Conditional Progress Upload Form

This form is for Conditional License Holders ONLY to upload 1 year progress documentation.

Acceptable document include:

• Submit an official transcript from an accredited educational program, or other documents that verify pending or successful completion of a medical imaging or radiation therapy education program; or
• Submit verification you are actively working towards registration; such as taking the examination(s) and submitting your pass/fail score sheet; or
• Provide copies of patient logs showing performing exams, or copies of completed structured didactic education/training; or
• Meets any other unique licensure or practice standard requirements as established by the Board on a case-by-case basis.