CLARION UNIVERSITY OF PA

Online Radiologic Sciences or Sonography Pre-Requisite Program Form

Completion of general education courses through Clarion University's Online Radiologic Sciences or Sonography Pre-Requisite Program does not guarantee admissions to a radiography or sonography program.  Before enrolling in general education courses at Clarion University, individuals should consult with the program director of the radiography or sonography program they hope to attend.

This is a non-degree program and as a result, students are not eligible to receive financial aid.  If you are interested in pursuing an associate's or bachelor's degree program at Clarion University, please complete the regular admissions process at www.clarion.edu/apply.  Students seeking a degree may receive financial aid.

Please complete the top portion of the form completely.  Use N/A for items that do not apply.   Items with an * are required entries.

Last Name*:                           First Name*:                          Middle Initial:   

Former Names: 

Street Address*:                            City*:                          

State*:                                    Zip*:                                  Email Address: 

Birthdate:*             (MM/DD/YYYY)       Sex*:     Select M F       Race:    Select White, Non-hispanic Asian or Pacific Islander Black, Non-Hispanic Hispanic American Indian/Alaska Native Prefer not to answer

Daytime Phone Number:          Home Phone Number*:     

PA Resident*:                        Select Yes No         If yes, name of county:                

Have you attended a college*:                      Select Yes No

If you have attended another college,  College Name*:              

College GPA:      College Attendance Dates: 

High School Attended*:            Dates Attended*:       

High School City and State*:       

GED:    Select Yes No               If GED earned, date GED was received: 

Have you attended Clarion University previously?                          Select No Yes

Term for which you are applying*:    Spring    Fall       Summer PreSession       Summer 1       Summer 2      Winter Intersession

Year for which you are applying*:                   
                                                    

Radiography or sonography school you hope to attend: 

How did you hear about the Online Radiologic Sciences Pre-Requisite Program? Please Select Clarion Website Email Direct Mail Telephone Friend, relative, or colleague Newspaper Search Engine (e.g. Google) Professional Organization Affiliation Other

This form must be completed each semester of enrollment.

By clicking the submit button, you are verifying that the information provided is accurate.