RAD
Mercer County Community College
Petition to Commence the Professional Phase of the
Radiography Program

INSTRUCTIONS: Complete and print this form indicating the core mathematics and science courses for which credit was earned and/or courses in progress.  Submit the completed form to the Science & Health Professions Division secretary in room MS128 or place in the lock box outside this office.  Acceptance is based upon the document, Criteria for Admission to Programs in the Health Professions.

Petitions will only be accepted from February 1 - February 28 for the next fall entering class.

Last Name:        First Name:        MCCC Student ID#:        U.S. Military Veteran?
    Yes No
  
Street Address:   City:   State:   Postal Zip Code:
     
Home Telephone:   Work Telephone:   Cell phone:   Work Extension:
     
  1. Did you submit a Radiography Petition Form previously?  Yes   No   If yes, what year?  
  2. Are you currently taking courses at MCCC?  Yes   No
  3. Current MCCC cumulative grade point average (overall):  
  4. Using your transcript, indicate only the core mathematics and science courses completed or in progress:
Course (Check all that apply:)   Semester Year Grade *College/University
Mathematics Elective (MAT135, MAT200, or approved alternative) 
Anatomy & Physiology I (BIO 103) 
Anatomy & Physiology II (BIO 104) 
Physical Science Concepts (PHY111)ª, Fundamentals of Physics (PHY109) or Equivalent Course

I verify that I have completed or am currently enrolled in the courses listed above.  I request consideration for acceptance into the professional phase of the radiography program in the fall semester.

Signature ______________________________________ Date_____________________

*Official transcripts for courses taken at another college or university must be submitted to the Admissions Office for review and possible transfer of credit.
ªPHY111 will only be accepted if successfully completed no earlier than fall semester 2012.

     

Updated: January 2017