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MRI Applicant Information
MRI Applicant Information
Eastern North Carolina Consortium of Computed Tomography & Magnetic Resonance Imaging
Step
1
of
2
50%
First Name
*
Middle Initial
Last Name
*
ECC Student ID Number
*
Gender
*
Male
Female
Date of Birth
*
Email Address
*
Enter Email
Confirm Email
Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
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New Hampshire
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New Mexico
New York
North Carolina
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip Code
*
Primary Phone
*
Alternate Phone 1
Alternate Phone 2
College Experience
*
School
Degree Earned
Graduation Date
If you have earned more than one degree, select (+) after Graduation Date field. If you have no college experience, enter N/A for each field and proceed to the next section.
Supplemental Questions
You must provide an answer to each of the following questions. Please answer in complete sentences.
If you are not accepted into the MRI diploma program, would you like to apply to the CT Certificate program?
*
If the fall term of the CT Certificate program is full, would you like to attend the spring term?
*
Would you like to do your clinical training on the first shift or second shift?
*
Is MRI your first choice of advanced modalities? If no, please indicate your first choice.
*
Are you applying to any other schools for advanced training? If so, which school/program is your first choice?
*
Would you like to attend class at VGCC or JCC? If so, indicate your order of preferece.
*
List three facilities you would like to attend for clinical training, in order of preference.
*
Are you employed? If yes, where?
*
Do you plan on working while you attend school? If so, what is your work schedule?
*
Please provide any information you would like to share.
*
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