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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.

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Page Updated: 6/20/2020 9:37:47 AM