Shadowing Requirement

Please fill out this questionnaire after you have spent at least 8 hours in a radiology department. You may visit more than one facility as long as it is verified that you have accumulated at least 8 hours of observation. Please obtain contact information for the clinic personnel conducting your clinical visit. Name, phone number and email address are required for the clinic verifying personnel to complete this form.

NAME

Last Name

First

Middle Name

Date (--/--/--)

		
	As part of your shadow requirement, Mitchell Technical Institute reserves the right to follow up on the contact information you list below for your clinic visit.		    	

Facility Name

Date of Visit (--/--/--)

Number of Observation Hours

Name of Verifying Personnel

Phone Number for Clinic Verifying Personnel

Email Address for Clinic Verifying Personnel

		
	For your shadow requirement, please write an essay about your clinical visit experience using the guidelines below. You may attach your essay document below.		    	

		
	1. Describe the radiology department (workflow, level of activity, types of equipment, etc.).		    	

2. Were you offered adequate opportunities to observe exams?

		
	3. What types of general (not ultrasound, CT, MRI, etc.) radiologic procedures were you able to observe? 		    	

4. Please describe a few exams that you found particularly interesting.

5. Describe one thing that surprised you about radiology.

		
	6. After your visit, describe what aspects of this field make it attractive to you as a career choice.		    	

		
	All attached documents must be in .doc, .docx, or .pdf format. All documents not in these formats will be discarded.		    	

Shadow Requirement Clinical Visit Essay:

Uploading Signed Verification of Clinical Hours:

Radiologic Technology Program

Radiologic Technology Application Process

Admission Information

Shadowing Requirement

Recommendation Form

Shadowing Requirement

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