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


— OR —

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

Student Signature