Medical Radiologic Technologist Certification Program
Application/Forms

Applications/Forms Complaint Process Contact Us Enforcement Actions Links Open Records Rules/Regulations Statutes/Laws

Obtain a copy of the following publications now, just click on your selection:

• MRT Application for Committee Appointment (Word format, 49KB)
• MRT Application for Committee Appointment Letter (Word format, 79KB)

• #F65-10710 MRT License Application Packet (MS Word format, 71KB)
• #F65-10710 MRT License Application Packet (Acrobat format, 43 KB)

• LMRT Exam Application (Word format, 34 KB)
• LMRT Exam Application (Adobe Acrobat format, 26 KB)
  
  
• Application for renewal/late renewal form (Word format, 40 KB)
• Application for renewal/late renewal form (Acrobat format, 47 KB)

• Application for Limited Education Program (Word format, 79 KB)
• Application for Limited Education Program (Acrobat format, 54 KB)

• Application to Upgrade Temporary General and/or Limited Certificate ( Word format, 34 KB)
• Application to Upgrade Temporary General and/or Limited Certificate ( Adobe Acrobat format, 30 KB)

• Amendment Application for Non-Certified Technician Training Program (MS Word format, 46 KB)
• Amendment Application for Non-Certified Technician Training Program(Acrobat format, 24 KB)
  
  
• Other License/Certificate Verification Form (Acrobat format, 15 KB)
• Other License/Certificate Verification Form (MS Word format, 33 KB)
  

• #F65-10711 Application Form for Hardship Exemption (Word format, 50 KB)
• #F65-10711 Application Form for Hardship Exemption (Adobe Acrobat format, 38 KB)
  
  
• General Information for Completing the NCT Training Program Application (Word format, 84 KB)
• General Information for Completing the NCT Training Program Application (Adobe Acrobat format, 69 KB)
  

• Non-Certified Technician (NCT) Application Form (MS Word format, 43 KB)
• Non-Certified Technician (NCT) Application Form (Acrobat format, 25 KB)

• Non-Certified Technician (NCT) Renewal Form (Word format, 29 KB)
• Non-Certified Technician (NCT) Renewal Form (Adobe Acrobat format, 23 KB)

• Affidavit for CE Exemption Form (Word format, 28 KB)
• Affidavit for CE Exemption Form (Acrobat format, 22 KB)

• List of Approved NCT Training Programs (Acrobat format,49 KB)
• List of Approved NCT Training Programs (Word format, 27 KB)

• List of LMRT Training Programs (Word format, 28 KB)
• List of LMRT Training Programs (Acrobat format, 17 KB)

To access documents in Adobe Acrobat format, you must download the Acrobat Reader software. Please see the DSHS file viewing page for more information and a link to the Adobe website.

Last Updated August 31, 2009