JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Radiography Application for Admission
Applications are validated by completing an information session September 2022 to March 2023.
Deadline for submission of the Health Science application is March 15, 2023.
Do not submit this application after March 15, 2023. Reach out the admissions counselor for inquiries.
Health Science Information Sessions:
https://www.edgecombe.edu/programs/health-sciences/health-science-information-sessions
Sign in to Google
to save your progress.
Learn more
* Required
First Name
*
Your answer
Last Name
*
Your answer
Student ID Number
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number
*
Your answer
Personal Email Address
*
Your answer
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
)
Your answer
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
No
Educational Experience
*
High School Graduate
GED
High school or GED completion date
*
MM
/
DD
/
YYYY
College/Training Previously Attended
*
Include all (1) colleges attended, (2) degrees/diplomas/certificates awarded, and (3) years attended.
Your answer
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
No
If you answered yes to the question above, list (1) Employer (2) Modality (3) Date/s you worked
Your answer
Do you have any active certifications (excluding CPR)?
*
Yes
No
If you answered yes to the question above, list (1) Certifying agency (2) Certificate earned (3) Date earned
Your answer
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?
*
MM
/
DD
/
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
