

Yes    No

If transferring, please complete the following information:

      Name of Institution(s)              Address                Dates of Attendance

I certify that all statements given on this application are true and accurate to the best of my knowledge.


E-Signature of Applicant:    Date:

Deadline for application and completion of ALL admission criteria:

April 30 - High School Students
May 20 - College Students and Early Placement Students