Radiography Application for Admission

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Applications are validated by completing an information session September 2023 to March 2024.

Deadline for submission of the Health Science application is March 15, 2024.

Do not submit this application after March 15, 2024. Reach out the admissions counselor for inquiries.

Health Science Information Sessions:
https://www.edgecombe.edu/programs/health-sciences/health-science-information-sessions

First Name *

Last Name *

Student ID Number *

Street Address *

City *

State *

Zip Code *

Phone Number *

Personal Email Address *

Student Email Address

Student email accounts are created upon application to the school. This is the address all faculty and staff will use to contact you once your application to the college has been submitted. Example: First Initial, Last Name, Date of Birth (jdoe0612@my.edgecombe.edu)

Have you completed an admissions application to Edgecombe Community College? *

You must complete the ECC application for admission: https://www1.cfnc.org/Applications/NC_Community_College/apply.html?application_id=1496 *DO NOT SIGN UP FOR TEAS UNLESS YOU HAVE COMPLETED THE ECC APPLICATION FOR ADMISSION

Yes

Do you have a high school diploma or GED? *

Yes

High school or GED completion date *

YYYY

Are you a high school senior or GED student who will graduate by June of this year? *

Yes

Are you an ECC Early College student who will be 18 years of age by the time radiography clinical rotation begins (week four of the semester)? *

Option 1

College/Training Previously Attended *

Include all (1) colleges attended, (2) degrees/diplomas/certificates awarded, and (3) years attended.

Official Transcripts *

I understand that I am responsible for having official copies of all transcripts sent to ECC, including high school or GED. It is my responsibility to check with the Office of Admissions to verify all transcripts have been received at admissions@edgecombe.edu.

Required

Do you have work experience related to the medical field? *

Yes

If you answered yes to the question above, list (1) Employer (2) Modality (3) Date/s you worked

Do you have any active certifications (excluding CPR)? *

Yes

If you answered yes to the question above, list (1) Certifying agency (2) Certificate earned (3) Date earned

Edgecombe Community College serves the public without regard to race, creed, color, religion, national origin, or sex.

When did you attend a health science information session? *

YYYY

ECC Health Sciences Admission Policies and Requirements *

I understand ECC’s admission policies and requirements for the program, and that I must meet these requirements to be considered for selection. I understand if admitted I will be required to submit to a drug screen and background check in order to perform the clinical rotations necessary to successfully complete this program of study.

Required

*All required fields must be completed for successful submission of this application.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Edgecombe Community College. Report Abuse

Forms