California Radiologic Technology Certificate Application
This document is used to apply for a radiologic technology certificate in the state of California. It includes personal information fields and requirements for both diagnostic and therapeutic radiologic technology certificates. Complete all required fields and submit the necessary documentation and fee.
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How do I fill this out?
To fill out this form, you must provide your full legal name, date of birth, and contact details. You must also select the type of radiologic technology certificate you are applying for and submit the required documentation and fee. Ensure all relevant sections are completed accurately to avoid processing delays.
How to fill out the California Radiologic Technology Certificate Application?
1
Enter your full legal name, date of birth, and contact details.
2
Select the type of certificate you are applying for: Diagnostic or Therapeutic.
3
Provide documentation of passing the applicable ARRT certification exam, if applicable.
4
Submit the non-refundable application fee of $112.00 via check or money order.
5
Mail the completed application and supporting documents to the specified address.
Who needs the California Radiologic Technology Certificate Application?
1
Individuals seeking certification in diagnostic radiologic technology from CDPH.
2
Individuals seeking certification in therapeutic radiologic technology from CDPH.
3
Nationally certified radiologic technologists looking to get certified in California.
4
Graduates of CDPH-approved radiologic technology schools who are not yet certified.
5
Radiologic technologists who need to renew their certification with the CDPH.
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1
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2
Use the editor to enter your information in the required fields.
3
Select the type of certificate you are applying for.
4
Upload any supporting documents directly to the form.
5
Save and download the updated document.
What are the instructions for submitting this form?
Mail the completed application, supporting documents, and non-refundable fee to the California Department of Public Health, Radiologic Health Branch, Accounts Receivable and Cashiering Unit, P.O. Box 997414, Sacramento, CA 95899-7414. Alternatively, send via express mail to 1500 Capitol Ave., Suite 520, Bldg. 172, Sacramento, CA 95814-5006. Ensure all required fields and documents are complete to avoid processing delays. My advice is to carefully review all instructions and double-check that all information provided is accurate and complete.
What are the important dates for this form in 2024 and 2025?
Important dates for this form include the 30-day notification period after application submission. Ensure all documents and fees are submitted timely to avoid delays.
What is the purpose of this form?
The purpose of this form is to apply for a Radiologic Technology Certificate in the state of California. This certification is necessary for individuals seeking to practice as radiologic technologists within the state. The form collects personal information, verifies educational and professional qualifications, and ensures compliance with state regulations.
Tell me about this form and its components and fields line-by-line.
- 1. Last Name: Provide your full legal last name. This is mandatory for identification purposes.
- 2. First Name: Provide your full legal first name. This is required for accurate identification.
- 3. Middle Name: Provide your full legal middle name, if applicable.
- 4. Date of Birth: Enter your date of birth in the required format.
- 5. SSN or ITIN: Provide your Social Security Number or Individual Taxpayer Identification Number for identification purposes.
- 6. Mailing Address: Enter your complete mailing address, including number, street or P.O. Box number.
- 7. City: Provide the city of your mailing address.
- 8. Phone Number: Enter a valid phone number where you can be reached.
- 9. Email Address: Provide a valid email address for communication purposes.
- 10. State: Enter the state of your mailing address.
- 11. Zip Code: Provide the ZIP code of your mailing address.
- 12. Certificate Category: Select the appropriate certificate category: Diagnostic or Therapeutic.
- 13. ARRT Certification: If applicable, provide documentation that you have passed the ARRT certification exam.
What happens if I fail to submit this form?
Failure to submit the form correctly may result in delays or denial of your certification application.
- Denial of Application: If the form is not filled out correctly or required documents are missing, your application may be denied.
- Processing Delays: Incomplete or incorrect forms can cause significant delays in application processing.
- Missed Certification: Failing to submit the application on time may result in missing certification deadlines.
How do I know when to use this form?
- 1. First-Time Applicants: Individuals applying for their first radiologic technology certificate in California.
- 2. Certification Renewal: Radiologic technologists renewing their certification.
- 3. Change of Certification: Technologists certified in other states applying for California certification.
Frequently Asked Questions
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Upload the PDF to PrintFriendly, enter your personal details, select the certificate type, and provide any necessary documents. Save and download the completed form.
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What payment methods are accepted for the application fee?
The non-refundable application fee of $112.00 can be paid via personal check, cashier's check, or money order made payable to CDPH-RHB.
Where do I mail the completed application and fee?
Mail the completed application, supporting documents, and fee to the California Department of Public Health, Radiologic Health Branch, Accounts Receivable and Cashiering Unit, P.O. Box 997414, Sacramento, CA 95899-7414.
What happens if my application is not accepted?
You will receive a notification letter within 30 days informing you of the next steps if your application is not accepted.
How long does it take to process the application?
You will receive a notification on the status of your application within 30 calendar days of submission.
Can I apply for both diagnostic and therapeutic certificates?
Yes, but you must submit a separate application and fee for each certificate.
Is my Social Security Number required on the form?
Yes, providing SSN/ITIN is mandatory for identification and is used for federal, state, or local law enforcement purposes.
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