Program Forms
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Program Change Forms
Please submit all forms via email to mail@jrcert.org
- Clinical Capacity Change – Radiography
- Clinical Capacity Change – Radiation Therapy
- Clinical Capacity Change – Magnetic Resonance
- Clinical Capacity Change – Medical Dosimetry
- Clinical Setting Disaffiliation
- Substantive Change
- Transfer of Sponsorship
- Clinical Preceptor CV Template
- Good Cause Extension Request Form
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Program Effectiveness Data Template and Program Information Update
Program Effectiveness Data Template
- Template for Radiography, Radiation Therapy and Magnetic Resonance
- Template for Medical Dosimetry
- Template for Limited Scope X-Ray Machine Operator (LXMO)
- Template for Radiography, Radiation Therapy and Magnetic Resonance with Calculation
- Template for Medical Dosimetry with Calculation
- Template for Limited Scope X-Ray Machine Operator (LXMO) with Calculation
Program Effectiveness Data Website Examples
Program Information Update Form (for 2022 Program Annual Report)
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Curriculum Analysis Grids
The curriculum grid is intended to assure the latest American Society of Radiologic Technologists (ASRT) or American Association of Medical Dosimetrists (AAMD) professional curriculum is utilized by the program.
Curriculum Analysis Grids
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Templates
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Recognition Certificates
Certificate of Excellence Award for Students Request
The purpose of this award is to recognize a student graduating from a JRCERT accredited program for achieving excellence in the radiologic sciences. The criteria for the award and the selection of the recipient is the prerogative of the program officials and its faculty. Each accredited program is limited to one award per year.
Program Directors: Send an email with the program name, number, nominee, presentation date to mail@jrcert.org.
Certificate of Excellence Award for Clinical Educators
The purpose of this award is to recognize a clinical educator from a JRCERT accredited program for achieving excellence in the radiologic sciences. The criteria for the award and the selection of the recipient is the prerogative of the program officials and its faculty. Each accredited program is limited to one award per year.
Program Directors: Send an email with the program name, number, nominee, presentation date to mail@jrcert.org.