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Nuclear Medicine Technology Program Application

Associate Degree

Galveston College Nuclear Medicine Technology Program has a selective admissions process. This process is non-discriminatory on the basis of race, color, national origin, gender, age, qualified disability, marital status, veteran’s status, or sexual orientation in admissions to the program.

Note: It is the student’s responsibility to provide the program director written notification of any changes in contact information.

Please complete the form below for application to the Nuclear Medicine Technology Program. Answers to all items are required. If a question does not pertain to you, simply put NA for the response.

Galveston College Student ID Number:

Application date:

Applying for semester:

Year:

Last Name

First Name

Middle/Other Name

Date of Birth (may require documentation)

Mailing Address

City

State

Zip Code

Last 4 digits of SS#:

Phone Number

Email


Please list academic institutions you attended and received terminal awards, degrees, and/or certifications from.

Institution(s):

Terminal awards, degrees, and/or certifications:

GPA:

Transcript(s) sent to Galveston College?
YesNo


Please list academic institutions you attended and earned college credits.

Institution(s):

Credit hours earned:

GPA:

Transcript(s) sent to Galveston College?
YesNo

I understand that falsifying any information on the application form may result in my application being denied and/or dismissal from the program.

Contact Nuclear Medicine Technology

Rebecca Montz
Nuclear Medicine Technology Program Director

Phone

409-944-1491

Fax

409-944-1511

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