Sentara RMH School of Radiologic Technology

Applicant Information:

Please list other names that you have used which may appear on requested documents such as transcripts.

Have you ever been convicted of a crime other than a minor traffic offense (including Military Service)?

YesNo

Person to notify in case of emergency

Relationship

Phone

Email

Have you ever applied to this program previously?

yesno

Have you ever been accepted to or attended any other Radiologic Technology School?

yesno

Education

Name of college

College address

From

To

Did you graduate?

YesNo

Name of college

College address

From

To

Did you graduate?

YesNo

Work Experience

In the space below, list your work experience with the most recent employment first.

1. Date of employment

Name of Employer

First Name

Last Name

Employer's Address

Address Line 1

Address Line 2

City

State

Zip code

Job Title

Reason for leaving

May we contact this employer

YesNo

2. Date of employment

Name of Employer

First Name

Last Name

Employer's Address

Address Line 1

Address Line 2

City

State

Zip code

Job Title

Reason for leaving

May we contact this employer

YesNo

Applicant Questions

Sentara RMH School of Radiologic Technology considers all applicants without regard to race, age, color, religion, sex, marital status, gender identity and expression, sexual orientation, pregnancy, childbirth, or related medical conditions including lactation, military status, genetic information, nation origin, disability or any other legally protected status.

Copyright © 2025 Sentara Health