Radiologic and Imaging Sciences Cert Request

Radiologic and Imaging Sciences Certificate
Application Form

Please turn in application only if you have completed the program.

I have successfully completed the required courses for the Certificate in Radiology and Imaging Sciences and am hereby entitled to receive the certificate.

Students: This certificate application is a record of your achievement. Like a grade report, it provides documentation for the certificate award. After you have completed all requirements, fill in this form and click the Submit Application button below.

Student Information

[Name as it should appear on the printed Certificate]

[Include Street Address, City, State and Zip Code]

Required Courses

Required Courses for Certificate Track: (Choose one of the following:)

RIS Education Certificate Track— (4 Required Courses)

  • RIS 511 | Informatics in RIS
  • RIS 530 | Pedagogy and Andragogy in RIS
  • RIS 531 | RIS Program Administration
  • RIS 532 | Academic Program Accreditation

— OR —

RIS Management Certificate Track — (4 Required Courses)

  • RIS 511 | Informatics in RIS
  • RIS 520 | Radiologic Management I
  • RIS 521 | Radiologic Management II
  • RIS 522 | Clinical Practice Accreditation

Student Signature