Mammography Application Form

JOHNSTON COMMUNITY COLLEGE

FALL 2022 MAMMOGRAPHY –Application

Deadline is June 15

Note: Official high school and all colleges attended transcripts must be on file in the Admission and Enrollment and Student Success Office. The college reserves the right to extended the application deadline date when warranty.

If you have a change of address, e-mail address or phone number it is your responsibility to notify us of any changes on this application after submitting.

*Required - Name - First

*Required - Name - Middle

*Required - Name - Last

*Required - JCC Student ID number

*Required - Date of Birth

*Required - Email

JCC Email

*Required - Cell Phone

*Required - ARRT Certified

Yes

*Required - Enrolled in the last semester of Radiography program

Yes

A letter from the Program Director must be included with application if enrolled in the last semester.

August 1 of admitting year is the deadline date to be ARRT certified.

*Required - Graduated From

Name of the College

A 2.5 cumulative grade point average is required to enroll in the Mammography program

*Required - Current GPA

Applicants must have met the admission requirements to apply to the Mammography program by the deadline date of June 15^th. Application packet must include

Application
Copy of current ARRT certification card or proof of applying for certification
If enrolled in the last semester of Radiography program letter from the Program Director
Documentation of a confirmed clinical site placement for clinical affiliate sponsor if choosing your own clinical affiliate.

Applications packet can be submitted to Director of Imaging or their designee.