Medical Radiologic Technologist Certification Program Application-Forms

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, 29 KB)
  
  
• General Information for Completing the NCT Training Program Application (Word format, 105 KB)
• General Information for Completing the NCT Training Program Application (Adobe Acrobat format, 95 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, 30 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  

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.