RHP Certificate Application

Personal Information

Name*

First Name

Last Name

Permanent Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Email*

Home Phone*

Cell Phone*

Gender*

Female Male

Date of Birth*

Place of Birth (City and State)*

Citizenship*

U.S. Citizen Permanent Resident (green card) Non-U.S. Citizen/Permanent Resident

Country of citizenship*

Do you need an I-20?*

Yes, I will need an I-20 No, I already hold an I-20

Demographics

Are you Hispanic or Latino (including Spain)?*

Yes No

What is your background?

Regardless of your answer to the prior question, indicate how you identify yourself:*

American Indian or Alaska Native (including all Original Peoples of the Americas) Asian (including Indian Subcontinent and The Philippines) Black or African American (including Africa and Caribbean) Native Hawaiian or Other Pacific Islander (Original Peoples) White (including Middle Eastern)

Religious Preference*

Program Start Date

When would you like to start attending Manhattan College?

Semester*

Fall Spring

Year*

Intended Program

Available Certificate Programs:*

Nuclear Medicine Technology Radiation Therapy Technology

Educational Information

List all Colleges/Universities Previously Attended*

Degree(s) Earned*

Dates Attended*

Personal Statement

Submit an essay of no more than 650 words. The essay demonstrates your ability to write clearly and concisely on a selected topic and helps you distinguish yourself in your own voice. What do you want the Admissions Committee to know about you apart from your academic record? Please also include the reasons why you have chosen this specific technology.

Essay*

Disciplinary Information

Have you ever been found responsible for a disciplinary violation at any educational institution from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavior misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution.

Have you ever been adjudicated, guilty or convicted of a misdemeanor or felony? Note that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential.

Have you been placed on probation, suspended, removed, dismissed, or expelled from any school or academic program?*

Yes No

Please explain:*

Have you ever been convicted of any misdemeanor, felony or other crime?*

Yes No

Please explain:*

Documents

Academic Letter of Recommendation*

No File Chosen

File uploads may not work on some mobile devices.

Resume*

No File Chosen

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Additionally, you must mail in an official copy of your high school and college transcripts to:

Manhattan College
ATTN: Office of Admissions
4513 Manhattan College Parkway

Riverdale, NY 10471

TOEFL, IELTS, SAT and/or ACT Score Report

No File Chosen

File uploads may not work on some mobile devices.

Course-by-course academic translation of all college level coursework

No File Chosen

File uploads may not work on some mobile devices.

Use one of the following evaluation services: World Education Services (www.wes.org), Educational Credential Evaluators (www.ece.org), Global Credential Evaluators (www.gceus.org)

Agreement

Signature - I certify that the information I have provided is accurate and complete.*

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Use your mouse or finger to draw your signature above.

Manhattan College has had a long-standing policy of non-discrimination. The College repudiates all discriminatory procedures and specifically those based on race, color, religion, national origin,age, sex, disability or any other protected status. The College does not knowingly support or patronize any organization or business which discriminates. No person shall be denied admission or access to the programs or activities of Manhattan College, nor shall any person be denied employment at the College, solely because of any physical, mental or medical impairment within reasonable accommodations. Inquiries concerning this policy may be referred to Human Resources. The Title IX and Age Act Coordinator is located within the Office of Human Resources, Memorial Hall Rm. 305, Tel. (718) 862-7398. The ADA/Section 504 Coordinator is located within the Specialized Resource Center, Miguel Hall Rm. 300A, Voice (718) 862-7101, TDD (718) 862-7885. The Specialized Resource Center (SRC) serves all students with special needs and is also a resource for the College at large. A sampling of auxiliary aids and/or academic adjustments offered by the SRC for students providing appropriate documentation based on their individual needs for no fee include: priority registration; priority seating; alternative testing environments; readers; note takers and scribes; access to adaptive technology; books on tape; and liaison with faculty and other college departments. The College’s annual Security and Fire Safety Annual Report is available at manhattan.edu/security. A paper copy of the full report is available upon request at the Office of Public Safety located in Jasper Hall, 1st floor. Phone: 718-862-7240; Fax: 718-862-8017; E-mail: publicsafety@manhattan.edu.